How is micronized progesterone (Progesterone) prescribed for prolonged bleeding?

Micronized Progesterone for Prolonged Bleeding

For prolonged bleeding, micronized progesterone should be prescribed at a dose of 200 mg daily for 12-14 days per month in a sequential regimen, or 100 mg daily for 25 days per month in a continuous regimen to effectively control bleeding and provide endometrial protection. 1

Dosing Regimens

Sequential Regimen (with withdrawal bleeding)

• Micronized progesterone 200 mg daily for 12-14 days every 28 days 1
• Can be administered orally at bedtime to minimize drowsiness 2
• Can also be administered vaginally for improved bioavailability 3

Continuous Regimen (for amenorrhea)

• Micronized progesterone 100 mg daily for 25 days per month 4
• This regimen induces amenorrhea in more than 90% of women by the third month of therapy 4
• Particularly useful when avoiding withdrawal bleeding is preferred 1

Route of Administration Options

• Oral administration: Take at bedtime to minimize side effects such as drowsiness 2
• Vaginal administration: Alternative route that provides good endometrial protection 3
  • For severe cases, can be dosed as 3 tablets (300 mg) twice daily starting on day 14 of the cycle for 12 days 3

Clinical Considerations

• Micronized progesterone is preferred over synthetic progestins due to:

  • Lower risk of cardiovascular disease and venous thromboembolism 1
  • Neutral effect on blood pressure 1
  • Better safety profile in terms of thrombotic risk 1
  • No negative effects on lipid metabolism 1

• For patients with prolonged bleeding, evaluate endometrial thickness by ultrasound before initiating therapy 1

• Treatment effectiveness should be evaluated after 3-6 months 1

• If bleeding persists despite treatment with micronized progesterone, consider:

  • Increasing the dose to 300 mg daily 4
  • Adding low-dose estrogen if medically eligible 1
  • NSAIDs for short-term treatment (5-7 days) during days of bleeding 1

Monitoring

• Assess bleeding pattern after 3 months of therapy 1, 4
• Expect significant reduction in bleeding intensity and duration by 6 months 3
• Monitor endometrial thickness with ultrasound if clinically indicated 1

Advantages of Micronized Progesterone

• Provides effective endometrial protection 4, 5
• Produces adequate plasma and tissue levels after oral administration 6
• Reproduces the anti-estrogenic effect on the endometrium 6
• No androgenic side effects, important for women with concerns about androgenic symptoms 6
• Minimal impact on coagulation factors and blood pressure 6, 1

Common Pitfalls to Avoid

• Failure to take oral micronized progesterone at bedtime may increase daytime drowsiness 2
• Inadequate duration of treatment (less than 12 days per month) may not provide sufficient endometrial protection 1
• Not considering the patient's preference regarding withdrawal bleeding when selecting between sequential and continuous regimens 1
• Stopping treatment prematurely before the full therapeutic effect is achieved (minimum 3 months) 1, 3