Should progesterone be taken during menstruation?

Progesterone Should Not Be Taken During Menstruation

Progesterone should be discontinued during menstruation and restarted after menstrual bleeding stops. This recommendation is based on the physiological pattern of progesterone levels, which naturally decrease during menstruation, and FDA-approved usage guidelines.

Physiological Basis

• Progesterone levels naturally decline before menstruation begins, triggering the shedding of the endometrial lining
• Taking progesterone during menstruation contradicts the normal hormonal pattern of the menstrual cycle
• Menstruation represents the end of the luteal phase when progesterone levels should be at their lowest

FDA-Approved Usage Guidelines

The FDA-approved labeling for progesterone capsules 1 provides clear guidance on administration:

• For secondary amenorrhea: 400 mg at bedtime for 10 days
• For endometrial protection in postmenopausal women: 200 mg at bedtime for 12 continuous days per 28-day cycle
• Neither regimen indicates taking progesterone during active menstrual bleeding

Clinical Applications

For Menstrual Disorders

• In women with heavy menstrual bleeding, progesterone is typically administered during the luteal phase (after ovulation until menstruation) 2
• For women with cyclic attacks of acute hepatic porphyrias related to the menstrual cycle, these attacks typically occur during the luteal phase when progesterone levels are highest, and resolve with the onset of menses 3
• This supports the approach of not taking progesterone during menstruation

For Hormone Therapy

• For endometrial protection in postmenopausal women on estrogen therapy, progesterone is given in a cyclic pattern with specific timing that mimics the natural cycle 1
• This cyclic pattern includes a hormone-free period to allow for withdrawal bleeding (similar to menstruation)

Potential Risks of Taking Progesterone During Menstruation

• May delay or disrupt normal menstrual flow
• Could potentially prolong bleeding by interfering with normal endometrial shedding
• May cause confusion in monitoring treatment effectiveness, especially when progesterone is used to regulate irregular cycles

Special Considerations

For women using progesterone for specific conditions:

• Preterm birth prevention: In pregnant women with short cervix, vaginal progesterone is used continuously until 36 weeks 3, but this is unrelated to menstruation
• Cyclic menstrual disorders: For women with menstrual-related disorders, timing progesterone to avoid the menstrual phase is particularly important 3

Practical Recommendation

1. Stop progesterone when menstruation begins
2. Wait until menstrual bleeding has completely stopped
3. Resume progesterone according to the prescribed schedule (typically starting on day 15-16 of the cycle for natural cycles, or as directed for therapeutic purposes)
4. Follow specific dosing instructions from your healthcare provider based on your condition

Following this approach aligns with the physiological hormonal patterns and optimizes the therapeutic benefits of progesterone while minimizing potential disruption to the normal menstrual cycle.