How can progesterone be used to stop a prolonged menstrual cycle?

Using Progesterone to Stop a Prolonged Menstrual Cycle

For women experiencing a prolonged menstrual cycle, oral progesterone at a dose of 400 mg daily for 10 days is the recommended treatment to stop bleeding and induce withdrawal bleeding after discontinuation. 1

Mechanism and Dosing

• Progesterone works by stabilizing the endometrial lining, reducing excessive bleeding, and eventually inducing controlled shedding of the endometrium when discontinued 1
• For secondary amenorrhea or prolonged bleeding, the FDA-approved regimen is 400 mg oral progesterone taken at bedtime for 10 days 1
• Taking progesterone at bedtime is specifically recommended because some women experience drowsiness and dizziness after administration 1

Administration Considerations

• Oral progesterone should be taken with a glass of water while standing to reduce difficulty in swallowing 1
• After completing the 10-day course, withdrawal bleeding typically occurs within 7 days of the last dose in approximately 80% of women 1
• For women with prolonged bleeding who don't respond to initial treatment, a second course may be considered after appropriate evaluation for underlying causes 2, 3

Effectiveness and Alternatives

• Oral progesterone is effective for stopping prolonged menstrual bleeding by stabilizing the endometrium, though it may be less effective than other options for heavy menstrual bleeding 4
• For women with persistent heavy bleeding, alternative options include:
  • NSAIDs (5-7 days of treatment) which can reduce bleeding volume 2
  • Combined hormonal contraceptives which may provide better bleeding control than progesterone alone 5
  • Levonorgestrel-releasing intrauterine system (LNG-IUS) which is more effective for long-term management of heavy bleeding 6

Precautions and Contraindications

• Progesterone should not be used in women with:

  • Known or suspected pregnancy
  • Current or history of thromboembolism
  • Undiagnosed vaginal bleeding
  • Liver disease
  • Known hypersensitivity to progesterone or peanuts (as some formulations contain peanut oil) 1

• Before initiating treatment, pregnancy should be ruled out, as this is a common cause of menstrual irregularities 7, 2

Common Pitfalls and Considerations

• Failure to rule out underlying pathology before attributing bleeding to hormonal imbalance can lead to missed diagnoses 7
• Some women may experience side effects such as drowsiness, dizziness, and rarely blurred vision or difficulty speaking; these should be discussed with a healthcare provider immediately 1
• If bleeding persists after treatment or recurs frequently, further evaluation for underlying conditions (fibroids, polyps, endometrial hyperplasia) is warranted 2
• For women with recurrent episodes of prolonged bleeding, long-term management options should be considered, including hormonal contraceptives or the levonorgestrel IUD 3