What happens if pro (progesterone) is administered intramuscularly (IM) instead of subcutaneously (SC)?

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Last updated: April 18, 2025View editorial policy

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From the Guidelines

Injecting progestin intramuscularly instead of subcutaneously can lead to faster absorption and potentially higher peak blood levels, but the specific effects on progestin-only injectables like Depot medroxyprogesterone acetate (DMPA) are not well-documented in the provided evidence. When considering the administration of DMPA, it is crucial to follow the recommended route to ensure the intended therapeutic effect and minimize potential side effects. According to the study published in Pediatrics 1, DMPA can be administered either intramuscularly (150 mg) or subcutaneously (104 mg), highlighting the importance of proper administration technique. Some key points to consider when administering progestin-only injectables include:

  • The potential for weight gain, delayed return to fertility, menstrual bleeding irregularities, and bone mineral loss, which is largely reversible after DMPA discontinuation 1.
  • The need for patients to be counseled about age-appropriate recommendations for supplementation with calcium and vitamin D and regular weight-bearing exercise, as well as avoidance of smoking and alcohol to maintain skeletal health 1.
  • The uncertainty surrounding the interaction between progestin-only injectables and the risk of HIV transmission to male partners, emphasizing the importance of informing women with HIV infection about potential risks and providing access to HIV-preventive measures 1. Given the potential for altered absorption and therapeutic outcomes when administering medications via the wrong route, it is essential to follow the recommended administration guidelines for progestin-only injectables like DMPA to ensure optimal efficacy and minimize adverse effects.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Progesterone is administered by intramuscular injection. The FDA drug label does not answer the question.

From the Research

Administration of Progesterone

  • The studies provided do not directly address the effects of injecting progesterone intramuscularly instead of subcutaneously 2, 3, 4, 5, 6.
  • However, it is mentioned that progesterone can be administered by many different routes, including oral, vaginal, and intramuscular administration 2.
  • The choice of administration route and dosage determination are key factors in progesterone therapy 2.
  • There is no information available in the provided studies to suggest that injecting progesterone intramuscularly instead of subcutaneously would have a specific effect.

Progesterone Therapy

  • Progesterone is essential for pregnancy maintenance and has been used in the treatment of various gynecological pathologies and assisted reproductive technologies 2.
  • The main uses of progesterone include threatened miscarriage, recurrent miscarriage, and preterm birth prevention 2.
  • Progesterone has also been implicated in the pathogenesis of intrahepatic cholestasis of pregnancy (ICP) 6.

Route of Administration

  • Vaginal progesterone treatment has been used for the prevention of preterm birth and ICP 6.
  • Intramuscular administration of progesterone is mentioned as one of the possible routes of administration, but no specific information is provided on its effects compared to subcutaneous administration 2.
  • Oral administration of micronized natural progesterone has been shown to have no liver-related side effects 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Progesterone in normal and pathological pregnancy.

Hormone molecular biology and clinical investigation, 2016

Research

Descriptive analysis of pro re nata medication use at a Canadian psychiatric hospital.

International journal of mental health nursing, 2017

Research

Liver metabolism during treatment with estradiol and natural progesterone.

Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 1993

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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