What dosage of progesterone (progestogen) is recommended for a woman using an estradiol patch 0.0375 for hormone replacement therapy (HRT)?

Progesterone Dosage for HRT with 0.0375 Estradiol Patch

For women using an estradiol patch 0.0375 mg for hormone replacement therapy, the recommended progesterone dosage is 200 mg of oral or vaginal micronized progesterone daily for 12-14 days every 28 days in a sequential regimen. 1

Progesterone Options and Dosing

• Micronized progesterone (MP) is the first choice for endometrial protection due to its physiological profile and lower risk of cardiovascular disease and venous thromboembolism 1
• For sequential regimens with transdermal estradiol:
  • 200 mg of oral or vaginal micronized progesterone daily for 12-14 days every 28 days 1
  • Alternative options if MP is contraindicated: 10 mg medroxyprogesterone acetate (MPA) or 10 mg dydrogesterone daily for 12-14 days per month 1
• For continuous regimens (no withdrawal bleeding):
  • Minimum of 1 mg oral norethisterone, 2.5 mg oral MPA, or 5 mg oral dydrogesterone daily 1

Administration Approaches

• Sequential regimen (with withdrawal bleeding):
  • Transdermal estradiol administered continuously
  • Progesterone administered for 12-14 days every 28 days 1
• Continuous regimen (without withdrawal bleeding):
  • Both estradiol and progesterone administered continuously 1
  • Useful for women who prefer to avoid monthly bleeding 1

Transdermal Combination Options

• Combined estradiol/progestin patches are available in some countries and may improve compliance 1
• Example of sequential combined patches: estradiol patches for 2 weeks, followed by estradiol/levonorgestrel combination patches for 2 additional weeks 1, 2
• Example of continuous combined patches: patches releasing estradiol and levonorgestrel daily without interruption 1

Important Considerations

• Progesterone is essential for endometrial protection in women with an intact uterus using estrogen therapy 3
• Without adequate progesterone, there is a risk of endometrial hyperplasia (observed at 4.8% incidence in women using estradiol patches without progesterone) 3
• Progestins with anti-androgenic effects should be avoided in women with iatrogenic POI who may already have low testosterone levels 1
• The dose of progesterone should be adjusted according to the dose of estrogen administered 1

Special Populations

• For women with premature ovarian insufficiency (POI), HRT should be continued until the average age of natural menopause (45-55 years) 1
• For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy can effectively treat vasomotor symptoms and may reduce disease reactivation 1
• Women with a BRCA gene mutation but no personal history of breast cancer can use HRT after prophylactic bilateral salpingo-oophorectomy 1
• HRT is generally contraindicated in breast cancer survivors 1

Monitoring

• Regular follow-up is recommended to assess symptom control, side effects, and endometrial safety 1
• Women with a history of TBI or Hodgkin lymphoma have an increased risk of breast cancer and require closer monitoring, including annual imaging from age 25 1