Progesterone Tablet Dosage and Treatment Duration
For progesterone tablets, the recommended dosage is 200 mg orally once daily at bedtime for 12 days sequentially per 28-day cycle for prevention of endometrial hyperplasia, or 400 mg orally once daily at bedtime for 10 days for treatment of secondary amenorrhea. 1
Dosage Recommendations by Indication
Prevention of Endometrial Hyperplasia
- Dosage: 200 mg oral progesterone daily at bedtime
- Duration: 12 days sequentially per 28-day cycle
- Patient population: Postmenopausal women with a uterus who are receiving daily conjugated estrogens 1
- Take with a glass of water while standing if swallowing difficulties occur 1
Treatment of Secondary Amenorrhea
- Dosage: 400 mg oral progesterone daily at bedtime
- Duration: 10 days
- Administration: Take with a glass of water while standing if swallowing difficulties occur 1
Preterm Birth Prevention
For women with singleton pregnancies and prior spontaneous preterm birth (SPTB), the evidence supports:
- 17-alpha-hydroxyprogesterone caproate (17P) is preferred: 250 mg IM weekly from 16-20 weeks until 36 weeks 2
- Vaginal progesterone is an alternative when 17P is unavailable 2
- For women with short cervical length (≤20 mm) at 24 weeks but no prior preterm birth: vaginal progesterone 90-mg gel or 200-mg suppository daily until 36 weeks 2
Important note: There is insufficient evidence supporting progesterone use for multiple gestations, preterm labor, or preterm premature rupture of membranes 2
Alternative Regimens for Postmenopausal Women
For postmenopausal women requiring hormone replacement therapy:
- For women wishing regular monthly bleeding: 300 mg/day (taken at bedtime) for 10 days a month 3
- For women willing to remain amenorrheic: 200 mg for 14 days a month or 100 mg for 25 days a month 3
Considerations for Administration
- Bedtime administration is recommended to minimize drowsiness, which is a mild and transient side effect 3
- Oral micronized progesterone has been recommended as the first choice for opposing estrogen therapy in nonhysterectomized postmenopausal women 3
- For women with difficulty swallowing, progesterone capsules should be taken with a glass of water while standing 1
Monitoring
- Initial evaluation should be done at 3-6 months after starting therapy
- Annual clinical review thereafter, monitoring for:
- Symptom control
- Compliance
- Blood pressure
- Weight
Potential Side Effects and Contraindications
- Common side effect: Mild and transient drowsiness (minimized by bedtime administration) 3
- Contraindications include:
- History of breast cancer
- Active thromboembolic disorders
- History of arterial thrombotic disease
- Undiagnosed vaginal bleeding
- Liver problems
Clinical Pearls
- Oral micronized progesterone has fewer metabolic and vascular side effects compared to synthetic progestins 3
- Progesterone must be added to estrogen therapy for at least 10-14 days per month to prevent endometrial hyperplasia in women with an intact uterus 3
- Dose-dependent effects have been observed, with higher doses (300 mg daily) achieving responses within the physiological range 4