In this review we systematically summarize the effects of progesterone and synthetic progestins on neurogenesis, synaptogenesis, myelination and six neurotransmitter systems. Several parallels between progesterone and older generation progestin actions emerged, suggesting actions via progesterone receptors. However, existing results suggest a general lack of knowledge regarding the effects of currently used progestins in hormonal contraception regarding these cellular and molecular brain parameters. Human neuroimaging studies were reviewed with a focus on randomized placebo-controlled trials and cross-sectional studies controlling for progestin type. The prefrontal cortex, amygdala, salience network and hippocampus were identified as regions of interest for future preclinical studies. This review proposes a series of experiments to elucidate the cellular and molecular actions of contraceptive progestins in these areas and link these actions to behavioral markers of emotional and cognitive functioning. Emotional effects of contraceptive progestins appear to be related to 1) alterations in the serotonergic system, 2) direct/indirect modulations of inhibitory GABA-ergic signalling via effects on the allopregnanolone content of the brain, which differ between androgenic and anti-androgenic progestins. Cognitive effects of combined oral contraceptives appear to depend on the ethinylestradiol dose.

在这篇综述中，我们系统地总结了黄体酮和合成孕激素对神经发生、突触发生、髓鞘形成和六种神经递质系统的影响。孕酮和老一代孕激素作用之间出现了一些相似之处，表明通过孕激素受体起作用。然而，现有结果表明，人们普遍缺乏关于目前使用的孕激素在激素避孕中对这些细胞和分子脑参数的影响的知识。审查了人类神经影像学研究，重点是随机安慰剂对照试验和控制孕激素类型的横断面研究。前额皮质、杏仁核、显着网络和海马体被确定为未来临床前研究的感兴趣区域。这篇综述提出了一系列实验来阐明避孕孕激素在这些领域的细胞和分子作用，并将这些作用与情绪和认知功能的行为标志联系起来。避孕孕激素的情绪影响似乎与 1) 血清素能系统的改变，2) 通过影响大脑的四氢孕酮含量直接/间接调节抑制性 GABA 能信号有关，这在雄激素和抗雄激素孕激素之间有所不同。复方口服避孕药的认知作用似乎取决于炔雌醇的剂量。避孕孕激素的情绪影响似乎与 1) 血清素能系统的改变，2) 通过影响大脑的四氢孕酮含量直接/间接调节抑制性 GABA 能信号有关，这在雄激素和抗雄激素孕激素之间有所不同。复方口服避孕药的认知作用似乎取决于炔雌醇的剂量。避孕孕激素的情绪影响似乎与 1) 血清素能系统的改变，2) 通过影响大脑的四氢孕酮含量直接/间接调节抑制性 GABA 能信号有关，这在雄激素和抗雄激素孕激素之间有所不同。复方口服避孕药的认知作用似乎取决于炔雌醇的剂量。