- Progesterone Therapy for Menopause
- Why treat Menopausal Women with Oral Micronized Progesterone?
- Is Oral Micronized Progesterone Therapy Safe?
- How should I Take Oral Micronized Progesterone?
- Are there things I should watch for on Oral Micronized Progesterone Treatment?
- How long should I take Oral Micronized Progesterone Therapy?
- Summary — Menopausal Oral Micronized Progesterone Therapy
- Progesterone Is Key to a Healthy Menstrual Cycle
- How Progesterone Supplements Are Produced Changes the Way It Affects the Body
- Micronized Progesterone Is Naturally Derived and Not Used for Contraception
- Synthetic Progestin Is Used to Prevent Pregnancy and Has Many Names
- Get All the Facts About the Kind of Progesterone You Are Being Prescribed and Why
- What is Prometrium?
- Important Information
- Before taking this medicine
- How should I use Prometrium?
- What happens if I miss a dose?
- What happens if I overdose?
- What should I avoid while using Prometrium?
- Prometrium side effects
- What other drugs will affect Prometrium?
- Further information
- More about Prometrium (progesterone)
- How does this medication work? What will it do for me?
- How should I use this medication?
- What form(s) does this medication come in?
- Who should NOT take this medication?
- What side effects are possible with this medication?
- Are there any other precautions or warnings for this medication?
- What other drugs could interact with this medication?
- Progesterone Side Effects
- In Summary
- For the Consumer
- For Healthcare Professionals
- More about progesterone
Hormone Therapy: Risks / Benefits
- What are the benefits of taking hormone therapy (HT)?
- What are the risks of taking hormone therapy (HT)?
- Does starting hormone therapy (HT) closer to the time of menopause make it safer?
- Who shouldn’t take hormone therapy (HT)?
- What are the side effects of hormone therapy (HT)?
- How can I reduce these side effects?
- Research Summary
- Before taking progesterone,
- Low Progesterone: Complications, Causes, and More
- 11 Vital progesterone dominance symptoms, tips, and treatments:
- #1: High Progesterone dominance side effects:
- ❓ Low energy
- Progesterone Dominance side effects
- #2: Progesterone
- Detailed description of progesterone
- Natural Progesterone
- Over-the-counter (OTC) progesterone
- Topical progesterone
- Progesterone uses
- Progesterone Cream
- Progesterone Gel
- #3: Progesterone Origins
- Wild Yams
- Profiting off of women
- Lacking research
- #4: Uses for progesterone.
- Hormone replacement therapy (HRT)
- Abnormal thickening of the endometrium (endometrial hyperplasia)
- Breast pain (mastodynia)
- Menopausal symptoms
- Premature labor
- #5: What Causes High Progesterone?
- #6: Estrogen
- #7: Most common causes of high progesterone in women
- #8: Symptoms of progesterone dominance
- Most common symptoms of high progesterone:
- Less common symptoms of high progesterone:
- Symptoms of excess estrogen
- #9: Things you should realize before you get tested:
- There are 4 things to know before you get tested
- #10: Treating High Progesterone
- #1. Treating high progesterone – from supplementing with too much progesterone:
- #2. Another common cause of high progesterone is due to adrenal overstimulation, which results in overproduction of progesterone in the adrenal glands:
- #3. Treating high progesterone related to elongation of your cycle or the luteal phase.
- Things you can do to manage your menstrual cycle:
- #4. Get your thyroid evaluated (and other hormones!)
- #11: Treating High Progesterone from Birth Control Medications
Progesterone Therapy for Menopause
“Bio-identical” is the trendy term for therapies we’ve used for a long time. Bio-identical therapies include Prometrium ® , Estrace ® , Estradot ® , Androgel ® , Climara ® and Estragel ® to list a few examples. It simply means hormonal therapies that are identical to ones that the human body makes.
The purpose of this article is to highlight the ways in which oral micronized progesterone therapy (taken by mouth as a pill) can be helpful for menopausal women with hot flushes, sleep disturbances or osteoporosis (menopause being one year after all flow has ceased). A second purpose is to identify the relative safety of progesterone (in contrast to the diseases that menopausal estrogen treatment causes). Rather than progesterone in general, this article focuses on oral micronized progesterone (hereafter just called Oral Progesterone) that is manufactured as Prometrium ® or can be compounded in olive or safflower oil as a capsule by local pharmacies. The advantages of Oral Progesterone are that blood levels from a given dose are known and that it increases deep sleep. The dose of 300 mg at bedtime keeps the progesterone blood level in normal ranges for the normal menstrual cycle’s luteal phase (after ovulation) range for 24 hours. The main problem with progesterone creams is that they have not yet been sufficiently standardized so that we know what doses correspond to what progesterone blood levels. A second problem is that the creams don’t help sleep as Oral Progesterone does.
This article is about Oral Progesterone as a therapy that is to be taken daily by symptomatic menopausal women who need treatment. I am not saying that it is normal to have high progesterone levels after menopause any more than it is normal to have high estrogen levels. In nature, except during pregnancy, progesterone is high only for two weeks at a time in menstruating premenopausal women.
Why treat Menopausal Women with Oral Micronized Progesterone?
The most important reason for using Oral Progesterone is for the treatment of hot flushes and night sweats. Since the 1970s, many progestins (synthetic cousins of progesterone), especially medroxyprogesterone (20 mg/d) have been proven to be effective treatment for hot flushes (1;2). One progestin called Megestrol (Megace ® ) that is used in women with advanced breast cancer decreased hot flushes by 83% over only one month (3). Progesterone cream in a dose of 40 mg decreased hot flushes significantly more than placebo in a one-year study (4). However, 32 mg once a day in a shorter study did not (5).
Ironically, we have information about the effectiveness of progestins and progesterone cream, yet so far we have nothing published about Oral Progesterone. For that reason, CeMCOR performed the first randomized, double blind placebo-controlled trial of Prometrium ® for night sweats and hot flushes.
Based on clinical experience, CeMCOR also recommends using Oral Progesterone to help menopausal women wishing to stop estrogen treatment. Women with past hot flushes who are on estrogen treatment can gradually discontinue that therapy and, by taking Oral Progesterone, not get severe flushes again. (For more information on this, read Stopping Estrogen Treatment).
A second reason for using Oral Progesterone therapy is for sleep disturbances. Lack of adequate sleep is not uncommon for menopausal women and this lack of sleep is linked to physical and emotional problems. Interestingly, studies of Prometrium ® and sleep have been performed in men but not in women! The men’s sleep study documented the phases of sleep in a sleep laboratory by treatment with Prometrium ® 300 mg at bedtime or placebo (6). This study showed that Oral Progesterone increased deep sleep by approximately 15 percent. Because Oral Progesterone causes deep sleep without risks for addiction, without suppression of breathing control (like all other powerful sedatives) and with no decrease in restorative rapid eye movement (REM) sleep, it is safer than all the sleeping pills currently available.
The third reason for using Oral Progesterone treatment for menopausal women is to assist in the treatment of osteoporosis. Progesterone stimulates formation of new bone (7). Normal cyclic progesterone levels, for example, are necessary to prevent bone loss in healthy premenopausal women ages 20-40 with regular menstrual cycles and normal estrogen levels (8). A study of cyclic medroxyprogesterone and calcium (or placebos) in physically active premenopausal women with mixed up periods showed a highly significant increase in spine bone density in the women getting medroxyprogesterone and an important but not quite significant effect of the extra calcium (9). A recent randomized controlled trial in menopausal women showed that very low dose medroxyprogesterone added to estrogen caused a significant 1-2% greater increase in spinal bone over two years than that caused by estrogen alone (10). A preliminary study also indicated that Oral Progesterone or medroxyprogesterone added to the positive effect of the bisphosphonate, Etidronate, on spine and hip bone densities (11). Whether or not Oral Progesterone will add to fracture prevention, when given together with therapies that decrease bone loss, is not yet known. By itself Oral Progesterone will not create new bone unless rates of bone loss are normal.
Is Oral Micronized Progesterone Therapy Safe?
The short answer is Yes! Oral Progesterone is safe. Right now is a time of very natural skepticism — after all, didn’t the experts tell us that estrogen was safe and prevented heart attacks and Alzheimer’s disease? And now we know the opposite is true (12). How can I be sure that Oral Progesterone is safe when the Canadian Pharmaceutical Compendium (13) and other drug reference books refer to a potential for it to cause abnormal vaginal bleeding, blood clots and to possibly increase the risk for breast cancer? The strongest evidence that progesterone does not cause harm comes from the very high levels of progesterone during pregnancy. As one of my patients said, “The Great Mother wouldn’t expose a fetus to high levels of progesterone if it weren’t safe!”
The most common side effect of Oral Progesterone is sleepiness, which is why it helps with sleep problems as described above. It can also cause a woozy or dizzy feeling (if you wake to go to the washroom within a couple of hours of taking it). It must not be taken when awake or if driving or operating machinery. Progesterone increases flow through small blood vessels (14) in a similar way as estrogen. It decreases blood pressure (15). It increases the rate of breathing and therefore is helpful for some lung diseases. It also causes us to burn about 300 more calories a day (16) because it increases our basal body temperature. And it blocks the production of dihydrotestosterone, the male hormone that causes acne and unwanted facial hair growth (17). Progesterone is used to prevent and treat endometrial cancer. And two randomized, placebo-controlled studies in women suggest that progesterone decreases breast cell growth that is liked to breast cancer (18; 19). Very large randomized controlled trials of Oral Progesterone and placebo have not yet been performed, however.
In day-to-day life the major “side effect” of Prometrium ® is its cost, which is about $2.00 a day for the 300-mg dose that is optimal for hot flushes, sleep and bone formation. The compounded Oral Progesterone, in a 300-mg capsule with olive oil, is significantly less expensive at about $1.00 a day.
How should I Take Oral Micronized Progesterone?
Instructions for menopausal Oral Progesterone treatment are similar to those for pre- and perimenopausal women Cyclic Progesterone Therapy except that the 300-mg dose is taken every day . Take a compounded oral micronized progesterone, rather than Prometrium ® if you are allergic to peanuts because it is dissolved in peanut oil. Progesterone should be taken on the way to bed . Then the drowsy side effects become helpful for sleep.
Are there things I should watch for on Oral Micronized Progesterone Treatment?
Women with liver failure (jaundice, fluid in the abdomen called ascites and very abnormal liver blood tests) should avoid Oral Progesterone. It is highly unusual to have vaginal bleeding or spotting on progesterone or medroxyprogesterone taken without estrogen. Sometimes, the endometrium (lining of the uterus) was thickened by past estrogen treatment or because of being overweight or perhaps having Type-2 diabetes. If any of those factors might apply to you, and you are just starting Oral Progesterone, take it for 14 days and then stop it for three to five days. If there is any lining to shed you will have some flow during those first days off Oral Progesterone. You can re-start Oral Progesterone with an extremely low risk for further bleeding.
Although Oral Progesterone is an effective treatment for endometrial cancer and does not cause it, if you have any spotting or bleeding while taking it every night, make sure that you are not also taking any kind of estrogen. That means you are not using a vaginal estrogen cream, or estrogen-like herbal products (isoflavone pills, black cohosh or Remifemin ®). Because bleeding after menopause could mean cancer, an endometrial biopsy is usually needed.
How long should I take Oral Micronized Progesterone Therapy?
In general the answer is “As long as you need it.” For women with hot flushes/night sweats, it is useful to try tapering off the Oral Progesterone once a year. For sleep disturbances you can do the same. For Oral Progesterone as an osteoporosis co-treatment with therapy preventing bone loss, I’d recommend taking it for at least five years. Physiology suggests that it is safe for longer periods of time but no long-term studies have yet been performed.
Summary — Menopausal Oral Micronized Progesterone Therapy
Three hundred milligrams of Oral Progesterone treatment at bedtime daily is useful for menopausal women with night sweats, hot flushes, sleep disturbances and osteoporosis. Oral Progesterone also helps women to stop estrogen without experiencing recurrent severe hot flushes. Those taking Oral Progesterone can safely continue it for as long as they need it. Symptomatic menopausal women are asking for effective, safe and bio-identical hormonal therapy. Oral Micronized Progesterone fits that bill.
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Nappi C, Affinito P, Di Carlo C, et al. Double-blind controlled trial of progesterone vaginal cream treatment for cyclical mastodynia in women with benign breast disease. J Endocrinol Invest 1992;15:801-6. View abstract.
Perino M, Brigandi FG, Abate FG, et al. Intramuscular versus vaginal progesterone in assisted reproduction: a comparative study. Clin Exp Obstet Gynecol 1997;24:228-31. View abstract.
Pouly JL, Bassil S, Frydman R, et al. Luteal support after in-vitro fertilization: Crinone 8%, a sustained release vaginal progesterone gel, versus Utrogestan, an oral micronized progesterone. Hum Reprod 1996;11:2085-9. View abstract.
Rosano GM, Webb CM, Chierchia S, et al. Natural progesterone, but not medroxyprogesterone acetate, enhances the beneficial effect of estrogen on exercise-induced myocardial ischemia in postmenopausal women. J Am Coll Cardiol 2000;36:2154-9.
Ross D, Cooper AJ, Pryse-Davies J, et al. Randomized, double-blind, dose-ranging study of the endometrial effects of a vaginal progesterone gel in estrogen-treated postmenopausal women. Am J Obstet Gynecol 1997;177:937-41. View abstract.
Schweizer E, Case WG, Garcia-Espana F, et al. Progesterone co-administration in patients discontinuing long-term benzodiazepine therapy: effects on withdrawal severity and taper outcome. Psychopharmacol (Berl) 1995;117:424-9. View abstract.
Smitz J, Devroey P, Faguer B, et al. A prospective randomized comparison of intramuscular or intravaginal natural progesterone as a luteal phase and early pregnancy supplement. Hum Reprod 1992;7:168-75. View abstract.
Warren MP, Biller BMK, Shangold MM. A new clinical option for hormone replacement therapy in women with secondary amenorrhea: effects of cyclic administration of progesterone from the sustained-release vaginal gel Crinone (4% and 8%) on endometrial morphologic features and withdrawal bleeding. Am J Obstet Gynecol 1999;180:42-8. View abstract.
Wyatt K, Dimmock P, Jones P, et al. Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review. BMJ 2001;323:776-80.. View abstract.
Young DS. Effects of Drugs on Clinical Laboratory Tests 4th ed. Washington: AACC Press, 1995.
Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res 1994;6:33-5. View abstract.
When it comes to taking care of your health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.
The first time my friend heard about progesterone, her gynecologist had casually mentioned that, by the looks of her cervix, she might need to take it before and during pregnancy—if and when the time came. She didn’t think much of it until years later when she miscarried and was diagnosed with polycystic ovarian syndrome (PCOS). Her OB-GYN prescribed progesterone and, a year later, she was able to conceive and carry her baby near full term. It sounds like a newfangled miracle drug for women with feminine health issues, but progesterone supplements have been used to treat feminine health issues since the late 1920s.
If you are curious about progesterone and want to know if it might help you, here’s what you need to know.
Progesterone Is Key to a Healthy Menstrual Cycle
Progesterone, a hormone produced during a woman’s monthly cycle, plays a significant role in preparing her body for pregnancy. After ovulation, a rise in progesterone thickens the uterine lining, so that if she conceives, the fertilized egg will have a healthy place to implant and thrive.
A drop in progesterone triggers the uterus to shed its lining and start a period. When that drop comes too soon, cycles are irregular and other symptoms (headaches, mood changes, low libido, weight gain, and so on) may be present too. Women with low levels of progesterone can have difficulty maintaining a pregnancy through the first trimester. Low progesterone can also cause irregular bleeding. The good news is, a doctor can prescribe progesterone for these cases.
How Progesterone Supplements Are Produced Changes the Way It Affects the Body
Because of its central role in the health of a woman’s reproductive system, progesterone is commonly prescribed for a number of reasons, including irregular periods, polycystic ovary syndrome, difficulty maintaining a pregnancy, and post-menopausal hormone therapy, as well as birth control. How can one substance effectively address such different feminine health issues?
Verily’s resident expert, Dr. A. Nicky Hjort, M.D., OB-GYN, explains, “We use different forms of different progesterones in many different ways to achieve many different goals.” It can be confusing, she says, since it appears to be prescribed to achieve opposing goals—on the one hand, as a form of contraception, and on the other, for the ability to maintain a pregnancy. The major difference is that how the hormone is produced changes how it affects the body when it’s applied.
Micronized Progesterone Is Naturally Derived and Not Used for Contraception
Some women who have experienced miscarriage may have a defect in which the body doesn’t produce enough progesterone to maintain a healthy uterine lining and support an embryo. A dramatic drop in progesterone can also be detected amongst women who suffer from severe PMS symptoms. One course of treatment is a dose of progesterone, usually as a vaginal suppository, beginning soon after ovulation until a day or two before her expected period.
Dr. Hjort notes that this type of micronized progesterone is very different from the kind of progesterone given as contraception. For one, it is derived from plants (specifically yams and soy beans) and more closely matches human progesterone than do the synthetic varieties used in birth control.
Synthetic Progestin Is Used to Prevent Pregnancy and Has Many Names
Synthetic progesterone, called progestins, don’t help maintain a pregnancy. They are used for a wide range of applications including birth control, regulating abnormal bleeding, and for hormone therapy after menopause. Below, Dr. Hjort cites the most commonly prescribed formulations of progestin, though more than forty other types than listed below exist.
- Norethidrone, commonly referred to as the “mini pill,” is a low-dose, single-hormone contraceptive. The pill is taken daily to suppress ovulation. It also thickens cervical mucus to make it more difficult for sperm to fertilize an egg, lowers the levels of other reproductive hormones, slows the passage of the egg through the Fallopian tubes, and stops the uterine lining from growing.
- Levonorgestrel is another progestin prescribed as birth control, also known as Plan B when taken orally. It is used to prevent ovulation, prevent fertilization, or prevent a fertilized egg from implanting in the uterus. Mirena administers levonorgestrel over the course of three to five years via an intrauterine device (IUD) inserted by a gynecologist.
- Etonogestrel is a progestin that comes in two different forms. Nexplanon and Implanon administer etonogestrel over a three-year period via a rod inserted into the upper arm. Etonogestrel acts on the the reproductive system in ways similar to levonorgestrel.
- Medroxyprogesterone, sold under the name Provera, is used to regulate abnormal bleeding in women of reproductive age and in combination hormone therapy for post-menopausal women. Medroxyprogesterone also acts on the reproductive system in ways similar to levonorgestrel.
Get All the Facts About the Kind of Progesterone You Are Being Prescribed and Why
If your doctor recommends progesterone, you should feel comfortable asking her whether the type she is prescribing is synthetic or natural, as the former tend to elicit more unpleasant side effects (blood clots, changes in cycle flow, depression, among them). Possible less serious side effects of any progesterone supplement include, but aren’t limited to: mild nausea, diarrhea, bloating, stomach cramps; dizziness; mild headache; joint pain; breast pain or tenderness; cough; acne or increased hair growth; changes in weight; or vaginal itching, dryness, or discharge. You’ll need to see your doctor regularly while you take progesterone, so don’t miss any appointments.
Make sure you aren’t being prescribed progesterone to cover up symptoms of a bigger feminine health issue, like endometriosis. If you have abnormal periods, including heavy or painful bleeding, it could be that you have a medical condition, and an IUD or progestin pill won’t heal that underlying condition. They only mask or treat the symptoms. Dr. Hjort tells Verily that taking progestin doesn’t always treat the real underlying problem and, on top of that, can even create a problem you previously didn’t have.
The best way to help you and your doctor find out whether you might need progesterone is to regularly chart your cycle. For a woman with PCOS, for instance, charting should reveal a pattern of long cycles, irregular bleeding, or prolonged cervical mucous production.
Ask your doctor how the specific drug is intended to work in your body and what that might mean for your short- and long-term health. There are options available to help you and your doctor identify the root of the issue you’re looking to treat. It never hurts to ask!
Generic Name: progesterone (proe JESS te rone)
Brand Name: First Progesterone MC10, Menopause Formula Progesterone, Prometrium
Medically reviewed by Drugs.com on Mar 18, 2019 – Written by Cerner Multum
- Side Effects
What is Prometrium?
Prometrium is a female hormone important for the regulation of ovulation and menstruation.
Prometrium is used to cause menstrual periods in women who have not yet reached menopause but are not having periods due to a lack of progesterone in the body. This medicine is also used to prevent overgrowth in the lining of the uterus in postmenopausal women who are receiving estrogen hormone replacement therapy.
Prometrium should not be used to prevent heart disease or dementia, because Prometrium may actually increase your risk of developing these conditions.
Prometrium may also be used for purposes not listed in this medication guide.
You should not use Prometrium if you have: abnormal vaginal bleeding, a history of breast cancer, liver disease, or if you have recently had a heart attack, stroke, or blood clot.
Do not use if you are pregnant.
Prometrium should not be used to prevent heart disease or dementia, because this medicine may actually increase your risk of developing these conditions.
Using Prometrium can increase your risk of blood clots, stroke, heart attack, or breast cancer.
Before taking this medicine
You should not use Prometrium if you are allergic to it, or if you have:
abnormal vaginal bleeding that a doctor has not checked;
a history of breast cancer;
a peanut allergy;
if you are pregnant;
if you have had a stroke, heart attack, or blood clot within the past year; or
if you have recently had an incomplete miscarriage or “missed” abortion.
Using Prometrium can increase your risk of blood clots, stroke, heart attack, or breast cancer.
To make sure Prometrium is safe for you, tell your doctor if you have:
heart disease, circulation problems;
seizures or epilepsy;
a history of depression; or
risk factors for coronary artery disease (such as high blood pressure, diabetes, lupus, high cholesterol, family history of coronary artery disease, smoking, being overweight).
Do not use Prometrium if you are pregnant. It could harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
Progesterone can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
How should I use Prometrium?
Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Take the Prometrium capsule with a full glass of water. It is best to take the medicine at night because this medicine can make you dizzy or drowsy.
Apply Prometrium cream to the skin as directed by your doctor.
Prometrium is sometimes used for only a short time, such as 10 to 12 days during each menstrual cycle. Follow your doctor’s dosing instructions very carefully.
Have regular physical exams and self-examine your breasts for lumps on a monthly basis while using Prometrium.
If you need surgery or medical tests or if you will be on bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using Prometrium.
Store at room temperature away from moisture, heat, and light.
What happens if I miss a dose?
Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.
Call your doctor if you miss more than one dose of this medication.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while using Prometrium?
Prometrium may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Prometrium side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
unusual vaginal bleeding;
pain or burning when you urinate;
a breast lump;
sudden vision problems, severe headache or pain behind your eyes;
symptoms of depression (sleep problems, weakness, mood changes);
severe dizziness or drowsiness, spinning sensation, confusion, shortness of breath;
heart attack symptoms–chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;
liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
signs of a stroke–sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with speech or balance;
signs of a blood clot in the lung–chest pain, sudden cough, wheezing, rapid breathing, coughing up blood; or
signs of a blood clot in your leg–pain, swelling, warmth, or redness in one or both legs.
Common side effects may include:
constipation, diarrhea, heartburn;
bloating, swelling in your hands or feet;
hot flashes; or
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect Prometrium?
There may be other drugs that can interact with Prometrium. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 1996-2018 Cerner Multum, Inc. Version: 9.01.
More about Prometrium (progesterone)
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- During Pregnancy or Breastfeeding
- Dosage Information
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- Support Group
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- En Español
- 23 Reviews
- Generic Availability
- Drug class: progestins
- Prometrium Oral (Advanced Reading)
Other brands: Crinone, Endometrin, First Progesterone MC10, Menopause Formula Progesterone, Prochieve
- Prometrium (FDA)
- … +1 more
Related treatment guides
- Progesterone Insufficiency
- Endometrial Hyperplasia, Prophylaxis
- Perimenopausal Symptoms
- Premature Labor
- Uterine Bleeding
How does this medication work? What will it do for me?
Progesterone belongs to the class of medications called progestins. It is used in combination with postmenopausal estrogen replacement therapy (ERT) to prevent the estrogen from thickening the lining of the uterus (a condition known as endometrial hyperplasia). This significantly reduces the risk of endometrial cancer. This medication is used for women who have a uterus.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
How should I use this medication?
The recommended dose of progesterone is 200 mg daily taken at bedtime for the last 14 days of estrogen treatment per cycle. Women who take high doses of estrogen should receive a progesterone dose of 300 mg per day. If the dose is 300 mg daily, 200 mg should be taken at bedtime and 100 mg should be taken 2 hours after breakfast for the last 12 to 14 days of estrogen treatment per cycle.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor. If you are using 200 mg daily and miss a dose of this medication at bedtime (i.e., 2 of the 100 mg capsules), take an extra dose of 100 mg (1 capsule) the following morning and continue taking the rest of the capsules as prescribed by your doctor. If you are taking 300 mg daily and miss a dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
What form(s) does this medication come in?
Each capsule contains 100 mg of micronized progesterone. Nonmedicinal ingredients: sunflower oil, gelatin, glycerin, soya lecithin, and titanium dioxide.
Who should NOT take this medication?
Do not take progesterone if you:
- are allergic to progesterone, peanuts (the capsules contain peanut oil), soya, or any ingredients of this medication
- are or may be pregnant
- have a history of blood clots (e.g., pulmonary embolism, deep vein thrombosis) or blood clotting disorders
- have a tumour dependent on progesterone or estrogen for growth (e.g., breast or endometrial cancer)
- have active liver disease
- have classical migraines
- have endometrial hyperplasia (overgrowth of the lining of the uterus)
- have had a stroke, heart attack, or heart disease
- have partial or complete loss of vision due to blood vessel disease of the eye
- have unexplained abnormal vaginal bleeding
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal pain or cramping
- breast pain or tenderness
- brown spots on exposed skin, possibly long-lasting
- change of sexual desire
- difficulty concentrating
- difficulty wearing contact lenses
- hot flashes
- short term joint or muscle pain
- loss or gain of body, facial, or scalp hair
- mood changes
- premenstrual syndrome (PMS)
- swelling of face, ankles, or feet
- weight gain
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- allergic reaction (e.g., hives, skin rash, itchiness)
- breast lump
- changes in vaginal bleeding, such as:
- heavier vaginal bleeding between regular monthly periods
- increased amounts of menstrual bleeding occurring at regular monthly periods
- lighter vaginal bleeding between menstrual periods
- stopping of menstrual periods
- fast or pounding heartbeat
- increased blood pressure
- worsened menstrual cramps
- painful urination
- pain during sexual intercourse
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
- vaginal itching or discharge
- worsening headaches or migraines
Stop taking the medication and seek immediate medical attention if any of the following occur:
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
- signs of a blood clot in blood vessels, such as sudden vision change or dizziness, chest pain, pain and swelling in one leg muscle
- signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
- signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Important information about estrogen:
- Estrogen should be used at the lowest dose that relieves your menopausal symptoms for the shortest time period possible.
- You should not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes.
Breast and ovarian cancer: Several studies have shown an association between a modest increase in the risk of developing breast cancer or ovarian cancer and the use of hormone replacement therapy during menopause when taken over the long term. Ask your doctor which cancer screening tests you may need and how to perform breast self-examination. Women who have breast nodules, fibrocystic disease, abnormal mammograms, or a strong family history of breast cancer should be closely monitored by their doctor.
Dementia: Women over the age of 65 receiving combined hormone replacement therapy (estrogen and progestin) may be at increased risk of developing dementia (loss of memory and intellectual function). If you are over 65, talk to your doctor about whether you should be tested for dementia.
Depression: Hormones, such as progesterone, have been known to cause mood swings and symptoms of depression. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, or notice them in a family member who is taking this medication contact your doctor as soon as possible.
Diabetes: As with other hormone replacement medications, progesterone may cause an increase in blood sugar levels and glucose tolerance may change. People with diabetes may find it necessary to monitor their blood sugar more frequently while using this medication.
If you have diabetes or are at risk for developing diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Follow-up examinations: It is important to have a follow-up examination 3 to 6 months after starting this medication to assess your response to treatment. Examinations should be done at least once a year after the first one.
Heart Disease: Several studies have demonstrated that the use of estrogen and progestins to treat menopausal symptoms is related to an increased risk of heart disease, blood clots, and stroke. If you have risk factors for heart disease or stroke, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Occupational hazards: Temporary and occasional drowsiness or dizziness may occur for some people 1 to 4 hours after taking progesterone, particularly if it is taken with food. If this occurs, avoid activities requiring concentration, good coordination, or reflex action such as driving or operating machinery. In most cases, these problems can be prevented by taking the capsules at the recommended times. The 200 mg dosage should be taken at bedtime. The 300 mg dosage should be divided into two doses: 100 mg 2 hours after breakfast and 200 mg at bedtime.
Vaginal bleeding: Progesterone can cause changes to your normal pattern of vaginal bleeding. If you experience menstrual bleeding that lasts longer or heavier than usual, contact your doctor.
Pregnancy: Do not take progesterone during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking progesterone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
What other drugs could interact with this medication?
There may be an interaction between progesterone and any of the following:
- barbiturates (e.g., pentobarbital, phenobarbital)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone, sitagliptin)
- estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
- low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
- St. John’s wort
- “statin” anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Prometrium
Progesterone Side Effects
Medically reviewed by Drugs.com. Last updated on Jan 23, 2019.
- Side Effects
Commonly reported side effects of progesterone include: abdominal cramps, depression, dizziness, and headache. Other side effects include: anxiety, cough, diarrhea, fatigue, musculoskeletal pain, nausea, bloating, emotional lability, and irritability. See below for a comprehensive list of adverse effects.
For the Consumer
Applies to progesterone: oral capsule, oral capsule liquid filled
Oral route (Capsule, Liquid Filled)
Estrogens plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia. Increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) have been reported with estrogen plus progestin therapy. An increased risk of developing probable dementia in postmenopausal women 65 years of age or older has also been reported. Risks should be assumed to be similar for other doses, combinations, and dosage forms of estrogens and progestins. Progestins with estrogens should be prescribed at the lowest effective doses and for the shortest duration possible.
Along with its needed effects, progesterone may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking progesterone:
- Chest pain
- cold or flu-like symptoms
- cough or hoarseness
- problems with urination
- Clear or bloody discharge from the nipple
- dimpling of the breast skin
- inverted nipple
- lump in the breast or under the arm
- persistent crusting or scaling of the nipple
- redness or swelling of the breast
- sore on the skin of the breast that does not heal
Incidence not known
- Abdominal or stomach pain
- blurred vision
- change in vaginal discharge
- clay-colored stools
- cleft lip or palate
- darkened urine
- difficult or labored breathing
- difficulty with swallowing
- difficulty with walking
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- fast, pounding, or irregular heartbeat or pulse
- irregular heartbeat
- joint pain, stiffness, or swelling
- loss of appetite
- noisy breathing
- numbness or tingling in the face, arms, or legs
- pain or feeling of pressure in the pelvis
- pains in the stomach, side, or abdomen, possibly radiating to the back
- pounding in the ears
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- redness of the skin
- shortness of breath
- slow heartbeat
- spontaneous abortion
- stomach or pelvic discomfort, aching, or heaviness
- swelling of the eyelids, face, lips, hands, or feet
- tightness in the chest
- trouble speaking, thinking, or walking
- unpleasant breath odor
- unusual tiredness or weakness
- vaginal bleeding
- vomiting of blood
- yellow eyes or skin
Some side effects of progesterone may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Breast pain or tenderness
- muscle or joint pain
- white or brownish vaginal discharge
Incidence not known
- Attack, assault, or force
- blurred or loss of vision
- change in walking and balance
- changes in behavior
- changes in patterns and rhythms of speech
- clumsiness or unsteadiness
- confusion about identity, place, and time
- continuing ringing or buzzing or other unexplained noise in the ears
- decreased awareness or responsiveness
- difficulty with moving
- disturbed color perception
- double vision
- extreme dizziness or drowsiness
- feeling drunk
- feeling of constant movement of self or surroundings
- feeling of unreality
- hair loss or thinning of the hair
- halos around lights
- hearing loss
- hives or welts
- longer or heavier menstrual periods
- loss of consciousness
- muscle cramps
- muscle stiffness
- night blindness
- normal menstrual bleeding occurring earlier, possibly lasting longer than expected
- overbright appearance of lights
- redness of the skin
- relaxed and calm
- sensation of spinning
- sense of detachment from self or body
- severe sleepiness
- slurred speech
- swollen tongue
- thoughts of killing oneself
- tunnel vision
- weight changes
For Healthcare Professionals
Applies to progesterone: compounding powder, intramuscular solution, oral capsule, topical cream, vaginal gel, vaginal insert, vaginal suppository
Common (1% to 10%): Ovarian hyperstimulation syndrome, breast pain, vaginal dryness, pruritus genital, uterine spasm, vaginal bleeding, altered periods, amenorrhea, intercurrent bleeding
Uncommon (0.1% to 1%): Vulvovaginal disorders, vaginal mycosis, breast disorders, pollakiuria, incontinence, ovarian enlargement, pelvic pain, vulvovaginal pruritus, galactorrhea
Frequency not reported: Vaginal irritation, vaginal burning, vaginal discomfort, fatty discharge, changes in cervical erosion and secretions
Postmarketing reports: Hypospadia, intra-uterine death, menorrhagia, menstrual disorder, metrorrhagia, ovarian cyst, spontaneous abortion
Very common (10% or more): Headache (31%), somnolence (27%), dizziness (24%)
Uncommon (0.1% to 1%): Dysgeusia
Frequency not reported: Extreme dizziness and/or drowsiness, slurred speech, difficulty walking, loss of consciousness, vertigo, confusion, disorientation, insomnia
Postmarketing reports: Convulsion, depressed consciousness, dysarthria, loss of consciousness, paresthesia, sedation, stupor, syncope (with and without hypotension), transient ischemic attack, abnormal gait, difficulty walking
Very common (10% or more): Emotional lability (23%), depression (19%), sleep disorder (18%), nervousness (16%), libido decreased (10%)
Common (1% to 10%): Worry
Uncommon (0.1% to 1%): Mood altered
Postmarketing reports: Aggression, depersonalization, disorientation, suicidal ideation
Very common (10% or more): Hot flashes (11%)
Uncommon (0.1% to 1%): Hemorrhage
Rare (less than 0.1%): Thromboembolism or thrombus formation
Postmarketing reports: Circulatory collapse, congenital heart disease (including ventricular septal defect and patent ductus arteriosis), hypertension, hypotension, tachycardia
Very common (10% or more): Abdominal pain (20%), abdominal bloating (12%)
Common (1% to 10%): Nausea/vomiting, diarrhea, abdominal distension, constipation
Uncommon (0.1% to 1%): Flatulence, gastric dilatation
Postmarketing reports: Acute pancreatitis, dysphagia, swollen tongue, cleft palate
Very common (10% or more): Joint pain (20%), cramps NOS (15%), musculoskeletal pain (12%)
Common (1% to 10%): Back pain, arthralgia, myalgia
Postmarketing reports: Cleft lip, muscle cramp
Common (1% to 10%): Coughing, upper respiratory tract infection
Frequency not reported: Shortness of breath
Postmarketing reports: Choking, dyspnea, asthma, throat tightness
Common (1% to 10%): Night sweats
Uncommon (0.1% to 1%): Pruritus, acne
Very rare (less than 0.01%): Urticaria, chloasma
Frequency not reported: Itching, hirsutism
Postmarketing reports: Alopecia, face edema
Very common (10% or more): Post oocyte retrieval pain (28%), viral infection (12%), hot flashes (11%)
Common (1% to 10%): Fatigue, pain, chest pain, swelling of hands and feet, breast excisional biopsy
Uncommon (0.1% to 1%): Peripheral edema, feeling cold, feeling of body temperature change, discomfort, weight increased
Frequency not reported: Feeling drunk, pyrexia
Postmarketing reports: Feeling abnormal, tinnitus, weight decreased
Common (1% to 10%): Cholecystectomy
Uncommon (0.1% to 1%): Cholestatic jaundice
Postmarketing reports: Cholestasis, cholestatic hepatitis, hepatic failure, hepatic necrosis, hepatitis, increased liver function tests (including alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase increases), jaundice
Common (1% to 10%): Hyperglycemia
Postmarketing reports: Blood glucose increased
Common (1% to 10%): Breast carcinoma
Uncommon (0.1% to 1%): Rectal neoplasm
Postmarketing reports: Endometrial carcinoma
Frequency not reported: Blurred vision
Postmarketing reports: Diplopia, visual disturbance
Uncommon (0.1% to 1%): Hypersensitivity reactions
Postmarketing reports: Anaphylactic reaction
Rare (less than 0.1%): Adrenal suppression or insufficiency
Frequency not reported: Injection site reaction
1. “Product Information. Endometrin (progesterone).” Ferring Pharmaceuticals Inc, Tarrytown, NY.
2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0
3. Cerner Multum, Inc. “Australian Product Information.” O 0
4. “Product Information. Crinone (progesterone).” Actavis U.S. (Alpharma USPD), Owings Mills, MD.
5. “Product Information. Prometrium (progesterone).” Virtus Pharmaceuticals LLC, Tampa, FL.
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Hormone Therapy: Risks / Benefits
What are the benefits of taking hormone therapy (HT)?
HT is prescribed to relieve:
- Hot flashes
- Vaginal dryness that can result in painful intercourse
- Other problematic symptoms of menopause, such as night sweats and dry, itchy skin
Other benefits of taking HT include:
- Reduced risk of developing osteoporosis and reduced risk of bone breakage
- Improvement of mood and overall sense of mental well-being in some women
- Decreased tooth loss
- Lowered risk of colon cancer
- Lowered risk of diabetes
- Modest improvement in joint pains
- Lower death rate for women who take hormone therapy in their 50s.
What are the risks of taking hormone therapy (HT)?
While HT helps many women get through menopause, the treatment (like any prescription or even non-prescription medicines) is not risk-free. Known health risks include:
- An increased risk of endometrial cancer (only if a woman still has her uterus and is not taking a progestin along with estrogen) .
- Increased risk of blood clots and stroke. However, in women within 5 years of menopause there was no statistically significant increase in stroke risk. Also, studies suggest that using estrogen delivered from the skin via a patch/cream might further lessen the risk of blood clots.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after a woman has been in menopause for 10 years. It is not yet known if it might be beneficial for women who start HT in their 50s.
Most of our understanding about the benefits and risks of hormone therapy on the heart and breast come from the Women’s Health Initiative (WHI) study (one of the largest studies done on hormone therapy):
HT and the heart
Recent analysis of WHI actually shows that the risk of heart disease may be related more to the advanced age of the participants as opposed to the HT. The study also found that HT given to younger women, at the onset of menopause, appeared to lower the risk of heart disease. More specifically:
An increased risk of heart disease is only seen in women taking long-term estrogen-progestin combination therapy (EPT) if they start HT in their mid-60s (or after 10 years from menopause). There does not seem to be an increased risk of heart disease when women start EPT in their 50s (or within 10 years of menopause). Estrogen alone (ET) has not been shown to increase the risk of heart disease. Analysis of the age since menopause actually shows a lower risk of heart disease when ET was started in younger women (those just beginning menopause).
Currently, it is not recommended to use hormone therapy solely for the purpose of preventing heart disease. However these studies give us reassurance that when women just newly approaching menopause need HT for a short time, it is safe to do so in terms of long term heart disease risk.
HT and breast cancer
Diagnosis of breast cancer increases when combination EPT is used beyond 3-5 years. This means that out of 10,000 women who use estrogen progestin therapy for more than 5 years, there will be 8 additional breast cancers diagnosed. In contrast, the WHI study showed women who use estrogen alone had no increase in risk of breast cancer even after 11 years of use. In fact, fewer breast cancers were seen in the group taking estrogen alone, though this was not statistically significant. When a woman comes off of hormone therapy, any potential increase in her risk of breast cancer quickly goes back to her baseline norm. This is why hormone therapy can be a safe option when women in their 50s (who are generally at lower risk for breast cancer compared to older women).
Does starting hormone therapy (HT) closer to the time of menopause make it safer?
One of the problems with the WHI study, which gave us much of our knowledge on the risks of HT, is that most women in the study were starting hormones in their mid-60s. Typically, women who need HT are newly menopausal, in their early 50s. Younger women in the WHI study had fewer risks and more benefits from HT. Newer studies are trying to understand the risks and benefits of HT in women in their 50s. One such study showed HT started early in postmenopausal women significantly reduced death rate, heart attacks and heart failure. These postmenopausal women who started HT early and used it for more than 10 years were not at increased risk of breast cancer or stroke.
Who shouldn’t take hormone therapy (HT)?
HT is not usually recommended for women who have:
- Active or past breast cancer
- Recurrent or active endometrial cancer
- Abnormal vaginal bleeding that has not been evaluated
- Recurrent or active blood clots
- History of stroke
- Known or suspected pregnancy
What are the side effects of hormone therapy (HT)?
Like almost all medications, hormone therapy has side effects. The most common side effects are:
- Monthly bleeding (if progestin given cyclical)
- Irregular spotting
- Breast tenderness
Less common side effects of hormone therapy include:
- Fluid retention
- Headaches (including migraine)
- Skin discoloration (brown or black spots)
- Increased breast density making mammogram interpretation more difficult
- Skin irritation under estrogen patch
How can I reduce these side effects?
Adjusting either the dosage or the form of the medication you are taking can often reduce side effects of HT. However, you should never make changes in your medication or stop taking it without first consulting your doctor.
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In this emerging area of progesterone research, several research studies attest to the neuroprotective effects of progesterone, an absence of neurological side effects, and a benefit for cognitive function.
Progesterone and the brain
By Margaret N. Groves Scientific Writer, ZRT Laboratory, Beaverton, Oregon
Many women are familiar with progesterone as a hormone that is essential for fertility and for sustaining a pregnancy. In fact, the name itself means “promoting gestation.” Once a woman’s reproductive life begins to wane and she enters perimenopause, progesterone production in the ovaries starts to decline. By the time she reaches menopause, circulating progesterone levels are so low, they are similar to those normally seen in men.
However, progesterone is far more than a gestational agent. Research is now surfacing which shoes that the benefits of progesterone reach to breast health, cardiovascular health, and nervous system health, most importantly brain function. The rest of this article will take a closer look at just how essential progesterone is for your brain.
Progesterone as a “neurosteroid”
As a result of its critical functions in the nervous system, progesterone has been classified as a “neurosteroid”. It is so essential that it comes from two different places to reach the brain: first, cells in the brain, spinal cord, and peripheral nervous system all synthesize progesterone from cholesterol. Secondly, progesterone that is circulating in the bloodstream also has direct access to the brain and nerves.
Normal brain function is not the only thing progesterone is required for in the nervous system. An important role of progesterone is to protect the brain from damage and promote repair after injury. It actually does this by promoting the growth and repair of the myelin sheath that protects the nerve fibers.
Progesterone protects the brain from damage after traumatic brain injury
Around 20 years ago, researchers who were studying rats after brain injury made a significant observation. Female rats which, at the time of the brain injury, were at the stage of their reproductive cycles when progesterone levels were the highest, had significantly less brain damage than male rats or females with lower progesterone levels. Such research led ultimately to human clinical studies, which have found that high doses of natural progesterone have significantly improved patients’ survival from traumatic brain injury.
One trial, given the name “ProTECT”, randomized intensive care patients with acute traumatic brain injury to either high dose progesterone injections for 3 days or placebo injections. While all the patients were at a very high risk of death, only 13% of the progesterone-treated patients died of their brain injuries compared with 30% of the placebo-treated patients.
A review published this year suggests that not only should progesterone be used to treat traumatic brain injuries, but that it may also have a role in treating stroke, because of its powerful protective effects on brain tissue. This is a very exciting area of progesterone research, as researchers and clinicians acknowledge the fact that natural progesterone has an excellent safety profile without long term side effects, making it a good candidate for high dose therapy that can also be carried out in a home environment as patients recover.
Progesterone and brain development – smarter kids?
There is published evidence that the children of women who were treated with progesterone during pregnancy showed enhanced development during infancy, achieved better academic results at ages 9-10, and were significantly more likely to attend universities. While researchers acknowledge that progesterone treatment could not be claimed to promote a new generation of “brainiacs”, the observed benefits can be explained by the fact that it is essential for optimal development of a normal brain in the fetus. If progesterone levels are too low, normal brain development may be affected, putting an infant at a developmental disadvantage.
Progesterone eases anxiety and facilitates memory
Progesterone naturally metabolizes in brain tissues to the metabolite allopregnanolone, which is known to produce calming, anti-anxiety and possibly enhanced memory effects. There is some speculation that it could be important in preserving cognitive function in women experiencing the decline in progesterone levels with age. However, it’s important to note that progesterone is produced by brain tissue itself, and so the reduction in blood progesterone levels as ovarian production decreases may not be as important as other aging processes that have direct effects on the brain’s function. It will be interesting to see further research on this as aging women increasingly use progesterone in hormone replacement.
Progesterone as a sleeping aid?
Women using an oral progesterone may notice a sedative effect, and doctors usually recommend that the oral form is taken at bedtime (actually, it is often a welcome “side effect” that helps counteract the sleeplessness of perimenopause!) Basically, there is a large quantity of metabolites produced in the liver after oral progesterone is absorbed by the intestines. These metabolites have known sedative and hypnotic effects.
On the other hand, women using progesterone cream do not produce metabolites in such large quantities because the progesterone is absorbed through the skin and bypasses the liver metabolism. However, as stated before, some women may experience progesterone’s calming effect after using it in cream form.
Progestins vs. Progesterone: Same effects?
Synthetic progestins are molecularly different from natural progesterone and therefore do not metabolize to the same compounds as natural progesterone. They do not show benefits for cognitive or anti-anxiety function. In fact, they have not been found to have any of progesterone’s neuroprotective properties. The progestin that has been the most extensively studied and which is commonly used in synthetic hormone replacement therapy, MPA (medroxyprogesterone acetate), has been found to have negative effects on the nervous system and even reduces the beneficial effects of estrogen.
Note: To find all references on this subject, search for the categories “progesterone” AND “brain” using our search tool at the top right of the page.
Before taking progesterone,
- tell your doctor and pharmacist if you are allergic to progesterone, oral contraceptives (birth control pills), hormone replacement therapy, any other medications, or peanuts.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Samdimmune); danazol (Danocrine); delaviridine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac); erythromycin (E.E.S, E-Mycin, Erythrocin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir), and saquinavir (Fortovase); isoniazid (INH, Nydrazid); lansoprazole (Prevacid, Prevpac); metronidazole (Flagyl); nefazodone (Serzone); omeprazole (Prilosec); oral contraceptives (birth control pills); ticlopidine (Ticlid); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor what herbal products you are taking, especially St. John’s wort.
- tell your doctor if you have or have ever had unexplained vaginal bleeding between periods; a miscarriage in which some tissue was left in the uterus; cancer of the breasts or female organs; seizures; migraine headaches; asthma; diabetes; depression; blood clots in the legs, lungs, eyes, brain, or anywhere in the body; stroke or ministroke; vision problems; or liver, kidney, heart, or gallbladder disease .
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking progesterone, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking progesterone.
- you should know that progesterone may make you dizzy or drowsy. Do not drive a car or operate machinery until you know how this medication affects you. If progesterone does make you dizzy or drowsy, take your daily dose at bedtime.
- you should know that progesterone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking progesterone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
Low Progesterone: Complications, Causes, and More
You may not have any symptoms of low progesterone, and you may not need treatment. But if you’re trying to have a baby, hormone therapy could be useful. Hormone therapy increases progesterone levels and may help thicken your uterine lining. This may improve your chances of a healthy pregnancy and carrying to term.
Menstrual irregularities and abnormal bleeding can improve with hormone therapy. For severe symptoms of menopause, hormone therapy usually involves a combination of estrogen and progesterone. Women who take estrogen without progesterone are at increased risk of developing endometrial cancer.
Treatment options for progesterone supplementation include:
- creams and gels, which can be used topically or vaginally
- suppositories, which are commonly used to treat low progesterone that causes fertility problems
- oral medications, like Provera
Hormone therapy (either estrogen only or a combination of estrogen and progesterone) may help ease symptoms such as:
- hot flashes
- night sweats
- vaginal dryness
For some women, progesterone improves mood. Oral progesterone may provide a calming effect, making it easier to sleep.
Hormone therapy may increase the risk of:
- heart attack and stroke
- blood clots
- gallbladder troubles
- certain types of breast cancer
Your doctor will probably advise against hormone therapy if you have a history of:
- breast cancer
- endometrial cancer
- liver disease
- blood clots
Natural remedies for raising low progesterone levels include:
- increasing your intake of vitamins B and C, which are necessary for maintaining progesterone levels
- eating more foods with zinc, like shellfish
- controlling stress levels, since your body releases cortisol instead of progesterone when you’re stressed
Progesterone is generally not supplemented in women who are experiencing menopausal symptoms of hormone imbalance. This is because menopausal symptoms are mostly caused by low estrogen levels.
Hormone replacement does carry some risks, so it’s important to discuss them with your doctor. There are prescription medications that are formulated to look the same to your body as your naturally occurring hormones. These are sometimes called “bioidentical hormones.” While these may sound more favorable, they have the same risks as other prescription formulations.
Progesterone substances used for medical uses are called progestogens. They are available in two forms: synthetic versions (progestins) and another version derived from plant sources, which is nearly identical to the body’s own hormone and is often called “natural progesterone.”
In addition to being included in birth control pills and hormone replacement therapy, progestogens may be used to treat a variety of conditions, including:
- menstrual or bleeding problems
- breast, kidney or uterine cancer
- appetite and weight loss in AIDS and cancer patients
They are also used as a diagnostic aid to measure estrogen’s effect in the uterine lining, and in their natural state may be used to treat infertility.
If you are considering a progestogen product, discuss with your health care professional any medical conditions you may have, especially asthma, epilepsy, cardiovascular or bleeding disorders, high cholesterol, history of blood clots or stroke, kidney or liver disorders, migraines, breast problems, depression or diabetes. Also share information about any medications you are taking.
Typical side effects of progestins include:
- breakthrough bleeding
- menstrual cramps
- bloating caused by water weight gain
- dry mouth
Many of these side effects mimic PMS, which is not surprising since PMS usually occurs when progesterone levels peak. Some women experience rarer side effects like depression, fainting, breast tenderness, trouble sleeping, severe headaches or vision problems.
Talk to your health care professional if you experience side effects. Many of these side effects subside with continued use. If not, switching to a different progestin-based product may help.
Uses of Progestin Products
Abnormal uterine bleeding: Because of their ability to inhibit bleeding, progestins are often used to manage excessive or abnormal uterine bleeding (AUB).
Endometriosis: Endometriosis may be treated with a progestin or with an estrogen-progestin birth control pill. The goal is to reduce estrogen production, thus keeping endometrial tissue from growing.
Irregular periods and polycystic ovary syndrome (PCOS): The shedding of the uterine lining that occurs with menstruation each month reduces the risk of endometrial cancer; thus, maintaining menstrual cycles is important during childbearing years. If you frequently skip periods due to PCOS, being overweight or underweight, or because of another disorder, your health care professional may recommend birth control pills containing estrogen and progestin to ensure regular cycles. If you can’t or won’t take birth control pills, you may need an occasional prescription for an oral progestin to help you balance unopposed estrogen and shed the uterine lining.
Birth control: Oral contraceptives typically contain estrogen and progestin. Combination pills suppress ovulation (the release of an egg) each month. The progestin in these pills also reduces the risk of pregnancy by altering the mucus in your cervix, making it harder for the sperm to move and connect with an egg. Continuous progestins in combination birth control pills also prevent the growth of the endometrium and alter uterine secretions to reduce the chance that a fertilized egg could implant in the uterine lining.
Combination pills come in different formulas. Some are based on a 28-day regimen (21 days of active tablets that contain the same amount of estrogen and progestin followed by seven days of placebo tablets or no tablets at all), called monophasic birth control pills. Others vary the dose of estrogen and/or progestin that a woman gets throughout her cycle and are called multiphasic birth control pills.
There is a 91-day oral contraceptive regimen (Seasonale and generics) that, provides women with birth control and fewer periods each year. Tablets containing the active hormones progestin (levonorgestrel) and an estrogen (ethinyl estradiol) are taken for 12 weeks (84 days), followed by one week of placebo tablets, so you only have four periods a year.
The FDA also has approved continuous-use birth control pills that contain ethinyl estradiol and levonorgestrel. Brand names include Lybrel, Alesse, Lessina, Nordette, Triphasil-28, Triphasil-21, and others. These are monophasic pill (containing the same levels of estrogen and progestin throughout the entire pill-taking schedule) that come in a 28- or 21-day pack and are designed to be taken continuously, with no break between pill packets. That means you won’t have a period. You may have some spotting or breakthrough bleeding, particularly when you first start using continuous birth control pills. But most women will have no bleeding (or hardly any) by the end of a year.
Estrogen-progestin birth control pills have some anti-cancer benefits in addition to birth control. They may reduce ovarian cancer risk, as well as uterine and colon cancer risk. However, combination pills are not recommended for women who have had breast cancer.
It’s important to understand that not all of the questions surrounding combined HRT and breast cancer risk have been answered. If you’ve had breast cancer or have a history of it in your family, discuss your risk with your health care professional.
These products also have side effects, the most common of which are nausea, breast tenderness and breakthrough bleeding. Most side effects decrease or disappear after three months of continuous use. Switching to another type of birth control pill can also relieve side effects. Nausea may vary depending on when you take the pills and whether you take them on a full or empty stomach.
Combination birth control pills are typically not an appropriate treatment choice if you are over 35 and smoke, have high blood pressure, have a history of migraine with aura or blood clots in your lungs or you are highly sensitive to side effects of this medication, such as headaches. Smoking while taking combination birth control pills significantly increases your risk of heart attack and stroke.
Estrogen-progestin contraceptives are available as a patch (Ortho Evra) and as a ring (Nuvaring).
Ortho Evra is a weekly prescription patch that releases norelgestromin (a progestin hormone) and ethinyl estradiol (an estrogen hormone) through the skin into the blood stream to prevent pregnancy. Each patch is worn for one week. On the same day of the week you start the patch, replace it with another. After three weeks (and three new patches) you have a week that is patch-free, during which you get your period. Ortho Evra contains higher levels of estrogen than lower dose birth control pills, and the FDA approved additions to the patch’s label addressing an increased risk of blood clots associated with its use. You should discuss this and other potential risks with your health care professional.
Side effects may include breast tenderness, headache, a reaction at the application site, nausea and emotional changes. Other risks are similar to those from using birth control pills, such as an increased risk of heart attack, blood clots and stroke, particularly in women who smoke and/or have a history of these conditions.
Another contraceptive that contains progesterone is Nuvaring, which consists of a soft, flexible, transparent, ring about 2 inches in diameter. It contains a combination of estrogen and progestin hormones (ethinyl estradiol and levonorgestrel). After it is inserted into the vagina, these hormones are slowly released on a continual basis. You need to insert a new ring each month for continuous contraception, removing it after three weeks, at which time you have your period.
Side effects are minimal but may include vaginal discharge, vaginitis and irritation. Like oral contraceptives, Nuvaring may increase the risk of blood clots, heart attack and stroke. Women who use Nuvaring are strongly advised not to smoke, as it may increase the risk of heart-related side effects.
Some women choose to take a progestin-only pill. Called the “mini-pill,” progestin-only pills allow women to avoid some of the worst side effects of estrogen, while improving regular menstrual cycles and preventing pregnancy. If you are breast-feeding, you may want to consider the mini-pill, since combination products may dry up your milk supply.
Progestin-based mini-pills are highly effective for preventing pregnancy (about 97 percent), but missing a pill or taking it at a different time of day is riskier than with combination estrogen-progestin pills. That’s because the mini-pill’s effects can wear off after a day, making you vulnerable to pregnancy. Women on mini-pills may also ovulate, even when they take the pills correctly. And if you miss a day, the potential availability of an egg makes getting pregnant more likely.
Longer-acting progestins may be a good birth control option if you want reliable protection without having to remember to take a pill each day. Injected medroxyprogesterone (Depo-Provera) lasts three months. The Mirena IUD, which delivers progesterone directly and continuously into the uterine lining for up to five years, is an additional longer-term option. Both are highly effective. Discuss the risks and benefits with your doctor before choosing the method that’s best for you.
Progestin-Only Contraceptive Products At-A-Glance
- Levonorgestrel (tablets and implants); marketed as emergency contraception tablets (Plan B One-Step and Next Choice) and the Mirena levonorgestrel-releasing intrauterine system
- Ulipristal acetate; a progesterone agonist/antagonist that is marketed as the “ella” tablet
- Medroxyprogesterone (injected); marketed as Depo-Provera contraceptive injection
- Norethindrone (tablets); marketed as Ortho Micronor and Nor-Q-D
Emergency contraception: Pills containing levonorgestrel (Plan B One-Step and Next Choice) can be used for emergency contraception within 72 to 120 hours of unprotected sex. With Plan B One-Step, you take one pill within 72 hours after unprotected sex to help prevent pregnancy. It can be taken up to 120 hours after sex but is less effective the more time lapses. Next Choice works similarly but involves taking one pill within 72 hours of unprotected sex and another 12 hours later. ella tablets cut the chances of becoming pregnant by about two-thirds for at least 120 hours after unprotected sex by delaying or inhibiting ovulation. You can buy the levonorgestrel emergency contraceptive pills over the counter without a prescription. You must ask for them at the pharmacy counter. ella is available only by prescription, but you could keep a supply at home.
Ask your health care professional or pharmacist for more information about how and when to use these products, if you want to keep them on hand. Combination birth control pills can also be used for emergency contraception if you already have a prescription for them, but talk to your health care provider about proper dosage and timing for use as an emergency contraceptive.
Perimenopause and menopause: For perimenopausal women with irregular or absent periods, the low-dose estrogen/progestin combination found in oral contraceptives often alleviates symptoms and helps maintain regular menstrual cycles.
Additionally, postmenopausal hormone therapy using either estrogen alone (ET) or an estrogen-progestin combination (HT) is sometimes recommended to treat moderate to severe perimenopausal or postmenopausal symptoms. Estrogen-only therapy is prescribed only if you’ve had a hysterectomy. If you still have your uterus, you’ll need to take some progestin with the estrogen (unless you use the estrogen-SERM combination, Duavee) because the progestin helps offset estrogen’s stimulating effects on the endometrium, which could increase your risk of endometrial cancer.
Some postmenopausal hormonal therapy products provide the same dose of progestin in each daily dose (called continuous therapy). Others are designed with progestin added during part of a monthly cycle and then stopped (called cyclic therapy). Women on the intermittent-progestin regimen report more bleeding problems than women on continuous therapy regimens.
Estrogen-progestin combinations may require cyclic therapy, during which you take different pills on different days, resulting in monthly bleeding similar to menstruation, or continuous therapy, during which you take estrogen and progestin together every day. Many women prefer the continuous combination therapy so they can avoid monthly bleeding. If bleeding persists more than three months, consult your health care professional.
Progestin-Only Products at a Glance:
Types of progestins available include intramuscular, oral, and cream. They include:
Hydroxyprogesterone (injected); marketed under the names Hylutin, Makena and Prodrox. It is prescribed for abnormal uterine bleeding, amenorrhea and readying the uterus for menstruation.
Medroxyprogesterone (tablets and injection); marketed under the names Curretab, Depo-Provera (injection) and Provera. Tablets are prescribed for abnormal uterine bleeding, amenorrhea, to get the uterus ready for menstruation and as part of menopausal hormone therapy with estrogen. Injections are prescribed for kidney or uterine cancer.
Megestrol (liquid and tablets); marketed as Megace. Liquid is prescribed for appetite or weight loss related to AIDS. Tablets are prescribed for breast or uterine cancer or for appetite or weight loss related to cancer.
Norethisterone acetate (tablets); marketed as Nor–Q-D and Aygestin. It is prescribed for abnormal uterine bleeding, amenorrhea or endometriosis.
Progesterone products include:
Micronized oral progesterone (Prometrium). It is prescribed for menopausal symptoms, infertility, abnormal uterine bleeding, endometriosis and amenorrhea (absence of a menstrual period).
Progesterone vaginal gel (Crinone). It is used to treat infertility and amenorrhea.
Many conditions for which progestin or progestin-estrogen combinations are prescribed cannot be prevented. Menopause, for example, is a normal phase of life. But while the changes in hormone levels cannot be avoided, the intense symptoms these changes may cause can often be relieved through medication and/or lifestyle changes.
As your body changes, it is very important to communicate openly with both your partner and your health care professional. Tell both about your symptoms and the physical and emotional changes you may experience. Your health care professional will be able to help you discover how to better manage and treat those symptoms, including how to maintain a healthy sex life. And your partner should know what’s happening to you, especially if the symptoms are causing distress and are affecting your sex life.
11 Vital progesterone dominance symptoms, tips, and treatments:
I think you might agree with me if you are one of the many women who suffer from progesterone dominance symptoms then getting relief is vital.
The problem is that education on female hormones is limited at best. To compound the matter, doctors are NOT taught ANYTHING about these hormones in medical school nor how to treat them.
Furthermore, pharmaceutical companies with aggressive marketing campaigns – pushing synthetic hormones, have done an excellent job confusing the situation about what is actually safe.
In our clinic I have assisted hundreds of women to work through progesterone dominance, hormonal balance issues, perimenopause, menopause, and hysterectomies, etc. We have helped turn once desperate and frustrated women into happy, loving, productive, sexually active, stress-free women and more.
In this post, I am going to teach you what progesterone dominance is, how to diagnose your symptoms, and how to treat them.
#1: High Progesterone dominance side effects:
Women take progesterone for many reasons, like to help restart their menstrual cycles that have stopped, treat severe symptoms of premenstrual syndrome (PMS), treat perimenopause or menopause.
Progesterone is also used to balance the effects of estrogen as part of planned hormone replacement therapy program.
If estrogen is given without progesterone, estrogen increases the risk of uterine cancer. For this reason, they are commonly given together.
However, sometimes too much progesterone can build up in the system causing unwanted symptoms.
Below are some known side effects of progesterone dominance.
❓ Low energy
❓ Upset stomach
❓ Aches & pains
Is it stress or symptoms of a cold or flu?
With the flu season on our doorstep, are we too quick to blame the dreaded office virus?https://t.co/eYdVG5NAWK#HumanResources #MentalHealth #Business #Stress pic.twitter.com/1mTDzGusLw
— Stress Less Work Smarter (@StressLessMgmt) October 26, 2018
Progesterone Dominance side effects
- stomach upset
- changes in appetite
- weight gain
- fluid retention and swelling (edema)
- drowsiness or insomnia
- allergic skin rashes
- breast discomfort or enlargement
- premenstrual syndrome (PMS) – like symptoms dizziness
- weight gain
- water retention
These are just some of the high progesterone symptoms.
Progesterone, a hormone that occurs naturally in the body, but can also be made in a laboratory is a hormone released by the corpus luteum in the ovary. It plays an important role in the menstrual cycle. Progesteone also maintains the early stages of pregnancy and may also be involved in the growth of certain cancers.
Detailed description of progesterone
Progesterone is in a class of steroids called progestogens. It is secreted by the corpus luteum in the ovaries during the second half of the menstrual cycle and in some part by the adrenals.
It is very important during pregnancy to protect the fetus, it stimulates the growth of breast tissue, prevents lactation and strengthens the pelvic wall for labor. Progesterone rises throughout pregnancy until the baby is born.
“Progestin” is a general term for a synthetic substance that causes some or all of the biologic effects of progesterone. The term “progestin” is sometimes used to refer to the progesterone made in the laboratory that is an oral contraceptive and hormone replacement therapy. However, all progesterone and progestin products are made in the laboratory.
The term “natural progesterone” is really a misnomer. Natural progesterone’, including the prescription products Crinone and Prometrium, are made from a chemical called diosgenin that is isolated from wild yam or soy.
In the laboratory, this component is converted to pregnenolone and then to progesterone.
The human body is not able to make progesterone from diosgenin, so eating wild yam or soy will not boost your progesterone levels.
Over-the-counter (OTC) progesterone
Over-the-counter progesterone products may not contain the actual progesterone concentrations as labeled. Over the counter progesterone cream is considered a cosmetic.
According to a British report, two-ounce jars of Progest cream used in a clinical trial contained 100 mg progesterone per ounce rather than the 465 mg claimed by the manufacturer.
DYK that most over-the-counter #cosmetics contain very few active ingredients? This is why you’re not getting the results you want. Our skincare was designed for industry professionals, meaning a #higher concentration of active ingredients that provide better and faster results. pic.twitter.com/CyYvUelyUF
— LeTellier Skincare (@LeTellierSkin) June 15, 2018
Topical progesterone products (preparations applied to the skin) marketed as cosmetics require no FDA approval prior to marketing.
There is currently no limit on the amount of progesterone allowed in cosmetic products.
In 1993 the FDA proposed a rule limiting progesterone-containing cosmetic products to a maximum level of 5 mg/oz with the product label instructing users not to exceed 2 oz per month. But this rule was never finalized.
Women commonly take progesterone to help restart menstrual periods that unexpectedly stopped, treat abnormal uterine bleeding associated with hormonal imbalance, and treat severe symptoms of premenstrual syndrome (PMS).
Progesterone is also used in combination with the hormone estrogen to “balance estrogen” as part of hormone replacement therapy.
If estrogen is given without progesterone, estrogen increases the risk of uterine cancer.
Progesterone cream is sometimes used in hormone replacement therapy and for treating menopausal symptoms such as hot flashes, and premenstrual syndrome (PMS).
Women use progesterone gel inside the vagina to treat breast pain associated with noncancerous breast disease, to prevent and treat abnormal thickening of the lining of the uterus (endometrial hyperplasia), and prevent premature labor.
Progesterone is also used intra-vaginally or by injection for treating infertility and symptoms of (PMS).
Progesterone can also be used for a variety of other conditions not listed above, but there is limited scientific research to support these other uses. Where does progesterone come from?
#3: Progesterone Origins
In 1929 the existence of the corpus luteum hormone was established, was proven to be necessary for a successful pregnancy, and thus given the name progesterone (ie “Pro-gestation”)
It wasn’t until 1939 when a scientist learned how to create a natural form of progesterone that could safely be supplemented which was synthesized from the wild yam plant.
From long ago, Native Americans have used wild yam for possible benefits ranging from menopause relief especially hot flashes, treating diverticulosis, gallbladder pain and rheumatoid arthritis.
Wild yam has many purported benefits, but not enough contemporary scientific data… pic.twitter.com/6FslmQQR8Q
— April Danann (@DanannSpl4ces) June 18, 2018
In the 1950’s it was discovered that only wild yams found in tropical regions with the Latin name (Dioscorea) could be converted into a laboratory with the exact same molecule as human progesterone yielding – bioidentical progesterone.
Not long after, the pharmaceutical industry realized that large profits could be made from creating their own version an inexpensively synthetic form of progesterone made from soybeans, one which they could patent.
Profiting off of women
Man-made (synthetic) hormones are far more profitable for commercial application because they can be patented.
These patented synthetic progesterones were created in pill and capsule forms that were more effective when taken orally. These same synthetic forms of progesterone, which are prescribed by traditional medical doctors, don’t provide the full spectrum of biological availability (meaning they don’t work as well), nor are they as safe.
Synthetic progesterone grew in popularity due to their ability to prevent pregnancy and their minimal protection of estrogen-induced risk of endometrial cancer.
It’s an alarming fact that corporations’ pursuit of profit over women’s health prevailed.
Pharmaceutical companies could now take perfectly good hormones, that our bodies know and love, and alter them creating synthetic compounds with similar results – but with toxic side effects.
Hormonal research in the last 2 decades has been entirely nonexistent. And the pharmaceutical companies that sell these products have been very successful in confusing doctors about the meaning of ‘progesterone’.
The typical doctor thinks that synthetic progesterone products are actually progesterone.
Since these synthetic progesterones’ called ‘progestins’ have a long list of undesirable and potentially dangerous side effects, doctors have been leery of prescribing natural progesterone.
Consequently, natural bioidentical progesterone has almost no side effects when supplied in the same doses the body makes naturally in a healthy woman with healthy function.
This conclusion is probably one of the reasons you are researching using bioidentical progesterone yourself.
Board-certified OB/GYN physician, Dr. Christiane Northrup confirms that “The most physiologic way to take hormones is through the skin—either with a cream or a vaginal gel. That way the hormone goes right into the bloodstream without having to be metabolized by the liver.”
Now that you understand where progesterone comes from there are many uses of progesterone to consider.
#4: Uses for progesterone.
There are many uses for progesterone from hormone replacement therapy, menopause to severe PMS. The following is a more detailed list with brief explanations of each.
The absence of menstrual periods is called amenorrhea. The common effective treatment strategies are to take progesterone by mouth and apply progesterone gel into the vagina for treating the absence of menstrual periods in premenopausal women.
Micronized progesterone is FDA-approved for this use, as is intravaginal progesterone gel (Crinone 4%).
Hormone replacement therapy (HRT)
Micronized progesterone (Prometrium) is FDA-approved for use with estrogen as a component of HRT. Research shows that adding progesterone to HRT protects against side effects of estrogen.
Intravaginal progesterone gel (Crinone 8%) is FDA-approved for use as a part of infertility treatment in women. Some research suggests that applying progesterone intravaginally and injecting it into the muscle may have similar effectiveness for increasing pregnancy rates as giving it by mouth.
Also, research suggests that intravaginal progesterone seems to be as effective for pregnancy rates as human chorionic gonadotropin (HCG).
Further information has been written on the subject of conceiving using progesterone cream (ttc) while trying to conceive. It’s worth reviewing in detail if you are considering having a baby and/or have been having trouble conceiving.
Abnormal thickening of the endometrium (endometrial hyperplasia)
Some research suggests that applying progesterone (Crinone) into the vagina prevents endometrial hyperplasia in women with an intact uterus that is taking estrogen replacement therapy.
Other early research shows that a specific intravaginal progesterone cream may help reverse abnormal thickening of the endometrium and decrease vaginal bleeding in premenopausal women with non-cancerous endometrial hyperplasia.
Breast pain (mastodynia)
There is also further research that suggests that applying progesterone (Crinone) into the vagina seems to reduce breast pain and tenderness in women with non-cancerous breast disease.
And more research suggests that applying a specific progesterone cream (Progest) to the skin reduces symptoms such as hot flashes in menopausal women. There have been countless articles written on the power of using progesterone cream to aid women in menopausal symptoms.
Most research suggests that applying progesterone gel into the vagina, alone or along with therapy to delay labor (tocolytic therapy), reduces the risk of premature delivery in some women at high risk of premature birth.
However, other research suggests that intravaginal progesterone gel does not decrease the frequency of premature birth in women with a history of premature birth.
With all the uses of progesterone out of the way let’s consider what actually causes high progesterone.
#5: What Causes High Progesterone?
Believe it or not, women have more progesterone than they have estrogen (in absolute concentration). What this means is, that progesterone is incredibly important to the female body because it directly counteracts the effects of estrogen.
You probably think of estrogen as the “female” sex hormone, responsible for the majority of sexual characteristics that females have like breast development, etc. But, like many things, too much of a good thing isn’t always better.
This principle is true of both estrogen AND progesterone; these two hormones live in balance with one another. Now let’s take a look at estrogen in depth to get a greater understanding of this balance.
Estrogen is often considered a growth hormone which makes things bigger, progesterone as the exact opposite. Estrogen causes breast tissue to grow, it causes endometrial tissue to grow and it causes fat cells to grow. Not exactly what most women want.
Progesterone, on the other hand, causes the exact opposite. Progesterone helps regulate breast tissue growth, it helps regulate your menstrual cycle and it can help with weight loss.
Balance is key in order to maintain a healthy system.
But what is most important to understand is that you need to balance these hormones.
It’s not as easy as simply increasing progesterone for weight loss, for instance, it’s the imbalance (lack of balance) of these two hormones which cause significant negative symptoms in many women.
To be fair, the majority of women nowadays have excess estrogen and too little progesterone.
This is commonly referred to as estrogen dominance, however, some women still suffer from the symptoms of excess progesterone.
How to Know If You Have Estrogen Dominance and What To Do About It
Most women suffer from low progesterone, however, there are quite a few that have excess progesterone. And this brings me to the most common causes of high progesterone in women.
#7: Most common causes of high progesterone in women
The following are the most common causes of high progesterone in women that you may avoid with proper care and a little attention to detail.
- Changes in your menstrual cycle (elongation of the luteal phase)
- A reduction in estrogen levels in the body
- Too much supplementation with progesterone (either oral or transdermal progesterone)
- Excess supplementation with pregnenolone or other progesterone precursors
- Adrenal related problems (overproduction of adrenal hormones or improper adrenal enzyme signaling)
As with other hormone imbalances, it’s always important to correctly identify what is causing the problem in your body.
Once you have identified the issue that is causing your symptoms then can you properly target them with the required treatment.
Before we talk about treatment let’s discuss the many symptoms of progesterone dominance.
#8: Symptoms of progesterone dominance
Here are the progesterone dominance symptoms that are most common. These symptoms arise from too much progesterone in the body. This is usually the result of taking too much over the counter progesterone, pregnenolone or during the luteal phase of your menstrual cycle (last 2 weeks)
Most common symptoms of high progesterone:
- Weight fluctuations (usually mild weight gain of 5-10 pounds)
- Depressed feeling but not overt depression
- Slight dizziness
- Waking up groggy or “on edge”
- Sense of physical instability
- Spinning sensation
- Discomfort or pain in the legs
- Water retention
- Anxiety or just feeling “tense”
- Changes to libido (usually decreased sex drive)
- Not feeling like yourself
Less common symptoms of high progesterone:
The following is a list of less common symptoms which are usually the result of taking much higher levels of progesterone or having much higher concentrations of progesterone in the body.
Interestingly enough these symptoms can actually mimic excess estrogen in the body.
Symptoms of excess estrogen
- Hot flashes (due to an overload of estrogen receptors)
- Increased appetite
- Overt anxiety or panic attacks
- Significant weight gain
As you might have noticed some of these symptoms are very subtle or very general. Therefore, this can make the diagnosis difficult. For this reason, it’s important to remember that each person will have different individual symptoms.
You know your body better than anyone, therefore it’s very likely that you will know when something is not right. If you feel you are having any of the symptoms above, have your progesterone levels checked.
You can check your progesterone levels through a blood serum test by checking serum progesterone.
#9: Things you should realize before you get tested:
There are 4 things you should consider before getting tested for progesterone dominance. You will want to evaluate progesterone and estradiol at the same time. Also, notice when you are menstruating as this matters, serum levels can fluctuate and may not be the most accurate, and progesterone levels change with age.
There are 4 things to know before you get tested
#1. You must evaluate progesterone AND estradiol at the same time.
Dealing with hormones is a delicate balance one in which you will want to balance estrogen and progesterone at the same time. Therefore, you will want to test and monitor both at the same time through serum blood tests or with a saliva test. Most physicians know how to test for these however it’s always a good idea to remind them to test for both just in case.
#2. The time of the month matters (if you are still menstruating)
If you are menstruating, then it’s important to check your progesterone and estradiol levels during days 19-21 of your cycle. At this point in your cycle progesterone most likely will be the highest and the ratio above applies.
I would suggest that you check your progesterone and estrogen levels multiple times per month. It’s very difficult to get an accurate reading if you randomly check your progesterone levels, with the exception after menopause. In menopause, you are not ovulating and its ok to check progesterone and estrogen at any time.
#3. Serum levels may not be the most accurate way to test your progesterone levels
Much like other hormones in your body, serum levels may not be the absolute best way to check what is really happening in your body. I generally recommend you start with serum levels first because they are easy to order and insurance will almost always cover the test. However, you may need to make sure that your doctor codes the forms correctly for insurance purposes.
If you continue to have symptoms or your serum levels are not helpful, you may need more advanced testing. In some cases, you can get a more accurate reading of progesterone by checking for urinary metabolites of pregnanediol. Checking urinary levels of sex hormones also allows you to get a better idea of what is happening to your estrogen levels (as there are at least 3 primary estrogen metabolites that are not regularly checked in the serum).
This process is somewhat more advanced than serum testing, so make sure you find a Doctor who understands this process and can help you interpret your tests.
#4. Progesterone levels change as you age.
Progesterone levels and progesterone metabolism change with age, in addition to your menstrual cycle. As women age progesterone levels tend to decrease and estrogen tends to rise which cause estrogen dominance. The issue is that sometimes estrogen dominance symptoms can appear similar to progesterone dominance. This rise in estrogen usually starts around age 35 but this is just an average and does not mean it will happen to you. It’s a great idea to check progesterone levels every time, perhaps with yearly physicals.
#10: Treating High Progesterone
Treating of high progesterone largely depends on what the cause is. By far the most common cause of high progesterone and therefore high progesterone symptoms are due to over supplementation.
Usually, the main culprit with high progesterone is over supplementing with progesterone. Treatment varies based on what the cause is. Below are 4 explanations you should know about.
#1. Treating high progesterone – from supplementing with too much progesterone:
Consider dropping your dose if you notice any of the symptoms above, however its best to check your serum progesterone levels before and after starting progesterone supplementation.
#2. Another common cause of high progesterone is due to adrenal overstimulation, which results in overproduction of progesterone in the adrenal glands:
Due to the high levels of stress in women’s lives, their adrenal glands are often taxed to the extreme. Excess levels of fatigue and stress cause abnormal hormone production or enzyme metabolism which can also affect cortisol levels. Studies have shown this to be the case. Stressing the adrenals combined with high cortisol levels may cause weight gain and other symptoms.
Here are some basic recommendations to get you started:
- Cut caffeine usage completely
- Manage and reduce your stress (if possible), try yoga, Thai chi, meditate
- If you are an exerciser, try reducing your exercise a little – see if that helps
- Take the right supplements designed to help balance cortisol levels
- Check your serum cortisol level and DHEA level
- Exclude refined carbs and sugars from your diet
This is just some basic information to get you started, however, all these steps are helpful as a yearly reset. If you feel you have adrenal issues its best to consult your medical provider and get tested.
We have already stressed the importance of balance, however, I think it’s good to point out that balancing your stress, thus managing your luteal phase (menstrual cycle) is also important as well. Managing your lifestyle by removing stresses, eating a balanced diet, exercising, etc. is a great way to manage your menstrual cycle. The less stress you have, the less likely you will have a longer menstrual cycle, therefore, the less progesterone your body will produce.
Things you can do to manage your menstrual cycle:
- Eating a real whole food diet without excessive caloric restriction
- Managing stress levels by taking certain supplements or partaking in certain activities which improve your natural stress response
- Making sure you sleep at least 8 hours each night
- Regulating your exercise so you aren’t exercising too much or too little
- Managing your weight (this means making sure you don’t gain too much weight or lose too much)
If you follow these recommendations you should be well on your way to managing your menstrual cycle and your luteal phase which can help level your progesterone levels.
#4. Get your thyroid evaluated (and other hormones!)
By now you will have a good understanding of how important balancing hormones are. Therefore, if you take into consideration how important thyroid function is, how it can affect both progesterone and cortisol levels, (8) and how stress can alter them and their effects on obesity, you are well on your way to a healthy life.
Slight changes in any of the hormones could affect progesterone levels. It’s a great idea to check your thyroid status and other hormones such as leptin, insulin, and testosterone if you notice you have high progesterone symptoms. A good doctor can run a hormone blood serum panel easily.
#11: Treating High Progesterone from Birth Control Medications
Another important consideration is birth control medications and how they can affect hormones and progesterone levels. Birth control medication can trick the body by acting as fake progesterone (synthetic) and can reduce or block your body’s normal production of endogenous progesterone.
This may cause the symptoms of high progesterone even though your serum progesterone levels may be “low” or “normal”. And this is also why so many women who start birth control medications end up with symptoms such as weight gain, swelling or mood swings (all symptoms of excess progesterone).
But does that mean it’s normal? Not by a long shot. So what do you do about it? Obviously, if you are reacting negatively to birth control medications your next step should be to go off of them (assuming that is an option for you).
Since birth control is a synthetic (known as progestin or progestogen) and acts like progesterone it may trigger incorrect messages to the brain. Therefore, these signals make your body think that it has excess progesterone, which may cause the symptoms of high progesterone – even though your serum progesterone levels may be ‘low’ or ‘normal’ when checked.
Furthermore, this can be the reason many women who begin taking birth control experience weight gain, swelling or mood swings (all symptoms of excess progesterone).
If you are interested in the possibility of getting pregnant and you are having any of the symptoms or problems listed in this article you may want to consider the effects birth control and progesterone can have on pregnancy.
As a side note, many women who take birth control for an extended period of time who then later experience trouble getting pregnant may want to consider the long-term effects of taking birth control when trying to conceive.
Having these negative reactions to birth control should not be considered normal. If you are reacting negatively to birth control medications your next step should be to go to the doctor and discuss getting off birth control or alternatives to synthetic birth control.
However, stopping birth control medication may not be enough to restore normal progesterone and estrogen function, you may need to properly eliminate and restore the metabolism of these hormones through the liver, and this can be achieved in a few ways.
In order to increase liver metabolism and phase I and phase II elimination pathways, you can take the supplement calcium-d-glucarate.
This supplement has been shown to increase glucuronidation (which is an elimination pathway in the liver). Taking milk thistle, or MSM for instance may also help improve liver function
Controlling (normalizing) your body weight and removing excess fat cells that you may have gained from taking birth control pills should help normalize your hormones and is a major concern. Fat can act as a storage device to fat-soluble substances which include hormones, like progesterone, endocrine disruptors, and fat-soluble vitamins.
If you think you are suffering from high progesterone, you may want to spend the time researching and educating yourself on what is causing the problem. This article is a great first step. Once you have figured out the root cause of your hormone imbalance you will have come a long way towards targeting the treatment to REVERSE the issue.
Tune in for actionable advice on topics like bioidentical progesterone cream, micronized progesterone things to know, biest progesterone concerns, and wild yam progesterone cream.
Bill is an experienced freelance writer, researcher, journalist and Naval corpsman who presently manages a functional medical clinic in Georgia. Find out how Bill went from watching his father stroke out and nearly die, become disabled to treating patients ailments naturally.