Prometrium (Progesterone) for Inducing Withdrawal Bleeding in Amenorrhea
Yes, Prometrium (micronized progesterone) can effectively induce withdrawal bleeding in women with amenorrhea who have adequate estrogen levels, with clinical studies showing 73.8-80% of women experiencing withdrawal bleeding within 7 days after a 10-day course of treatment. 1
Mechanism and Efficacy
Prometrium works by causing endometrial secretory transformation and subsequent shedding when withdrawn. According to FDA-approved clinical data:
- In premenopausal women with secondary amenorrhea for at least 90 days, 80% experienced withdrawal bleeding within 7 days after completing a 10-day course of Prometrium 300 mg daily 1
- In another multicenter study, 73.8% and 76.8% of women with secondary amenorrhea experienced withdrawal bleeding after 10 days of Prometrium at 300 mg or 400 mg daily, respectively 1
Dosing Recommendations
For inducing withdrawal bleeding in amenorrhea:
- Prometrium 300-400 mg daily for 10 days 1
- After completing the progesterone course, withdrawal bleeding typically occurs within 7 days
Clinical Context and Considerations
When to Use Prometrium for Amenorrhea
- In women with normal estrogen levels but absent menses
- When endometrial protection is needed due to unopposed estrogen
- For diagnostic purposes to assess estrogen status (bleeding response indicates adequate estrogen levels)
Contraindications and Cautions
- Pregnancy should be ruled out before initiating therapy 2
- Not effective in women with hypoestrogenic states (will not induce bleeding if estrogen is inadequate)
- Common side effects include fatigue (8%), headache (16%), dizziness (24%), and abdominal pain/cramping (20%) 1
Alternative Options
For comparison, other progestins can also induce withdrawal bleeding:
- Dydrogesterone has shown efficacy with 65.4% of women experiencing withdrawal bleeding versus 30.8% with placebo 3
- Medroxyprogesterone acetate (MPA) 10 mg daily for 12-14 days can be used as an alternative 4
Long-Term Management Considerations
For women requiring ongoing management of amenorrhea:
- Cyclic regimen: Prometrium 200 mg daily for 12-14 days every 28 days (with estrogen if needed) 4
- For those preferring amenorrhea: Continuous low-dose progesterone regimens can be used 5, 6
Monitoring
- Assess for withdrawal bleeding within 7 days after completing progesterone course
- If no bleeding occurs, consider evaluation for hypoestrogenism or structural abnormalities
- Regular follow-up to assess response and adjust treatment as needed
Prometrium offers the advantage of being bioidentical to endogenous progesterone with potentially fewer metabolic side effects compared to synthetic progestins, making it a suitable option for inducing withdrawal bleeding in women with amenorrhea who have adequate estrogen levels.