Can a premenopausal woman take progesterone (a hormone) during her menstrual period?

Progesterone Use During Menstrual Period in Premenopausal Women

Premenopausal women should not routinely take progesterone during their menstrual period as there is no medical indication for this practice according to current clinical guidelines. 1

Understanding Progesterone's Role in the Menstrual Cycle

Progesterone is naturally produced by the corpus luteum after ovulation and serves important functions in the female reproductive system:

• During the luteal phase of the menstrual cycle, progesterone prepares the endometrium for potential implantation
• When pregnancy doesn't occur, progesterone levels naturally decline, triggering menstrual bleeding
• By the time menstruation begins, progesterone levels are already low as part of the normal cycle

Clinical Indications for Progesterone Supplementation

Progesterone supplementation is only recommended in specific clinical scenarios:

Indicated Uses:

• Prevention of preterm birth in women with:

  • Prior spontaneous preterm birth (20-36 6/7 weeks): 17-alpha-hydroxyprogesterone caproate (17P) 250 mg IM weekly from 16-20 weeks until 36 weeks 1, 2
  • Short cervical length (≤20 mm): Vaginal progesterone 90 mg gel or 200 mg suppository daily until 36 weeks 1

• Recurrent pregnancy loss with current bleeding:

  • Vaginal micronized progesterone may benefit women with three or more previous miscarriages and current pregnancy bleeding 1

• Luteal phase support in assisted reproductive technology:

  • For 1-3 weeks after pregnancy confirmation in natural or stimulated cycles 1
  • In artificial cycles, continued for 3-4 weeks with gradual reduction 1

Not Indicated:

• Menstrual disorders in premenopausal women without specific pathology
• Multiple gestations without other risk factors
• Preterm labor (for tocolysis)
• Threatened miscarriage in women without history of previous miscarriage 1

Potential Risks of Inappropriate Progesterone Use

Taking progesterone during menstruation could potentially:

• Disrupt the normal hormonal pattern of the menstrual cycle
• Cause side effects such as headaches and abnormal vaginal bleeding 3
• Lead to treatment discontinuation in 6-21% of patients due to adverse effects 3

Special Considerations

While progesterone has been studied for abnormal uterine bleeding and heavy menstrual bleeding 4, its use specifically during the menstrual period is not supported by current guidelines.

The Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists have clear guidelines about when progesterone supplementation is appropriate, and routine use during menstruation is not among the recommended indications 1, 2.

Clinical Decision-Making Algorithm

1. Assess for specific indications:

   • History of preterm birth? → Consider 17P from 16-20 weeks until 36 weeks
   • Short cervical length? → Consider vaginal progesterone
   • Recurrent pregnancy loss with current bleeding? → Consider vaginal progesterone
   • Undergoing fertility treatment? → Follow fertility specialist recommendations

2. If none of these indications exist:

   • Progesterone supplementation during menstruation is not recommended
   • Consider alternative treatments for menstrual symptoms if present

3. If abnormal uterine bleeding is present:

   • Complete appropriate diagnostic workup before considering hormonal therapy
   • Consider other evidence-based treatments for abnormal uterine bleeding

Remember that after 8-10 weeks of pregnancy, the placenta produces sufficient progesterone to maintain pregnancy, making supplementation less relevant in established pregnancies 1.