Starting Dose of Progesterone for Postmenopausal Women
For postmenopausal women with an intact uterus, the recommended starting dose of progesterone is 200 mg orally at bedtime for 12 days sequentially per 28-day cycle when used in combination with estrogen therapy. 1
Dosing Recommendations Based on Clinical Scenario
Standard Hormone Replacement Therapy
- For postmenopausal women receiving daily conjugated estrogens who require endometrial protection, progesterone should be administered as a single daily dose of 200 mg orally at bedtime for 12 days per 28-day cycle 1
- Micronized progesterone is preferred due to its lower cardiovascular and venous thromboembolism risk compared to synthetic progestins 2
- Progesterone capsules should be taken with a glass of water while standing if swallowing difficulties occur 1
Alternative Dosing Regimens
- For women who prefer to avoid monthly withdrawal bleeding, a lower dose of 100 mg daily for 25 days per month can effectively protect the endometrium while inducing amenorrhea in most women 3, 4
- For women with secondary amenorrhea (not related to postmenopausal status), a higher dose of 400 mg at bedtime for 10 days may be used 1
Administration Considerations
- Progesterone should be administered at bedtime due to potential drowsiness and dizziness 1
- Some women may experience extreme dizziness, drowsiness, blurred vision, difficulty speaking, difficulty walking, and feeling abnormal during initial therapy 1
- The medication contains peanut oil and should not be used in patients with peanut allergies 1
Monitoring and Follow-up
- Regular discussions with healthcare providers about the continued need for progesterone therapy are recommended 1
- Treatment effect should be evaluated after 3-6 months of therapy 5
- Unusual vaginal bleeding while taking progesterone should prompt immediate medical evaluation 1
Important Precautions
- Hormone therapy is generally contraindicated in breast cancer survivors 5, 2
- Hormone therapy may increase the risk of dementia in women aged 65 and older 1
- Hormone therapy may increase the risk of certain conditions including stroke, heart attack, blood clots, and certain cancers 5, 1
- Women with high blood pressure, high cholesterol, diabetes, or who use tobacco may have higher risk for heart disease when using hormone therapy 1
Evidence Quality
The recommendations for progesterone dosing are primarily based on FDA-approved labeling and clinical guidelines. The 200 mg dose for 12 days per 28-day cycle has strong evidence for endometrial protection, while the alternative regimen of 100 mg for 25 days per month has shown efficacy in smaller studies for women who prefer amenorrhea 3, 4, 6.