From the Guidelines
Progesterone is a viable alternative for treating hot flashes in women who cannot take estrogen therapy, with moderate effectiveness in reducing hot flash frequency and severity. According to the most recent and highest quality study 1, hormonal treatments for the relief of hot flashes in women include combination estrogen and progestins or estrogen alone, with micronized progestin being preferred over medroxyprogesterone acetate due to lower rates of venous thromboembolism and breast cancer risk. Some key points to consider when using progesterone for hot flashes include:
- Typical doses of 100-300 mg daily can reduce hot flash frequency and severity by about 40-60% 1
- Oral micronized progesterone at 100-200 mg before bedtime is a common formulation used
- Treatment typically continues for several months, with effects often noticeable within 2-4 weeks
- Progesterone works by affecting temperature regulation in the hypothalamus and stabilizing the vasomotor symptoms that cause hot flashes
- Side effects can include drowsiness, dizziness, and breast tenderness
- Women with a history of hormone-sensitive cancers, liver disease, or blood clotting disorders should consult their healthcare provider before starting progesterone therapy 1. It's also important to note that alternatives to hormonal therapy, such as non-hormonal medications and lifestyle changes, should be considered and discussed with a healthcare provider before starting progesterone therapy.
From the Research
Effectiveness of Progesterone for Hot Flashes
- There is no direct evidence in the provided studies that supports the use of progesterone as an effective treatment for hot flashes 2, 3, 4, 5, 6.
- The most effective treatment for hot flashes is estrogen, but it is not recommended for women with a history of breast cancer or those at high risk of developing breast cancer due to associated health risks 2, 4.
- Nonhormonal treatments such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and gabapentin have shown robust evidence for reducing hot flashes 3, 5.
- Complementary and alternative therapies like isoflavone supplementation and mindfulness-based stress reduction therapy also have evidence of effectiveness in reducing hot flashes 3.
Alternative Treatment Options
- SSRIs, SNRIs, and gabapentin are considered effective nonhormonal treatments for hot flashes 3, 5.
- Isoflavone supplementation has been shown to reduce hot flashes, with effectiveness similar to SSRIs, SNRIs, and gabapentin 3.
- Mindfulness-based stress reduction therapy is also an effective option for reducing hot flashes 3.
- Hormone therapy, including estrogen, remains the most effective treatment for menopausal symptoms like hot flashes but comes with potential risks and is not suitable for all women 4.