Starting Micronized Progesterone in Sequential Hormone Therapy
For postmenopausal women with a uterus taking estrogen, start micronized progesterone on day 14 (or between days 14-17) of each 28-day cycle and continue for 12 consecutive days. 1
Dosing Schedule
The FDA-approved regimen is clear and specific:
- Dose: 200 mg orally as a single daily dose at bedtime
- Timing: Days 14-25 of each 28-day cycle (12 consecutive days)
- Administration: Take at bedtime due to drowsiness and dizziness that commonly occur 1
This sequential regimen provides endometrial protection while allowing for predictable withdrawal bleeding, which is preferred for recently menopausal women who are prone to breakthrough bleeding during the first 1-2 years of therapy 2.
Clinical Rationale
The 12-day sequential approach (rather than continuous daily dosing) is specifically designed for women in early menopause who:
- Still experience some cyclic symptoms
- Prefer predictable bleeding patterns
- Are within the first few years of menopause 2
The combined sequential regimen includes estrogen for 20-25 days and progestogen for 12-15 days each month, with the progestogen typically starting mid-cycle 2. The 12-day duration at 200 mg daily has been proven effective in preventing endometrial hyperplasia—reducing the rate from 64% (with estrogen alone) to only 6% when progesterone is added 1.
Important Administration Details
- Take with a glass of water while standing if you have difficulty swallowing capsules 1
- Bedtime dosing minimizes side effects like drowsiness, dizziness, blurred vision, and difficulty walking 1
- Do not use if allergic to peanuts (the capsules contain peanut oil) 1
Alternative Timing from Research
While the FDA label specifies days 14-25, research studies have explored slight variations:
However, stick with the FDA-approved days 14-25 (12 days) at 200 mg nightly as this is the evidence-based regimen that demonstrated endometrial protection in clinical trials 1.
Common Pitfall to Avoid
Do not confuse this sequential regimen with the continuous combined regimen (where both estrogen and progestogen are taken daily without breaks). The sequential approach is specifically for women who need predictable bleeding patterns and are in early menopause 2.