Can menstruation be postponed with progesterone (a steroid hormone)?

Postponing Menstruation with Progesterone

Yes, menstruation can be effectively postponed using progesterone, particularly for women who experience cyclic attacks related to the menstrual cycle. This approach is specifically recognized in clinical guidelines for managing menstrual-related conditions.

Mechanism and Evidence

Progesterone plays a critical role in the menstrual cycle:

• During the luteal phase, progesterone levels rise naturally after ovulation
• When progesterone levels drop at the end of the cycle, menstruation is triggered
• By maintaining elevated progesterone levels through supplementation, menstruation can be delayed

According to the guidelines for acute hepatic porphyrias, some women develop cyclic attacks related to the menstrual cycle, typically during the luteal phase when progesterone levels are highest 1. These attacks resolve with the onset of menses, suggesting the relationship between hormonal fluctuations and symptoms.

Clinical Applications

Progesterone can be used to postpone menstruation in several scenarios:

For Cyclic Menstrual-Related Conditions:

• Women with menstrual-related conditions (like acute hepatic porphyrias) can use progesterone to manage symptoms 1
• For women with regular menstrual cycles (26-32 days), hormonal manipulation can be used to control timing 1

Administration Options:

• Oral progesterone (as indicated in the FDA drug label) can be used at bedtime 2
• For secondary amenorrhea, a single daily dose of 400 mg progesterone at bedtime for 10 days is recommended 2
• For endometrial protection in postmenopausal women, 200 mg daily for 12 continuous days per 28-day cycle is used 2

Considerations and Cautions

When using progesterone to postpone menstruation, consider:

1. Timing: Progesterone should be started before the expected onset of menstruation and continued until the desired time for menstruation to occur

2. Side effects: Common side effects include:

   • Drowsiness and dizziness (take at bedtime) 2
   • Blurred vision, difficulty speaking or walking in some cases 2
   • Breakthrough bleeding may occur

3. Alternative approaches: For women with cyclic attacks related to menstruation, other options include:

   • GnRH analogues
   • Low-dose hormonal contraceptives
   • Prophylactic treatments specific to the underlying condition 1

4. Contraindications: Progesterone should not be used in women with:

   • Unusual vaginal bleeding
   • Current or history of certain cancers
   • History of stroke, heart attack, or blood clots
   • Liver problems
   • Peanut allergy (some formulations contain peanut oil) 2

Clinical Algorithm for Postponing Menstruation

1. Confirm regular menstrual cycles (ideally 26-32 days)

2. Determine timing needs:

   • Calculate when menstruation would naturally occur
   • Determine how long postponement is needed

3. Select appropriate progesterone regimen:

   • For short-term postponement: Start progesterone 3-4 days before expected menstruation
   • Continue until ready for menstruation to occur
   • Withdrawal bleeding will typically begin 2-3 days after stopping progesterone

4. Monitor for side effects:

   • Drowsiness (take at bedtime)
   • Breakthrough bleeding
   • Other hormonal effects

5. For recurrent needs:

   • Consider longer-term solutions like hormonal contraceptives
   • Evaluate for underlying conditions if postponement is frequently needed

Remember that while progesterone can effectively postpone menstruation, it should be used judiciously and with appropriate medical guidance, especially for repeated use.