What is the recommended dose of progesterone (a steroid hormone) for treating abnormal uterine bleeding?

Recommended Progesterone Dosing for Abnormal Uterine Bleeding

For abnormal uterine bleeding, cyclic oral progestin treatment with 400 mg of progesterone daily at bedtime for 10 days is the recommended dose for secondary amenorrhea, while 200 mg daily at bedtime for 12 continuous days per 28-day cycle is recommended when used in combination with estrogen therapy. 1

Dosing Recommendations by Clinical Scenario

Secondary Amenorrhea

• Dose: 400 mg oral progesterone daily
• Duration: 10 days
• Timing: Take at bedtime
• Efficacy: Results in approximately 80% of women experiencing withdrawal bleeding within 7 days of the last dose 1

Abnormal Uterine Bleeding with Estrogen Therapy

• Dose: 200 mg oral progesterone daily
• Duration: 12 continuous days per 28-day cycle
• Timing: Take at bedtime
• Purpose: Prevents endometrial hyperplasia in women taking estrogen therapy 1

Acute Heavy Menstrual Bleeding

• For hemodynamically unstable women with uncontrolled bleeding, high-dose oral or injectable progestin-only medications may be considered for short-term use 2
• In these cases, higher doses than the standard regimens may be required to achieve hemostasis

Administration Considerations

• Progesterone capsules should be taken at bedtime due to potential side effects of drowsiness and dizziness 1
• If difficulty swallowing occurs, take the daily dose at bedtime with a glass of water while standing 1
• For patients with cardiovascular concerns (such as SCAD), careful clinical judgment is required as hormonal therapy may be relatively contraindicated 2

Alternative Treatment Options

For Patients with Cardiovascular Risk Factors

• Progestin-eluting intrauterine devices (such as levonorgestrel 20 μg/day) may be preferable to oral progesterone for controlling abnormal bleeding 2
• These devices result in 71-95% reduction in menstrual blood loss with minimal systemic absorption 2
• Lower-dose progestin devices (levonorgestrel 14 μg/day) may offer advantages for patients with cardiovascular concerns 2

For Patients with Contraindications to Hormonal Therapy

• Consider second-generation endometrial ablation techniques when hormonal options are contraindicated 2
• Advantages include effectiveness in managing bleeding and reduction of pregnancy risk 2

Monitoring and Safety

• Common side effects include headaches, breast pain, irregular vaginal bleeding, abdominal cramps, nausea, and fluid retention 1
• Serious but less common side effects include abnormal blood clotting, stroke, heart attack, and pulmonary embolism 1
• Patients should be monitored for unusual vaginal bleeding while taking progesterone 1
• Regular follow-up is recommended to assess symptom control and compliance 1

Important Precautions

• Progesterone capsules contain peanut oil and should not be used in patients with peanut allergies 1
• Contraindicated in patients with:
  • Unusual vaginal bleeding (undiagnosed)
  • Current or history of certain cancers
  • History of stroke or heart attack
  • Current or history of blood clots
  • Current or history of liver problems 1

Remember that progesterone therapy should be tailored based on the specific cause of abnormal uterine bleeding, with different approaches for anovulatory versus ovulatory bleeding patterns. The goal is to achieve effective control of bleeding while minimizing risks associated with hormone therapy.