What is the proper dosage and administration of progesterone (Progesterone) pills?

Proper Dosage and Administration of Progesterone Pills

For adult women with a uterus requiring hormone replacement therapy, progesterone capsules should be given as a single daily dose of 200 mg orally at bedtime for 12 days sequentially per 28-day cycle. 1

Dosage Recommendations Based on Indication

Prevention of Endometrial Hyperplasia

• 200 mg orally once daily at bedtime for 12 days sequentially per 28-day cycle, in women receiving daily conjugated estrogens 1
• This sequential regimen provides adequate endometrial protection while minimizing side effects 2

Treatment of Secondary Amenorrhea

• 400 mg orally once daily at bedtime for 10 days 1
• This dosage is sufficient to induce withdrawal bleeding in women with secondary amenorrhea 1, 3

Continuous Regimen for Amenorrhea Induction

• 100 mg daily for 25 days per calendar month can effectively induce amenorrhea in over 90% of women 4
• This lower continuous dose provides adequate endometrial protection while avoiding withdrawal bleeding 4

Administration Guidelines

Timing

• Progesterone should be taken at bedtime to minimize side effects such as drowsiness 5
• Taking progesterone while standing and with a full glass of water can help with swallowing difficulties 1

Regimen Options

1. Sequential Combined Regimen:

   • Estrogen administered continuously
   • Progesterone added for 12-14 days every 28 days (typically days 14-28)
   • Results in regular withdrawal bleeding 2

2. Continuous Combined Regimen:

   • For women who prefer to avoid withdrawal bleeding
   • Lower daily doses of progesterone (100 mg) given continuously for 25 days per month 2, 4

Special Considerations

Route of Administration

• Oral micronized progesterone undergoes significant first-pass metabolism (>90%), resulting in lower bioavailability 3
• This first-pass effect can cause drowsiness due to metabolites, particularly those reduced at the 5-alpha position 3, 5
• Alternative routes (vaginal, transdermal) may be considered if oral administration causes excessive side effects 6

Monitoring

• Annual clinical review is recommended for women on hormone replacement therapy 2
• No routine monitoring tests are required but may be prompted by specific symptoms or concerns 2

Common Side Effects

• Mild and transient drowsiness (minimized by bedtime administration) 5
• No significant negative effects on lipid profiles when used as recommended 6

Important Cautions

• Progesterone is contraindicated in women with breast cancer history 2
• Women with BRCA1/2 mutations without personal history of breast cancer may use progesterone after bilateral salpingo-oophorectomy 2
• For women with endometriosis who required oophorectomy, combined estrogen/progesterone therapy can be effective for vasomotor symptoms 2

Practical Tips

• Micronized progesterone is preferred over synthetic progestins due to fewer metabolic and vascular side effects 5
• Natural progesterone is devoid of androgenic activity, making it suitable for long-term use 6
• For maximum effectiveness, ensure consistent timing of administration 2