How can progesterone be used to stop a long menstrual period (menorrhagia)?

Using Progesterone to Stop a Long Menstrual Period

Oral progesterone at a dose of 400 mg daily at bedtime for 10 days is effective for stopping prolonged menstrual bleeding and treating secondary amenorrhea. 1

First-Line Treatment Options

• Levonorgestrel-releasing intrauterine device (LNG-IUD) is the most effective first-line treatment for heavy menstrual bleeding, reducing blood loss by 71-95% 2, 3
• For immediate management of a prolonged period, oral progesterone can be given as a single daily dose of 400 mg at bedtime for 10 days to stop the bleeding 1
• NSAIDs (5-7 days of treatment) are also effective for unscheduled spotting or light bleeding, as well as heavy or prolonged bleeding 4

Mechanism of Action

• Progesterone helps regulate menstrual cycles by providing the hormonal support needed when your body doesn't produce enough progesterone on its own 1
• When taken orally, progesterone induces secretory transformation of the endometrium, which helps control excessive bleeding 1
• For women with ovulatory dysfunction bleeding, progesterone therapy can help regulate the menstrual cycle and reduce bleeding 3

Dosing Regimens

• For secondary amenorrhea (absence of periods): 400 mg progesterone capsules at bedtime for 10 days 1
• For heavy or prolonged bleeding:
  • Oral progesterone for 21 days per month (days 5-26 of the cycle) is effective for reducing menstrual blood loss 4, 5
  • Cyclic oral progestin treatment can reduce bleeding by approximately 87% 2

Important Considerations

• Progesterone capsules should be taken at bedtime as some women become very drowsy and/or dizzy after taking them 1
• In rare cases, side effects may include blurred vision, difficulty speaking, difficulty walking, and feeling abnormal 1
• For women who experience cyclic heavy bleeding related to the menstrual cycle (typically during the luteal phase), progesterone therapy can be particularly effective 4
• If bleeding persists or is unacceptable despite treatment, alternative methods should be considered 4, 3

Comparative Effectiveness

• The levonorgestrel-releasing intrauterine system is more effective than oral progestogens for reducing menstrual blood loss 5
• Tranexamic acid is also approved for treatment of ovulatory bleeding but is more expensive than progesterone therapy 6
• For women with persistent heavy bleeding despite medical therapy, endometrial biopsy should be considered to rule out hyperplasia or malignancy, especially in women 35 years or older with recurrent anovulation 6

Special Considerations

• Women taking progesterone should be monitored for side effects, which may include breast tenderness and intermenstrual bleeding 5
• If a woman has structural causes for bleeding (such as fibroids or polyps), medical management with progesterone may be less effective, and surgical options may need to be considered 6
• For women with heavy bleeding due to fibroids, progesterone therapy may still be effective, but the LNG-IUD has shown superior results 4

Remember that progesterone therapy is generally well-tolerated and effective for managing prolonged menstrual bleeding, but the specific approach should be based on the underlying cause of the bleeding and individual patient factors.