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Human Reproduction, Vol. 15, No. suppl_1, pp. 159-165, 2000
© 2000 European Society of Human Reproduction and Embryology

Mechanisms of uterine specificity of vaginal progesterone

E. Cicinelli1, L.M. Schonauer, P. Galantino, M.G. Matteo, R. Cassetta and V. Pinto

1st Institute of Gynecology and Obstetrics, University of Bari, Policlinico Piazza G.Cesare 70124, Bari, Italy

Correspondence: 1To whom correspondence should be addressed

Endometrial transformations achieved by vaginal progesterone exceed those normally expected from the circulating concentrations obtained, this suggests some degree of direct vagina to uterus transport. We speculate on the different mechanisms involved in uterine specificity of vaginal progesterone and report data of a preliminary randomized study comparing progesterone concentrations in serum and endometrial tissue obtained from hysterectomy specimens after vaginal or i.m. administration. Eight post-menopausal women undergoing transabdominal hysterectomy were randomized to receive either vaginal progesterone gel, 90 mg, or i.m. progesterone formulation, mg, at 08.00 and 20.00 on the day before surgery and at 06.00 on the day of surgery. Venous blood samples for progesterone measurement were drawn at 08.00 on the day before surgery and during the surgery. Endometrial progesterone concentrations were markedly higher in women who received vaginal progesterone (1.38 ± 0.66 and 0.38 ± 0.19 ng/mg protein, for vaginal and i.m. groups respectively) (P > 0.02) despite lower serum concentrations (4.17 < 0.56 and 32.32 ± 11.06 ng/ml, for vaginal and i.m. groups respectively) (P < 0.001). The vaginal route induces endometrial progesterone concentrations that far exceed those expected from the serum progesterone concentrations achieved.

Key words: endometrial concentrations/mechanisms/uterine specificity/vaginal progesterone


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