Gel Progestogel for the treatment of mastopathy: rules of use

Gel composition and mechanism of action

Hormonal agents are actively used in the treatment of mastopathy. Progestogel gel is one of these. The main active ingredient of the drug is the hormone progesterone (1%). Among the auxiliary components are castor oil, ethanol, water, carbomer 980, trolamine. The gel is produced by a large pharmaceutical company, Besins Healthcare, headquartered in Belgium, and is supplied as an officially registered medicine to 90 countries around the world. Today it is one of the most popular topical drugs for the treatment of mastopathy. It belongs to the category of gestagens - drugs that block the synthesis of female sex hormones.

The main cause of diffuse mastopathy is considered to be an imbalance of progesterone and estradiol in a woman’s body, which leads to an increased level of estradiol in the blood. The free hormone provokes fibrotic changes and proliferation of the connective tissue of the mammary gland. In addition, estradiol affects the condition of the milk ducts, which leads to the formation of cysts of different sizes in them.

An increase in the amount of progesterone, which Progestogel ointment provides, leads to a decrease in the level of free estradiol. This affects the condition of the mammary gland - the pathological growth of tissue stops, the pressure on the milk ducts decreases. Progesterone can also influence the synthesis of prolactin, another culprit of breast pain (a characteristic symptom of mastopathy caused by such disorders is nipple discharge).

Progestogel price, where to buy

As it turned out, the price of Progestogel in Moscow pharmacies varies between 445-577 rubles. Approximately the same price for Progestogel gel is observed in other Russian regions. A course of treatment may require 2-3 tubes of the drug.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine
Online pharmacies in KazakhstanKazakhstan

ZdravCity

Progestogel gel 1% 80g NOT DEFINED
RUR 1,111 order

Pharmacy Dialogue

Progestogel gel (tube 1% 80g)Besins Manufacturing Belgium
Read also: Diclofenac 100 mg (extended release tablets)
1102 rub. order

Pharmacy24

Progestogel 1% 80 g gel
219 UAH. order

PaniPharmacy

Progestogel gel Progestogel gel 80g + spar. dosage No. 1 Belgium, Besins Manufacturing Belgium
261 UAH. order

Prescriptions and contraindications

Most often, Progestogel gel is prescribed for the treatment of diffuse mastopathy. Before using the drug, you need to consult a doctor, because topical medications are only part of a complex therapy). In addition, the product is excellent for treating mastodynia (pain in the mammary glands) of various origins. For example, it is prescribed for soreness of the mammary glands caused by the use of oral contraceptives, as well as during PMS. “Progestogel” is recommended during puberty and premenopause, if hormonal changes in the body greatly affect your well-being. Despite the fact that the gel is used with great caution during pregnancy, doctors often recommend it to relieve pain in the 1st trimester. In the 2nd and 3rd trimester, it is better to avoid applying Progestogel. Before using the drug, you should definitely consult a doctor, because not all forms of mastopathy can be treated with the gel. In case of nodular disease (with the formation of large cysts) and tumors of an unknown nature, the ointment cannot be used - the effect of progesterone can worsen the course of the disease. Other contraindications include:

Liver diseases.
Risk of blood clots.
Diabetes.
Arterial hypertension (hypertension).
Epilepsy.
Bronchial asthma.

Since the cream can cause allergies, it is recommended to apply it to a small area of skin on the wrist or elbow before use. If there is no redness, itching or general deterioration in health, apply on the mammary glands.

Advantages of using gel over tablets

Progestogel is a hormonal drug, but still has significant advantages over systemic drugs. Among them:

High concentration of the hormone in the application area. When using cutaneous applications, the effect of progesterone increases 10 times.
Low absorption. Only 10% of the applied substance enters the bloodstream. Studies have shown that 1 hour after applying Progestogel (when its concentration in the glandular tissues is highest), the level of hormones in the blood remains virtually unchanged.
Additional effect due to the high content of the hormone in breast tissue. Progesterone acts on the glandular epithelium and vasculature of the mammary glands. This helps relieve swelling, which plays a key role in the development of mastalgia during PMS.
There is no effect of hormones on the liver and other organs. Systemic hormonal drugs affect the entire body and can lead to various complications. Hormonal imbalances affect metabolic processes and can cause subsequent obesity and thyroid diseases. Progestogel does not have such an effect.

It should be borne in mind that mastopathy is a disease caused by an incorrect balance of hormones in the blood. Therefore, the local action of drugs, despite the noticeable effect, is still not considered a full-fledged treatment. For mastopathy, Progestogel is used exclusively as an adjuvant, part of complex therapy.

The pregnancy period is characterized by hormonal changes caused by the cessation of cyclic processes in the reproductive system. This period does not always proceed physiologically. Individual balances of steroid and pituitary hormones in some women cause manifestations of mastopathy of varying severity. Most often they manifest themselves as pain in the mammary glands (mastalgia), a feeling of increase in their volume and engorgement (mastodynia). A moderate degree of these manifestations is perceived by doctors and patients as the norm. But in some cases, pain in the mammary glands (MG) is so severe that the patient’s sleep is disturbed, thoughts about the development of a malignant disease appear, and social maladjustment occurs [1, 3]. Increased nervousness always negatively affects the course of pregnancy.

It is now considered established that the reasons leading to the development of these disorders are an absolute or relative deficiency of progesterone in the blood plasma.

It is known that during pregnancy, hyperprolactinemia is often observed, which causes a decrease in the level of gestagens, negatively affecting their production in the early stages of pregnancy [2]. In addition, regardless of hyperprolactinemia, luteal phase deficiency (LPF) is sometimes detected, which in some pregnant women requires the administration of small doses of gestagens in the first and second trimesters to prevent miscarriage. Sometimes therapy with gestagens continues into the third trimester.

Deficiency of gestagens during pregnancy, absolute or relative (in balance with estrogens), as in non-pregnant women, causes various pathological processes in the mammary glands, first at the functional level, and subsequently leads to the development of proliferative and dysplastic manifestations in the epithelium of the ducts and lobules. Conventional hormonal therapy for luteal phase deficiency in the systemic version has little effect on processes in the mammary glands. And in cases necessary for the treatment of mastopathy, it would be desirable to somehow strengthen it, but at the same time not harm the pregnancy.

Among the various means used to normalize the condition of the breast in non-pregnant women (vitamin and homeopathic preparations, oral contraceptives, gestagens, etc.), currently the most widely used are local drugs, which, in particular, include progestogel (“BEZEN INTERNATIONAL Laboratories” , France). The drug is registered in many countries of the world, and since 1999 it has been recommended for clinical use in Russia. Progestogel is a gel containing natural progesterone (1 g of progesterone per 100 g of gel). By affecting the condition of the epithelium and vascular network, progestogel has virtually no effect on the level of progesterone in the blood plasma. The concentration of progesterone delivered by progestogen to the breast tissue is 10 times higher than in the systemic circulation. This, in contrast to the oral administration of gestagens, makes it possible to obtain a therapeutic effect almost only in the mammary glands, thereby avoiding effects on the endometrium and preventing other unwanted systemic side effects.

The purpose of this study is to determine the possibility of using progestogel to increase the effectiveness of therapy for dyshormonal conditions of the mammary glands in pregnant women with luteal phase deficiency receiving systemic treatment.

The objectives of the study were:

— assessment of the effectiveness of progestogen when used to relieve mastalgia and mastodynia during gestagen therapy in pregnant women with NLF;

— study of the effect of progestogen on benign formations and gravid hyperplasia of the mammary gland lobules;

— assessment of the safety of the use of progestogen.

Material and methods

The studies were carried out on the basis of the Yekaterinburg City Breast Center of the City Clinical Hospital No. 40 of Yekaterinburg.

Under observation were 40 pregnant women with NLF, with benign formations in the mammary glands and clinical manifestations of mastopathy, among them 30 with symptoms of mastalgia.

All women underwent a comprehensive examination necessary both for prescribing gestagen therapy and for monitoring its implementation. The condition of the breast was studied, including examination and palpation, ultrasound of the breast and (if necessary) puncture biopsy of focal formations under ultrasound control, and morphological examination.

20 pregnant women with established luteal phase deficiency, complaining of pain, palpable benign formations in the breast, or a feeling of distension, increased volume and engorgement of the glands at the beginning of pregnancy, were prescribed progestogel in the form of a gel of 2.5 g (1 applicator dose) on the surface of each breast once a day, daily (with a monotonous regimen of gestagenic therapy of NLF with utrozhestan at a dose of 200 mg per day). These patients made up the main group.

20 pregnant women, matched on a copy-pair basis and receiving only utrozhestan at a dose of 200 mg per day, formed the comparison group.

Results and discussion

Mastalgia and mastodynia at the beginning of pregnancy were observed in 30 women, among whom 5 had diffuse fibroadenomatosis, 10 had diffuse fibrocystic mastopathy with lobular hyperplasia. In 10 pregnant women, fibrotic lobules of the breast were detected, and in 6 – in combination with ductectasia. In 14 women, small fibroadenomas and lipomas were detected, while pain from the mammary glands was absent in 5 of them, as well as in 5 women without focal changes in the breast.

An assessment of the effectiveness of progestogel in relieving mastalgia and mastodynia against the background of NLF in pregnant women is presented in the table.

As can be seen from the table,

Among those who used progestogel in combination with progestin drugs prescribed for the treatment of NLF, mastalgia was no longer present by the end of the first trimester. In the comparison group, mastalgia persisted in 5 pregnant women until the third trimester.

Hyperplasia of the lobules of the mammary glands 3 months after the start of progestogel therapy reversed in 3 out of 5 women, and by the beginning of the third trimester it disappeared in all.

The dynamics of benign formations in the mammary glands did not differ between women who received progestogel in combination with gestagens for the treatment of NLF, and those treated only with utrogestan. In both groups, an improvement in the structure of the mammary glands was noted in the form of disappearance of lipomas and cystic dilated ducts in both groups [4, 5]. Fibrous lobules and fibroadenomas in both groups did not undergo changes.

Pregnancy in both groups, i.e. among those who received only utrozhestan (comparison group) and among those who received additional external applications of progestogel (the main group), proceeded absolutely identically. With the use of progestogel, no undesirable side effects or negative effects on the ongoing pregnancy were identified.

conclusions

1. The use of progestogel in the form of a gel in the first 3 months of complex treatment of NLF in pregnant women with hormonal dysplasia of the mammary glands seems quite rational. It is pathogenetically substantiated and clinically effective: it allows you to almost completely eliminate mastalgia and mastodynia in a short time, without causing unwanted side effects, and does not have a negative effect on pregnancy.

2. The lack of resolving effect of fibroadenoma and fibrotic lobules during treatment with progestogel may be due to the predominance of the fibrous component and pronounced fibrosis of their capsule, which prevents the penetration of the gel.

How to use the gel

Treatment of diffuse mastopathy always extends over a long period; as a rule, the standard course of therapy lasts 3-6 months. "Progestogel" is designed for a maximum of 3 months. After this, you need to take a break (at least 30 days), if necessary, and on the recommendation of a doctor, repeat the cycle.

The ointment is applied with a special applicator, which is sold along with the gel. 1 application is 2.5 g. The product is evenly distributed over the surface of the mammary gland, the procedure is done carefully, since the gel cannot be rubbed into the skin. After this, the woman must wait until the drug is completely absorbed - only after that can she get dressed. This is due to the fact that underwear or other clothing can wash off part of the ointment and then the required concentration of progesterone will not be achieved. Progestogel is applied twice a day, preferably at even intervals, that is, every 12 hours. If the medicine is prescribed for mastopathy, it is used daily, if it is used to relieve premenstrual pain, from the 16th to the 25th day of the cycle.

Instructions for Progestogel (Method and dosage)

This ointment is administered transdermally. To calculate the daily dose, use a special plastic dispensing spatula. When you need to apply Progestogel gel, the instructions for use advise pressing on the tube in a place above the line of the spatula. One dose corresponds to a column of gel along the length of the indentation on the ruler. Usually a tube is enough for 30 doses.

The squeezed product is applied to the skin surface of each breast . Often women doubt the accuracy of applying this product and would like to see a video “How to apply Progestogel correctly . However, there is nothing complicated in this process. This procedure must be performed daily, regardless of the frequency of the menstrual cycle or on the days established by a specialist. After application, the gel should be completely absorbed into the skin. The average duration of treatment is 3 months. A doctor's prescription is required for re-therapy.

Gel effectiveness

The gel has undergone clinical trials, so there are accurate statistics on the effectiveness of the product.

In 80% of women diagnosed with fibrous mastopathy, the pain characteristic of this disease disappears already on the second day of applying the cream.
After a full course of Progestogel (3 months), symptoms disappear in 90% of patients - pain, hypersensitivity, swelling and discomfort go away.

Judging by the reviews of Progestogel gel for mastopathy, it really helps relieve symptoms. Those who use the gel during PMS, premenopause, and puberty, when the menstrual cycle has not yet stabilized, also speak well of it. In these cases, the remedy successfully controls the symptoms, and for most, breast tenderness does not return. But with severe diffuse mastopathy, the gel, according to many women, helps only for the period of treatment. Pain and heaviness return 2-3 weeks after completion of the course. Doctors explain this low effectiveness of the drug by saying that it was used incorrectly. The use of Progestogel as the only treatment for mastopathy is unacceptable, because it does not affect the cause of the disease and does not correct the synthesis of female sex hormones. Therefore, it is quite natural that after progesterone stops entering the body, mastopathy returns.

Reviews about Progestogel

It should be noted that many patients use Progestogel gel, reviews of which are very varied. Women often report its effectiveness, for example, thanks to the use of this external remedy, “seals soften, pain decreases,” and the general condition of the female body improves. However, there are also reviews from patients when, as a result of treatment with the gel, they, on the contrary, began to feel severe pain, hardening and lumpiness in the area of application. Other ladies are simply afraid to use hormonal drugs, believing that they will further undermine their health.

At the same time, reviews from doctors show that when contacting a specialist, a full selection of complex therapy is carried out, which often includes Progestogel. If treatment is started in a timely manner, then in most cases it is highly effective. The main problem is the fact that women are in no hurry to see a doctor, trying to independently eliminate unpleasant symptoms using traditional medicine methods. It is this approach that causes severe consequences, with the development of pathologies that significantly complicate further treatment.

Drug analogues

As already mentioned, Progestogel is considered one of the most popular topical remedies for mastopathy. This is the gel that doctors prescribe most often. However, if the patient is allergic to the components of the drug, another drug can be used. Among the most popular analogues:

Endau. Like Progestogel, it contains progesterone. It is used not only for pain in the mammary glands, it is prescribed for soft tissue bruises and for the prevention of breast cancer.
Mastofit. A dietary supplement is not a medicine. The active substance indole-3-carbinol blocks estrogen receptors, which helps restore the ratio of hormones in the tissues of the mammary glands. Unlike Progestogel, it is prescribed even if a malignant process is suspected.
Doctor. Product based on plant components (red palm oil). Increases blood flow in the mammary gland, thereby relieving swelling and soreness. The ointment should be rubbed vigorously for 3-4 minutes.
Traumeel. Homeopathic analgesic cream, used to relieve symptoms of mastopathy, as well as during PMS. According to the manufacturer, it affects the growth of cancer cells and suppresses the activity of malignant neoplasms.

Source
: mastomed.ru