What is the recommended oral progesterone (hormone) supplement and dosage?

Recommended Oral Progesterone Supplement and Dosage

For hormone replacement therapy, micronized progesterone at 100-200 mg daily is the recommended oral progesterone supplement due to its physiological profile and safety advantages over synthetic progestins. 1

Recommended Formulations and Dosages

The optimal oral progesterone supplement depends on the specific indication:

For Postmenopausal Women on Estrogen Therapy

• First-line recommendation: Micronized progesterone 200 mg orally once daily at bedtime for 12 days sequentially per 28-day cycle 2
• This regimen effectively prevents endometrial hyperplasia in women receiving daily conjugated estrogens 2
• Should be taken with a glass of water while standing if swallowing difficulties occur 2

For Secondary Amenorrhea

• Micronized progesterone 400 mg orally once daily at bedtime for 10 days 2

For Menopausal Symptoms

• Dosage options based on bleeding preferences:
  • 300 mg/day at bedtime for 10 days monthly (for women desiring regular monthly bleeding)
  • 200 mg daily for 14 days monthly
  • 100 mg daily for 25 days monthly (for women preferring amenorrhea) 3

Advantages of Micronized Progesterone

Micronized progesterone offers several benefits over synthetic progestins:

• Identical to natural progesterone produced by the corpus luteum 3
• Minimizes metabolic and vascular side effects associated with synthetic progestins 3
• Does not suppress the vasodilating effects of estrogens 3
• Provides adequate plasma and tissue levels when properly micronized 4
• Reproduces the anti-estrogenic effect on the endometrium at 200 mg daily 4
• Has no adverse effects on lipid profile, coagulation factors, or blood pressure 4

Administration Considerations

• Take at bedtime to minimize the mild and transient drowsiness that may occur 3
• Oral micronized progesterone is rapidly absorbed, with peak concentrations occurring approximately 2.8 hours after administration 5
• Peak concentrations are equivalent to those observed in the midluteal phase of normal cycles 5
• Effects persist for at least 6 hours after a single oral dose 5

Clinical Monitoring

• Evaluate patients clinically every 3-6 months initially, then annually 1
• Patients should report any persistent or recurrent abnormal vaginal bleeding 1
• Monitor for side effects, though they are typically minimal with micronized progesterone compared to synthetic progestins 3

Common Pitfalls and Caveats

1. Bioavailability concerns: Earlier concerns about poor bioavailability of oral progesterone have been addressed through micronization, which significantly improves absorption 4, 5

2. OTC progesterone creams: Be cautious about over-the-counter progesterone creams, as they can produce significant drug exposure comparable to FDA-approved oral preparations 6. These should not be substituted for prescription oral progesterone without medical supervision.

3. Standing position: Some women may experience difficulty swallowing progesterone capsules. In these cases, advise taking the medication with a glass of water while standing 2

4. Timing of administration: Bedtime administration is recommended to minimize drowsiness side effects 3

5. Duration of treatment: Use the lowest effective dose for the shortest duration consistent with treatment goals 1