Micronized Progesterone for Low Progesterone and Insomnia
Micronized progesterone at a dose of 200-300 mg taken orally at bedtime is recommended for patients with low progesterone levels experiencing insomnia. 1, 2
Mechanism and Benefits
Micronized progesterone offers several advantages for treating insomnia related to low progesterone:
- Acts as a physiological sleep regulator rather than a hypnotic drug
- Restores normal sleep when sleep is disturbed without inhibiting deep sleep 2
- Increases slow-wave sleep duration by almost 50% and total slow-wave activity by almost 45% 2
- Reduces wake time after sleep onset by 53% 2
- Produces sedative-like effects through neuroactive metabolites 2
- Improves sleep quality in postmenopausal women with insomnia 3
Dosing Recommendations
- Initial dose: 200-300 mg orally at bedtime 1, 2
- Timing: Administration at bedtime minimizes the mild drowsiness side effect and maximizes sleep benefits 4
- Duration: Sleep quality improvements are typically observed within the first month of treatment 3
Patient Selection Considerations
Micronized progesterone is particularly beneficial for:
- Postmenopausal women with sleep disturbances 1, 2
- Women with low progesterone levels experiencing insomnia 5
- Patients who prefer a "physiologic" regulator rather than traditional hypnotic medications 2
- Women with increased risk of cardiovascular and metabolic diseases (micronized progesterone has a better safety profile than synthetic progestins) 5
Monitoring and Follow-up
- Evaluate treatment effect after 3-6 months 1
- Initial follow-up at 3 months, then annual follow-up 1
- Monitor for improvement in sleep quality using validated tools like the Pittsburgh Sleep Quality Index 3
- Assess for side effects, particularly mild drowsiness or dizziness 5
Contraindications
Micronized progesterone should be avoided in patients with:
- Active liver disease 1
- History of breast cancer 1
- History of coronary heart disease 1
- Previous venous thromboembolism or stroke 1
- Severe peanut allergies (many formulations contain peanut oil) 6
- Hormone receptor-positive breast cancer 6
Advantages Over Synthetic Progestins
- Identical to the steroid produced by the corpus luteum 4
- Fewer metabolic and vascular side effects 4
- Better safety profile regarding breast cancer risk and venous thromboembolism 5
- Minimal side effects (primarily mild and transient drowsiness) 4
Practical Considerations
- Vaginal gel formulations (without peanut oil) can be used in patients with peanut allergies 6
- Micronized progesterone preserves full potential of progesterone activity without many side effects of synthetic progestins 5
- Can be used as part of hormone replacement therapy in appropriate candidates 1
Micronized progesterone offers a physiological approach to managing insomnia in patients with low progesterone levels, with significant improvements in sleep quality and minimal side effects when administered at bedtime.