Recommended Progesterone Therapy Regimen for Postmenopausal Women
For postmenopausal women with an intact uterus who are taking estrogen therapy, oral micronized progesterone at a dose of 200 mg daily for 12 days per 28-day cycle is the recommended progesterone regimen. 1, 2
Evidence-Based Recommendations
Standard Regimen
- Oral micronized progesterone: 200 mg daily at bedtime for 12 consecutive days per 28-day cycle 1
- Must be taken with estrogen therapy to prevent endometrial hyperplasia
- Should be taken at bedtime due to potential drowsiness
- Take with a glass of water while standing if swallowing difficulties occur
Alternative Regimens
- Continuous combined regimen: Medroxyprogesterone acetate 2.5 mg daily with daily estrogen 2
- Sequential regimen: Medroxyprogesterone acetate 10 mg daily for 10-14 days per month with daily estrogen 3
Clinical Considerations
Safety Profile
- Micronized progesterone is preferred over synthetic progestins due to:
Route of Administration
- Transdermal estradiol (50-100 μg/day) combined with oral micronized progesterone offers the safest HRT profile for:
- Women with cardiovascular risk factors
- Those at risk for venous thromboembolism
- Older women (>60 years) 2
Duration of Therapy
- Use the lowest effective dose for the shortest time necessary 5
- Approximately 75% of women can discontinue HRT without major difficulty 5
- For women who cannot tolerate discontinuation, the symptom relief value may outweigh risks 5
Monitoring
- Initial follow-up every 1-3 months to assess symptom control and bleeding patterns 2
- Annual gynecological assessment including pelvic examination 2
- Monitor for:
- Irregular vaginal bleeding
- Signs of thromboembolism
- Cardiovascular events
Important Cautions
- HRT with estrogen plus progestin should not be recommended for secondary prevention of coronary disease 3
- Combined estrogen-progestin therapy is associated with increased risk of:
Special Populations
- Women who have had a hysterectomy: Do not require progesterone therapy with estrogen 3, 2
- Women with history of breast cancer: Avoid combined estrogen-progestin therapy 2
- Smokers over 35: Use with caution due to increased cardiovascular risk 2
Remember that progesterone therapy is specifically indicated for endometrial protection in women with an intact uterus who are taking estrogen therapy. The FDA-approved indication for progesterone capsules is prevention of endometrial hyperplasia in postmenopausal women with a uterus who are receiving concomitant estrogen therapy 1.