Test Catalog

Interpretive Handbook

Test 8141 :
Progesterone, Serum

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Sources of progesterone are the adrenal glands, corpus luteum, and placenta.

 

Adrenal Glands:

Progesterone synthesized in the adrenal glands is converted to other corticosteroids and androgens and, thus, is not a major contributor to circulating serum levels unless there is a progesterone-producing tumor present.

 

Corpus Luteum:

After ovulation, there is a significant rise in serum levels as the corpus luteum begins to produce progesterone in increasing amounts. This causes changes in the uterus, preparing it for implantation of a fertilized egg. If implantation occurs, the trophoblast begins to secrete human chorionic gonadotropin, which maintains the corpus luteum and its secretion of progesterone. If there is no implantation, the corpus luteum degenerates and circulating progesterone levels decrease rapidly, reaching follicular phase levels about 4 days before the next menstrual period.

 

Placenta:

By the end of the first trimester, the placenta becomes the primary secretor of progesterone.

Useful For Suggests clinical disorders or settings where the test may be helpful

Ascertaining whether ovulation occurred in a menstrual cycle

 

Assessment of infertility

 

Evaluation of abnormal uterine bleeding

 

Evaluation of placental health in high-risk pregnancy

 

Determining the effectiveness of progesterone injections when administered to women to help support early pregnancy

 

Workup of some patients with adrenal disorders

Interpretation Provides information to assist in interpretation of the test results

Ovulation results in a midcycle surge of luteinizing hormone (LH) followed by an increase in progesterone secretion, peaking between day 21 and 23. If no fertilization and implantation has occurred by then, supplying the corpus luteum with human chorionic gonadotropin-driven growth stimulus, progesterone secretion falls, ultimately triggering menstruation. Typically, day 21 to 23 serum progesterone concentrations of more than 10 ng/mL indicate normal ovulation and concentrations below 10 ng/mL suggest anovulation, inadequate luteal phase progesterone production, or inappropriate timing of sample collection.

 

Increased progesterone concentrations are occasionally seen with some 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 overproduction by the adrenal glands.   

 

Low concentrations of progesterone may be associated with toxemia in late pregnancy, decreased ovarian function, amenorrhea, ectopic pregnancy, and miscarriage.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Twelve hours before this blood test do not take multivitamins or dietary supplements containing biotin or vitamin B7, which are commonly found in hair, skin, and nail supplements and multivitamins.

 

Assessment of the function of the corpus luteum requires correlation with the phase of the menstrual cycle.

 

Taking estrogen and progesterone supplements can affect results.

 

As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from specimens drawn from patients who have been treated with monoclonal mouse antibodies or have received them for diagnostic purposes

 

In rare cases, interference due to extremely high titers of antibodies to ruthenium and streptavidin can occur.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Males:

<4 weeks: Not established

4 weeks-<12 months: < or =0.66 ng/mL (confidence interval 0.63-0.94 ng/mL)

12 months-9 years: < or =0.35 ng/mL

10-17 years:

-Concentrations increase through adolescence and puberty

-12 months-9 years: < or =0.35 ng/mL

-> or =18 years (central 90th %): <0.20 ng/mL

> or =18 year:

<0.20 ng/mL (Reference intervals are central 90th % of healthy population)

 

Females:          

<4 days old: Not established

4 days-<12 months: < or =1.3 ng/mL (confidence interval 0.88-2.3 ng/mL)

12 months-9 years: < or =0.35 ng/mL

10-17 years:

-Adult concentrations are attained by puberty

-12 months-9 years: < or =0.35 ng/mL

-Adult (central 90th %):

 - Follicular phase: < or =0.89 ng/mL

 - Ovulation: < or =12 ng/mL

 - Luteal phase: 1.8-24 ng/mL

  -  Pregnancy

   -   1st trimester: 11-44 ng/mL

   -   2nd trimester: 25-83 ng/mL

   -   3rd trimester: 58-214 ng/mL

> or =18 years: 

-Reference intervals are central 90th % of healthy population

-Follicular phase: < or =0.89 ng/mL

-Ovulation: < or =12 ng/mL

-Luteal phase: 1.8-24 ng/mL

-Post-menopausal: < or =0.20 ng/mL

-Pregnancy

 - 1st trimester: 11-44 ng/mL

 - 2nd trimester: 25-83 ng/mL

 - 3rd trimester: 58-214 ng/mL

 

Pediatric reference intervals adopted from the CALIPER study. www.sickkids.ca/caliperproject/index.html The Hospital for Sick Children. Toronto, Canada.

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Lippe BM, LaFranchi SH, Lavin N, et al: Serum 17-alpha-hydroxyprogesterone, progesterone, estradiol, and testosterone in the diagnosis and management of congenital adrenal hyperplasia. J Pediatr 1974;85:782-787

2. Haymond S, Gronowski AM: In Tietz Textbook of Clinical Chemistry and Molecular  Diagnostics. Fourth edition. Edited by CA Burtis, ER Ashwood, DE Bruns. St. Louis, Elsevier, Inc, 2006, pp 2097-2152

3. CALIPER Database. The Hospital for Sick Children. Toronto, Canada. Available at: www.sickkids.ca/caliperproject/index.html