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Vaginal or Intramuscular Administration of Progesterone Gel
Title:Direct transport of progesterone from vagina to uterus
Author: E. Cicnelli, et al.
Address: Bari, Italy
Source: Obstetrics and Gynecology 95: 403-406 (March) 2000
Summary: This randomized open study was conducted to compare progesterone concentrations in serum and endometrial tissue from hysterectomy specimens after vaginal or intramuscular (IM) administration of progesterone gel. Subjects were 14 postmenopausal women undergoing transabdominal hysterectomies. They received either vaginal progesterone gel, 90 mg, or IM progesterone, 50 mg twice on the day before surgery and once on the day of surgery. After removal of the uterus, the endometrium was sampled from the anterior and posterior walls. Ratios of endometrial to serum progesterone concentrations were markedly higher in women who received vaginal progesterone compared with IM injections (14.1 median, 8.5-59.4 range vs. 1.2 median, 0.5-13.1 range). Researchers conclude that this data should reassure clinicians who may be puzzled by the low levels of progesterone observed after daily use of the controlled, sustained-release vaginal progesterone gel Crinone. With this product, maximum benefit is drawn from the uterine trophicity of vaginal progesterone. Progesterone remains in the vagina, where it is continuously transferred to the uterus.
Comment: In no area of medicine is our tradition either so short or hard to break than assisted reproduction. If something has worked, that is progesterone injections, we are loathed to change it. There is no comparison in comfort levels of administration. The vaginal route seems to be every bit as good as the IM route.