When Progesterone May Be Used

Progesterone may be used with systemic estrogen in women with an intact uterus to help protect the endometrium. It may also be used as part of menopausal and perimenopausal hormone therapy, for secondary amenorrhea, and for cycle regulation when clinically appropriate. The appropriate indication, formulation, and schedule depend on a patient’s symptoms, menstrual and menopausal status, whether the uterus is present, other hormones being prescribed, and individual medical risk factors.

Progesterone and Estrogen Therapy

For a woman with an intact uterus who is receiving systemic estrogen, an appropriate progestogen regimen is generally used to reduce the increased risk of endometrial hyperplasia and endometrial cancer associated with unopposed estrogen. Treatment may be prescribed continuously or cyclically depending on the clinical situation.

Micronized Progesterone and Other Progestogens

FDA-approved oral micronized progesterone is a bioidentical progesterone option. Other progestogens are also used in hormone therapy. Selection should be individualized according to the treatment goal, tolerability, medical history, route of estrogen therapy and the evidence supporting the regimen.

How Progesterone Can Be Given

Progesterone and progestogens may be available in oral formulations and, depending on the indication and product, in combined hormone products, intrauterine systems or certain vaginal formulations. Compounded preparations may also be available, but compounded hormone products are not FDA-approved finished products and should not automatically be considered safer or more effective than FDA-approved options.

Potential Benefits

When appropriately prescribed with systemic estrogen in a woman with a uterus, the principal benefit of progesterone or another progestogen is endometrial protection. The overall benefits of a hormone regimen depend on the indication and the other hormones being used.

Potential Side Effects and Risks

Potential effects can include changes in bleeding patterns, breast tenderness, bloating, headaches, mood changes, dizziness or drowsiness, depending on the medication and patient. The risks of combined menopausal hormone therapy vary according to age, medical history, hormone type, dose, route, timing and duration. Any unexpected or persistent postmenopausal bleeding requires appropriate medical evaluation.

Comprehensive Evaluation Before Treatment

Progesterone should not be prescribed based on a hormone level alone. Evaluation should consider symptoms, menstrual and menopausal history, uterine status, medications, personal and family history, breast and gynecologic history, cardiovascular and thrombotic risk, and the reason hormone therapy is being considered.

Individualized Treatment and Monitoring

There is no single progesterone regimen that is appropriate for every patient. Treatment should be individualized, with follow-up to assess response, side effects, bleeding patterns and whether the hormone regimen remains appropriate.