Oral Micronized Progesterone Dosing for Menopausal Symptoms
For treatment of menopausal symptoms, oral micronized progesterone 300 mg at bedtime is the recommended dose, which effectively reduces vasomotor symptoms by approximately 55% and improves sleep quality. 1
Primary Treatment Regimen
Oral micronized progesterone 300 mg taken at bedtime is the evidence-based dose for treating hot flashes and night sweats in postmenopausal women. 1, 2 This dose demonstrated:
- 55% overall reduction in vasomotor symptoms in a 3-month randomized controlled trial 1
- 58.9% improvement in vasomotor symptoms compared to 23.5% with placebo 2
- Greater effectiveness in women with ≥50 moderate-to-severe vasomotor symptoms per week 1
- No withdrawal-related vasomotor symptom rebound 1
- Improved deep sleep without causing depression 1
When Combined with Estrogen Therapy
If progesterone is being used for endometrial protection in women taking estrogen (rather than as monotherapy for symptoms), the dosing differs:
Sequential Regimen
- 200 mg oral micronized progesterone daily for 12-14 days per 28-day cycle 3, 4
- This provides proven endometrial protection when combined with estradiol 3
- The 12-14 day duration is critical—shorter durations provide inadequate endometrial protection 3
Continuous Regimen
- 100 mg oral micronized progesterone daily without interruption 3, 4
- This regimen avoids withdrawal bleeding for women preferring amenorrhea 3
Pharmacokinetic Considerations
The FDA label confirms that oral micronized progesterone demonstrates dose-proportional pharmacokinetics across the therapeutic range 5:
- Maximum serum concentrations occur within 1.5-2.3 hours 5
- Food increases bioavailability, supporting bedtime dosing after an evening meal 5
- Progesterone is 96-99% protein-bound and metabolized primarily by the liver 5
Critical Clinical Advantages
Micronized progesterone is strongly preferred over synthetic progestins due to superior safety profiles: 3, 4
- Lower cardiovascular disease risk compared to synthetic progestins 3, 4
- Lower venous thromboembolism risk 3, 4
- An 8-year prospective cohort study in over 80,000 menopausal women showed progesterone prevented breast cancer in estrogen-treated women 1
- Equally or more effective than estradiol in improving cardiovascular endothelial function 1
Common Pitfalls to Avoid
Never use progesterone for fewer than 12 days per cycle in sequential regimens when providing endometrial protection—this is inadequate. 3 The only exception is when using progesterone as monotherapy for vasomotor symptoms (300 mg at bedtime), where endometrial protection is not the primary goal.
Do not start with lower doses (100-200 mg) when treating vasomotor symptoms as monotherapy. 1, 2 The evidence specifically supports 300 mg for symptom relief, with lower doses showing less consistent efficacy 2, 6.
Side Effects and Tolerability
The primary side effect is mild, transient drowsiness, which is minimized by bedtime administration 7. In clinical trials:
- Side effects (headaches, vaginal bleeding) led to discontinuation in only 6-21% of patients 2
- The therapy is generally well-tolerated with no significant changes in blood pressure or weight 6
- No depression or mood worsening occurs at therapeutic doses 1
Monitoring
Annual clinical review focusing on compliance, bleeding patterns, and symptom control is recommended, with no routine laboratory monitoring required unless specific symptoms arise 3.