Progestins are classified according to their structure in C19 and C21 progestagens. The C19 ones are derived from testosterone, the C21 ones from progesterone. C21 progestagens include cyproterone acetate, dydrogesterone, medroxyprogesterone acetate, chlormadinone acetate, megestrol and promegestone. Of these, dydrogesterone is structurally most similar to progesterone. C19 progestagens include norethisterone, (levo)norgestrel, lynestrenol, desogestrel, norgestimate, gestodene and tibolone.

Different progestins have different combinations of androgen (testosterone-like) and progesterone activity. If the activity of 1 mg of norethindrone is taken as the baseline, 1 mg of the other progestins have activities as follows:

Norethindrone was synthetized for the first time in 1951 by the Mexican chemist Luis E. Miramontes. This substance became the basis for the contraceptive pill.

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CME/CE posttest
From Journal of Family Practice, 9/1/04

Please select the best answer to each of the following 10 questions and record the answers on the Posttest Answer Form (page S21).

CME expiration date for credit: August 31, 2006

AANP expiration date for credit: September 30, 2005

1. Of the currently available progestogenic agents in the United States, which is an analogue of spironolactone, rather than 19nortestosterone, and therefore has antimineralocorticoid and antiandrogenic properties?

a. Desogestrel

b. Norgestimate

c. Drospirenone

d. Levonorgestrel

2. Ovarian activity is more effectively suppressed with a standard hormone-free interval of 7 days, recommended for most currently available oral contraceptives (OCs), vs a shorter hormone-free interval.

a. True

b. False

3. Serotonin reuptake inhibitors provide effective treatment for premenstrual dysphoric disorder (PMDD); however, they are associated with a nonresponse rate that may be as high as

a. 25%

b. 35%

c. 45%

d. 55%

4. Use of an OC that contains a progestogenic agent with antimineralocorticoid properties reduces feelings of bloating and weight gain.

a. True

b. False

5. Although gonadotropin-releasing hormone agonists are effective treatment for premenstrual symptoms and PMDD, they induce menopause and may require the use of add-back hormone therapy.

a. True

b. False

6. In a study in Finland (where hysterectomy is generally delayed for women who do not have cancer), 64% of women originally scheduled for hysterectomy canceled the procedure after receiving a levonorgestrel intrauterine system (LNG-IUS).

a. True

b. False

7. Intrauterine devices (IUDs) only increase the risk for upper genital tract infection if the patient's cervix is infected with pathogens at time of insertion.

a. True

b. False

8. The LNG-IUS decreases menstrual blood loss by

a. Decreasing the thickness of the endometrium

b. Creating a sterile inflammatory response

c. Preventing implantation of ova

d. All of the above

9. The IUDs increase the risk for ectopic pregnancy.

a. True

b. False

10. All OCs that contain estrogen are useful in treating mild-to-moderate acne.

a. True

b. False

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