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Autoimmun Rev. 2015 Jun;14(6):536-42. doi: 10.1016/j.autrev.2015.02.004. Epub 2015 Feb 16.

Hormonal modulation of the immune system - A spotlight on the role of progestogens.

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Division of Rheumatology, Temple University School of Medicine, PA, United States.
Division of Rheumatology, Albert Einstein College of Medicine, NY, United States.
Department of Medicine, Wolfson Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel.


This article reviews the effects of progestogens on the innate and adaptive immunity and its role in the pathogenesis of autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. The interplay between the sex hormones such as progestogens and the immune system is very complex. Multiple factors affect immunomodulatory effects of the progestogens including fluctuations in the endogenous sex hormone levels, stress, use of exogenous hormones (dose, route and the timing of administration), and alterations in the hormonal metabolism. Although immunomodulatory effects of progesterone, especially progesterone's effect on T cells, T cell subsets and their ratios, dose effects, and the use of synthetic progestins have been studied, there are still wide open areas for further explorations of the progestogens' multifaceted impact on the immune system. Better understanding of the intricate immunomodulatory effects of the progestins may pave the path to developing clinically meaningful therapeutic interventions in certain autoimmune diseases.


Autoimmunity; Gender; Immunomodulation; Multiple sclerosis; Progesterone; Progesterone receptor; Progestogens; Rheumatoid arthritis; Sex hormones; Synthetic progestins; Systemic lupus erythematosus; T cells

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