Management of a Missed Evening Progesterone Dose
Take the missed progesterone dose as soon as you remember it the next morning, even if it means taking two doses in the same day, then continue with your regular evening dosing schedule. 1
Rationale for This Approach
The key principle in managing missed hormone doses is that a delay of less than 24 hours is considered a "late" dose rather than a completely missed dose, which minimizes potential risks. 1 This approach maintains more consistent hormone levels and reduces the risk of breakthrough bleeding or loss of endometrial protection.
Pharmacokinetic Considerations
Oral micronized progesterone reaches peak plasma concentrations approximately 2 hours after ingestion, with levels declining substantially within 12-24 hours. 2
The biologically active metabolite 20α-dihydroprogesterone maintains elevated concentrations for at least 12 hours after administration, providing some sustained progestational effect even when a dose is delayed. 2
This relatively short half-life means that waiting until the next scheduled evening dose (potentially 36+ hours after the last dose) creates a significant gap in hormone coverage. 2
Specific Instructions
Take the missed dose immediately upon remembering, regardless of the time of day. 1
Continue with your regular evening dose at the scheduled time, even if this means taking two doses on the same day. 1
No backup contraception or additional monitoring is required after a single missed dose of less than 24 hours. 1
Important Caveats
If vomiting occurs within 2 hours of taking an oral progesterone dose, treat it as a missed dose and take another dose as soon as possible. 1
Contact your healthcare provider if you have missed multiple consecutive doses (≥48 hours without progesterone), as this may require different management. 1
If you experience unusual symptoms after missing a dose (vaginal bleeding, cramping), contact your healthcare provider promptly. 1