Hormone therapy Menopause<unk> is used in combination with an estrogen as a component of menopausal hormone therapy for the treatment of menopausal symptoms in peri- and postmenopausal women. It is used specifically to provide endometrial protection against unopposed estrogen-induced endometrial hyperplasia and cancer in women with intact uteruses. A 2016 systematic review of endometrial protection with<unk> recommended 100 mg/day continuous oral<unk>  200 mg/day cyclic oral<unk>  45 to 100 mg/day cyclic vaginal<unk>  and 100 mg alternate-day vaginal<unk>  Twice-weekly 100 mg vaginal<unk> was also recommended, but more research is needed on this dose and endometrial monitoring may be advised. Transdermal<unk> was not recommended for endometrial protection. The REPLENISH trial was the first adequately powered study to show that continuous 100 mg/day oral<unk> with food provides adequate endometrial protection. Cyclic 200 mg/day oral<unk> has also been found to be effective in the prevention of endometrial hyperplasia, for instance in the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. However, the PEPI trial was not adequately powered to fully quantify endometrial hyperplasia or cancer risk. No adequately powered studies have assessed endometrial protection with vaginal<unk>  In any case, the Early versus Late Intervention Trial with Estradiol (ELITE) found that cyclic 45 mg/day vaginal<unk> gel showed no significant difference from placebo in endometrial cancer rates. Due to the vaginal first-pass effect, low doses of vaginal<unk> may allow for adequate endometrial protection. Although not sufficiently powered, various other smaller studies have also found endometrial protection with oral or vaginal<unk>  There is inadequate evidence for endometrial protection with transdermal<unk> cream. Oral<unk> has been found to significantly reduce hot flashes relative to placebo. The combination of an estrogen and oral<unk> likewise reduces hot flashes. Estrogen plus oral<unk> has been found to significantly improve quality of life. The combination of an estrogen and 100 to 300 mg/day oral<unk> has been found to improve sleep outcomes. Moreover, sleep was improved to a significantly better extent than estrogen plus medroxyprogesterone acetate. This may be attributable to the sedative neurosteroid effects of<unk>  Reduction of hot flashes may also help to improve sleep outcomes. Based on animal research,<unk> may be involved in sexual function in women. However, very limited clinical research suggests that<unk> does not improve sexual desire or function in women. The combination of an estrogen and oral<unk> has been found to improve bone mineral density (BMD) to a similar extent as an estrogen plus medroxyprogesterone acetate. Progestogens, including<unk>  may have beneficial effects on bone independent of those of estrogens, although more research is required to confirm this notion. The combination of an estrogen and oral or vaginal<unk> has been found to improve cardiovascular health in women in early menopause but not in women in late menopause. Estrogen therapy has a favorable influence on the blood lipid profile, which may translate to improved cardiovascular health. The addition of oral or vaginal<unk> has neutral or beneficial effects on these changes. This is in contrast to various progestins, which are known to antagonize the beneficial effects of estrogens on blood lipids.<unk>  both alone and in combination with an estrogen, has been found to have beneficial effects on skin and to slow the rate of skin aging in postmenopausal women. In the French E3N-EPIC observational study, the risk of diabetes was significantly lower in women on menopausal hormone therapy, including with the combination of an oral or transdermal estrogen and oral<unk> or a progestin. Transgender women<unk> is used as a component of feminizing hormone therapy for transgender women in combination with estrogens and antiandrogens. However, the addition of progestogens to HRT for transgender women is controversial and their role is unclear. Some patients and clinicians believe anecdotally that<unk> may enhance breast development, improve mood, and increase sex drive. However, there is a lack of evidence from well-designed studies to support these notions at present. In addition, progestogens can produce undesirable side effects, although bioidentical<unk> may be safer and better tolerated than synthetic progestogens like medroxyprogesterone acetate. Because some believe that progestogens are necessary for full breast development,<unk> is sometimes used in transgender women with the intention of enhancing breast development. However, a 2014 review concluded the following on the topic of<unk> for enhancing breast development in transgender women: Our knowledge concerning the natural history and effects of different cross-sex hormone therapies on breast development in transgender women is extremely sparse and based on low quality of evidence. Current evidence does not provide evidence that progestogens enhance breast development in transgender women. Neither do they prove the absence of such an effect. This prevents us from drawing any firm conclusion at this moment and demonstrates the need for further research to clarify these important clinical questions. Data on menstruating women shows there is no correlation between water retention, and levels of<unk> or estrogen. Despite this, some theorise<unk> might cause temporary breast enlargement due to local fluid retention, and may thus give a misleading appearance of breast growth. Aside from a hypothetical involvement in breast development, progestogens are not otherwise known to be involved in physical feminization. In some cases, transgender women use<unk> to alleviate symptoms of estrogen withdrawal. Estrogen must be withdrawn from transgender women's hormonal regime before they undergo sex reassignment surgery. Pregnancy support Vaginally dosed<unk> is being investigated as potentially beneficial in preventing preterm birth in women at risk for preterm birth. The initial study by Fonseca suggested that vaginal<unk> could prevent preterm birth in women with a history of preterm birth. According to a recent study, women with a short cervix that received hormonal treatment with a<unk> gel had their risk of prematurely giving birth reduced. The hormone treatment was administered vaginally every day during the second half of a pregnancy. A subsequent and larger study showed that vaginal<unk> was no better than placebo in preventing recurrent preterm birth in women with a history of a previous preterm birth, but a planned secondary analysis of the data in this trial showed that women with a short cervix at baseline in the trial had benefit in two ways: a reduction in births less than 32 weeks and a reduction in both the frequency and the time their babies were in intensive care. In another trial, vaginal<unk> was shown to be better than placebo in reducing preterm birth prior to 34 weeks in women with an extremely short cervix at baseline. An editorial by Roberto Romero discusses the role of sonographic cervical length in identifying patients who may benefit from<unk> treatment. A meta-analysis published in 2011 found that vaginal<unk> cut the risk of premature births by 42 percent in women with short cervixes. The meta-analysis, which pooled published results of five large clinical trials, also found that the treatment cut the rate of breathing problems and reduced the need for placing a baby on a ventilator. Fertility support<unk> is used for luteal support in assisted reproductive technology (ART) cycles such as in vitro fertilization (IVF). It is also used to correct luteal phase deficiency to prepare the endometrium for implantation in infertility therapy and is used to support early pregnancy. Birth control A<unk> vaginal ring is available for birth control when breastfeeding in a number of areas of the world. An intrauterine device containing<unk> has also been marketed under the brand name Progestasert for birth control, including previously in the United States. Gynecological disorders<unk> is used to control persistent anovulatory bleeding. It is used in non-pregnant women with a delayed menstruation of one or more weeks, in order to allow the thickened endometrial lining to slough off. This process is termed a<unk> withdrawal bleed.<unk> is taken orally for a short time (usually one week), after which it is discontinued and bleeding should occur. Other uses<unk> is of unclear benefit for the reversal of mifepristone-induced abortion. Evidence is insufficient to support use in traumatic brain injury.<unk> has been used as a topical medication applied to the scalp to treat female and male pattern hair loss. Variable effectiveness has been reported, but overall its effectiveness for this indication in both sexes has been poor. Breast pain<unk> is approved under the brand name Progestogel as a 1% topical gel for local application to the breasts to treat breast pain in certain countries. It is not approved for systemic therapy. It has been found in clinical studies to inhibit estrogen-induced proliferation of breast epithelial cells and to abolish breast pain and tenderness in women with the condition. However, in one small study in women with cyclic breast pain it was ineffective. Vaginal<unk> has also been found to be effective in the treatment of breast pain and tenderness. Premenstrual syndrome Historically,<unk> has been widely used in the treatment of premenstrual syndrome. A 2012 Cochrane review found insufficient evidence for or against the effectiveness of<unk> for this indication. Another
Progesterone 
Estrogen 
Estrogen
Androgen
Estradiol 
Estradiol
Methyltestosterone
Progestogen