What Is Progynova 2 mg?

• Active Ingredient: Estradiol valerate (2 mg)
• Pharmaceutical Form: Tablet, oral.
• Manufacturer / Marketer: Bayer Zydus Pharma Pvt Ltd.
• Brand Classification: It’s part of Hormone Replacement Therapy (HRT), specifically estrogen therapy.

Mechanism of Action

• Estradiol valerate is a prodrug: once ingested, it’s converted in the body into 17β-estradiol, which is the same estrogen that the body naturally produces.
• This estradiol binds to estrogen receptors (ER-α, ER-β) in various tissues (bone, brain, blood vessels, uterus, etc.), activating the normal physiological effects of estrogen.
• Because it’s taken orally, there is a first-pass effect in the liver, meaning the liver metabolizes a significant portion before it reaches systemic circulation. That has implications for side effects, especially on liver-synthesized proteins.

Indications / What It’s Used For

Progynova 2 mg is typically prescribed for:

• Relief of menopausal symptoms: such as hot flushes, night sweats, mood changes, sleep disturbances, irritability, dizziness, urinary issues, and signs of mucocutaneous atrophy (vaginal dryness, thinning of skin) after menopause.
• Estrogen deficiency after ovariectomy (surgical removal of the ovaries) or radiological castration (if it was done for non-cancerous diseases).
• Prevention of osteoporosis in postmenopausal women, when other treatments are not suitable.

Dosage and Administration

• Usually, Progynova 2 mg is taken once daily, orally.
• It can be taken with or without food, but consistency matters (same time each day is recommended).
• Before you start, a full medical and gynecological check is often done (including breast examination), to assess risk factors.
• Depending on whether a woman still has her uterus, additional progestogen therapy might be required to counteract estrogen’s risk on the uterine lining. (Note: unopposed estrogen can lead to endometrial hyperplasia.)

Contraindications / When Not to Use

Progynova should not be used in:

• Pregnancy.
• Women with current or past estrogen-dependent tumors (e.g., certain breast cancers, endometrial cancer).
• Active or previous thromboembolic disorders (blood clots), such as deep vein thrombosis, pulmonary embolism, stroke, or heart attack.
• Severe liver problems, or history of liver tumors.
• Unexplained vaginal bleeding that hasn’t been evaluated.
• Certain metabolic disorders, e.g., severe diabetes with vascular disease, lipoprotein metabolism disorders.

Warnings and Special Precautions

• Long-term use of estrogen therapy carries risks: breast cancer, endometrial hyperplasia, and possibly ovarian cancer.
• There is an increased risk of blood clots (venous thromboembolism), heart disease, and stroke.
• Memory loss is possible if HRT is started at older ages (e.g., > 65 years).
• If you’re planning surgery, talk to your doctor because estrogen therapy may affect bleeding risk; sometimes it’s stopped in advance.
• For women with a uterus, taking a progestogen in addition to estradiol is very important to reduce risk of endometrial overgrowth.
• Regular check-ups are recommended (e.g., mammograms, pelvic exams).

Side Effects

Some of the more common side effects include:

• Headache, migraine
• Breast pain or tenderness
• Irregular vaginal bleeding or spotting
• Abdominal bloating, nausea, vomiting
• Weight changes, fluid retention (swelling)
• Hair loss
• There’s also a risk of more serious events: blood clots, stroke, heart disease.

Drug Interactions

• Progynova may interact with antiepileptic drugs (like phenytoin) or antibiotics/antimicrobials (like rifampicin) and herbal remedies (e.g., St John’s Wort), which can reduce its effectiveness.
• Some antifungal drugs (e.g., fluconazole) may increase estradiol levels, increasing side effect risks.
• Grapefruit juice may interfere with metabolism.
• It can also affect lab tests — for example, thyroid-function tests may be altered when taking estrogen.

Pharmacokinetics

• After absorption, estradiol valerate is rapidly hydrolyzed into estradiol and valeric acid.
• Because of first-pass metabolism in the liver, a portion is metabolized before reaching systemic circulation, contributing to its risk profile.
• It increases the production of certain liver proteins (clotting factors, globulins), which plays a role in its risk of thrombosis.

Use in Special Populations

• Postmenopausal women: Common indication, especially for symptoms of menopause and osteoporosis risk.
• Women without a uterus: May be used as estrogen-only therapy (but only under medical supervision).
• Women with a uterus: Usually need a progestogen added to reduce risk of endometrial hyperplasia.
• Older women: Risk–benefit must be carefully evaluated (e.g., for cardiovascular risk, cancer risk).
• Pregnancy / Breastfeeding: Contraindicated / not recommended.

Storage

• Follow the medicine packaging instructions (often in blister packs).
• Keep out of reach of children.
• Do not use after the expiry date printed on the package.

Summary / Key Points

• Progynova 2 mg (estradiol valerate) is an oral estrogen therapy, primarily used in hormone replacement therapy for menopausal symptoms and for estrogen deficiency.
• It mimics the body’s natural estrogen once converted to estradiol, but because of how it’s metabolized, it has some significant risks, especially for blood clots, cancer, and cardiovascular disease.
• Because of these risks, it should be prescribed and monitored carefully by a physician; the lowest effective dose for the shortest possible duration balancing benefits and risks is typically recommended.
• Patients need to be aware of side effects, interactions, and the importance of regular checkups.