Progesterone Dosage for HRT with 0.5mg Estradiol
For a patient on 0.5mg of estradiol for Hormone Replacement Therapy (HRT), the recommended progesterone dosage is 200mg daily for 12-14 days per month in a cyclic regimen, or 100mg daily in a continuous regimen. 1
Progesterone Options and Dosing
- Micronized progesterone is the preferred progestin option at a dose of 200mg daily for 12-14 days every 28 days in a cyclic regimen 1
- For continuous combined regimens, micronized progesterone at 100mg daily provides adequate endometrial protection when paired with 0.5mg estradiol 2, 3
- Alternative options include medroxyprogesterone acetate (10mg daily for 12-14 days per month in cyclic regimens) or dydrogesterone (10mg for 12-14 days per month) 1
Administration Routes and Considerations
Transdermal estradiol is preferred over oral administration due to:
Oral micronized progesterone is generally preferred over synthetic progestogens because:
- It has no androgenic or glucocorticoid activity
- It demonstrates a better cardiovascular safety profile
- It may have a lower risk of breast cancer compared to synthetic progestogens 2
Monitoring and Adjustment
- Estradiol and progesterone levels should be monitored to ensure adequate dosing, particularly in women under 60 years who are amenorrheic for ≤12 months prior to treatment 4
- If vaginal bleeding occurs while on treatment, immediate physician consultation is recommended 4
- Bone mineral density should be assessed periodically in patients on HRT 1
Clinical Considerations
- The combination of 0.5mg estradiol with 100mg progesterone has been shown in clinical trials to effectively manage menopausal symptoms while providing endometrial protection 5
- This combination demonstrated significant reductions in vasomotor symptom frequency and severity compared to placebo at weeks 4 and 12 in clinical trials 5
- No endometrial hyperplasia was observed with this combination in a 12-month randomized controlled trial 5
Potential Side Effects and Risks
- Common side effects include changes in mood and breast tenderness 6
- Continuous progestin regimens should not be used for more than 6 months without reassessment due to potential risks 6
- Progestins with anti-androgenic effects should be avoided as they may worsen hypoandrogenism 1
Remember that while these are evidence-based recommendations, regular follow-up with healthcare providers is essential to monitor efficacy and adjust dosing as needed.