This test measures pregnanediol, a metabolite of progesterone. It is used in the evaluation and decision making in women who are having difficulty becoming pregnant or maintaining a pregnancy. It is also used to monitor “high-risk” pregnancies.
Urinary pregnanediol is measured to evaluate progesterone production by the ovaries and placenta. The main effect of progesterone is on the endometrium. It initiates the secretory phase of the endometrium in anticipation of implantation of a fertilized ovum.
Usually, progesterone is secreted by the ovarian corpus luteum after ovulation. Both serum progesterone levels and urine concentration of progesterone metabolites (pregnanediol and others) are significantly increased during the second half of an ovulatory cycle.
Pregnanediol is the most easily measured metabolite of progesterone. Because pregnanediol levels rise rapidly after ovulation, this study is useful in checking whether ovulation has occurred and, if so, exactly when. During pregnancy, pregnanediol levels normally rise because of placental production of progesterone. Repeated testing can be used to monitor the status of the placenta in women who have difficulty becoming pregnant or maintaining a pregnancy. Repeated testing can also be used to monitor the status of the placenta in high-risk pregnancy. Hormone testing for urinary pregnanediol are primarily used to monitor progesterone supplementation in patients with an inadequate luteal phase to maintain an early pregnancy. Urinary assays may be supplemented by plasma testing, which are quicker and more accurate.
Various normal ranges*:
*the Luteal Range is the premenopausal range. When patients are taking oral progesterone this range for progesterone metabolites is not luteal and reflects the higher levels expected when patients take oral progesterone. This test is intended to be taken in the luteal phase of the menstrual cycle (days 19-22 of a 28 day cycle) for premenopausal women.
References:
- Lobo RA. Reproductive endocrinology: neuroendocrinology, gonadotropins, sex steroids, prostaglandins, ovulation, menstruation, hormone assay. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 4.
- Lehmann HP, Henry JB. SI units. In: McPherson RA, Pincus MR, eds. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 21st ed. Philadelphia, Pa: Saunders Elsevier; 2006:appendix 5.
Low or low-normal levels of pregnanediol signal less than optimal progesterone. This commonly results in an increase in symptoms occurring in the luteal phase. In the perimenopausal years, progesterone levels tend to fall faster than estrogens, resulting in a relative estrogen dominance. Botanicals or supplemental progesterone can be useful for managing symptoms. Low levels are commonly associated with sleep disturbances, anxiety, stress, and edema.
In postmenopausal women the level of pregnanediol is expected to be much lower than in premenopausal women with optimal luteal ovarian function.
Possible causes of low levels:
- Progesterone is made by the placenta during pregnancy. Pregnanediol is a metabolite of progesterone, which is decreased when placental viability is threatened.
- Ovarian neoplasm: Ovarian epithelial cancers can destroy functional ovarian tissue. Progesterone levels may decrease.
- Amenorrhea, Ovarian hypofunction: Without ovulation, a corpus luteum will not develop. Progesterone will not be secreted, and progesterone and pregnanediol levels will be lower than expected.
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High progesterone metabolites can occur with progesterone or pregnenolone supplementation.
It can also occur with stress as the adrenals release more progesterone during stress, although ovarian production will exceed adrenal production with ovulation.
High progesterone is also seen in PCOS when ovulation occurs because of excessive luteinizing hormone secretion. Some women may naturally make high levels of progesterone and, if symptom free, it is usually not concerning. Symptoms of high progesterone may include bloating, fatigue and food cravings, especially high calorie foods.
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