Progesterone (PROG)

EPIC Test Name

PROGESTERONE

EPIC Code

LAB529

Clinical Indications

Progesterone is a female sex hormone. Its physiological role is known in preparing the uterus for implantation of the blastocyst and in maintaining pregnancy. In nonpregnant women, progesterone is mainly secreted by the corpus luteum of the ovaries. Luteal secretion of progesterone is regulated by LH and FSH. The progesterone concentrations in the circulation correlate with the development and regression of the corpus luteum. Progesterone is barely detectable In the follicular phase of a menstrual cycle, start to rise one day prior to ovulation, peaks in the mid of the luteal phase and decrease to a low or barely detectable level at end of the luteal phase. The fall of progesterone secretion ultimately triggers menstruation. In the second half of the cycle or ovulation phase, progesterone can be detected in saliva and its metabolite, prognanediol-3-glucuronide can be detected in urine. If pregnancy or implantation occurs, the trophoblasts begin to secrete human chorionic gonadotropin (hCG), which maintains the corpus luteum and its secretion of progesterone. By the end of the first trimester, the placenta becomes the primary source of progesterone. During pregnancy, progesterone inhibits the contraction of the myometrium, and together with estrogens, promotes the proliferation and secretion disposition of the alveoli of the mammary gland.

Additional Information

• Sample collection should be correlated with the phase of menstrual cycle.
• Administration of estrogen and progesterone supplements can affect progesterone results.

Common Synonyms

PROGESTERONE, ADULT

Interpretative Information

• Occurrence of progesterone concentration peak in day 21 to 23 of a menstrual cycle indicates normal ovulation, and its absence suggests anovulation, inadequate luteal phase progesterone production, or inappropriate timing of sample collection.
• Increased progesterone concentrations can also occur to patients with ovarian cysts, molar pregnancies, rare forms of ovarian cancer, adrenal cancer, congenital adrenal hyperplasia, and testicular tumors.
• Increased progesterone may also be a result of congenital adrenal hyperplasia.
• Low concentrations of progesterone may be associated with toxemia in late pregnancy, decreased ovarian function, amenorrhea, ectopic pregnancy, and miscarriage.

CPT

84144

LOINC

2839-9

References

1. Carr BR: Disorders of the ovary and female reproductive tract. RH Williams DW Foster HM Kronenberg et al. Williams textbook of endocrinology. 9th ed 1998 W.B. Saunders Philadelphia 751-817
2. Yeh J, Adashi EY: The ovarian life cycle. SSC Yen RB Jaffe RL Barbieri Reproductive endocrinology: Physiology, pathophysiology, and clinical management. 4th ed 1999 W.B. Saunders Co. Philadelphia 153-190.
3. Johnson MR, Carter G, Grint C, et al. Relationship between ovarian steroids, gonadotrophins and relaxin during the menstrual cycle. Acta Endocrinol 1993;129:121-5.
4. Laufer N, Navot D, Schenker JG. The pattern of luteal phase plasma progesterone and estradiol in fertile cycles. Am J Obstet Gynecol 1982;143:808-13.
5. Veldhuis JD, Christiansen E, Evans WS, et al. Physiological profiles of episodic progesterone release during the midluteal phase of the human menstrual cycle: analysis of circadian and ultradian rhythms, discrete pulse properties, and correlations with simultaneous luteinizing hormone release. J Clin Endocrinol Metab 1988;66:414-21.
6. Filicori M, Butler JP, Crowley WF Jr. Neuroendocrine regulation of the corpus luteum in the human. J Clin Invest 1984;73:1638-47.
7. Guillaume J, Benjamin F, Sicuranza B, et al. Maternal serum levels of estradiol, progesterone and h-Choriongonadotropin in ectopic pregnancy and their correlation with endometrial histologic findings
8. Surg Gynecol Obstet 1987;165:9-12.
9. Thienpont L, Siekmann L, Lawson A, et al. Development, Validation and Certification by Isotope Dilution Gas Chromatography-Mass Spectrometry of Lyophilized Human Serum Reference Materials for Cortisol (CRM 192 and 193) and Progesterone (CRM 347 and 348). Clin Chem 1991;37:540-6.
10. Bablok W, Passing H, Bender R, et al. A general regression procedure for method transformation. Application of linear regression procedures for method comparison studies in clinical chemistry, Part III. J Clin Chem Clin Biochem 1988;26:783-90.
11. Verhaegen J, Gallos I D, van Mello N M, Abdel-Aziz M, Takwoingi Y, Harb H et al. Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies BMJ 2012; 345 :e6077 doi:10.1136/bmj.e6077

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