What is the appropriate dosage of progesterone for managing bleeding?

Progesterone Dosage for Managing Bleeding

For managing abnormal uterine bleeding, oral micronized progesterone should be administered at 400 mg daily at bedtime for 10 days to effectively control bleeding, with 80% of women experiencing withdrawal bleeding within 7 days of completing treatment. 1, 2

Progesterone Options Based on Clinical Scenario

For Secondary Amenorrhea

• First-line treatment: 400 mg oral progesterone daily at bedtime for 10 days 1, 2
  • Efficacy: 80% of women experience withdrawal bleeding within 7 days of completing treatment
  • Alternative dosing: 300 mg daily for 10 days (73.8% effective for inducing withdrawal bleeding) 2

For Abnormal Uterine Bleeding on Antiplatelet Therapy

• Progestin-eluting intrauterine devices (levonorgestrel 20 μg/day releasing device)

  • Results in 71-95% reduction in menstrual blood loss 3
  • Most effective approach, comparable to endometrial ablation
  • Main effect is at endometrial level with minimal systemic absorption

• Cyclic oral progestin treatment

  • Can reduce bleeding by up to 87% 3
  • May result in irregular bleeding patterns but generally reduces menses to light bleeding

• For hemodynamically unstable women with uncontrolled bleeding:

  • Consider short-term high-dose oral or injectable progestin-only medications 3

For Postmenopausal Women on Estrogen Therapy

• Standard dosing: 200 mg oral progesterone daily at bedtime for 12 days per 28-day cycle 1, 2

  • Effectively prevents endometrial hyperplasia (only 6% hyperplasia rate vs. 64% with estrogen alone) 2

• For women preferring amenorrhea:

  • 100 mg oral progesterone daily for 25 days per month 4, 5
  • Achieves amenorrhea in over 90% of women by the 3rd month of therapy 5
  • Effectively protects the endometrium by inhibiting mitoses 5

Administration Considerations

• Timing: Take oral progesterone at bedtime to minimize side effects of drowsiness and dizziness 1, 4
• Duration:
  • For acute bleeding control: 10 days of therapy
  • For cyclic therapy: 10-14 days per month
  • For continuous therapy: 25 days per month (if amenorrhea is desired)

Monitoring and Follow-up

• Evaluate response to therapy after first treatment cycle
• For persistent or recurrent abnormal bleeding:
  • Consider endometrial biopsy to rule out hyperplasia or malignancy
  • Assess for other causes of bleeding (fibroids, polyps, etc.)

Important Considerations and Cautions

• Natural micronized progesterone has a better safety profile than synthetic progestins 1, 4

  • Lower risk of breast cancer
  • No negative impact on HDL/LDL cholesterol ratio
  • No adverse effects on carbohydrate metabolism, blood pressure, or body weight

• Contraindications: Known or suspected pregnancy, undiagnosed vaginal bleeding, active thromboembolic disorders, history of arterial thrombotic disease, current or history of hormone-dependent cancers, liver problems 1

• For women with cardiovascular disease (including SCAD), carefully weigh risks and benefits of hormonal therapy; progestin-eluting IUDs may be preferred due to minimal systemic absorption 3

The evidence strongly supports that oral micronized progesterone at appropriate doses effectively manages abnormal uterine bleeding while minimizing side effects when administered properly.