Will progesterone stop vaginal bleeding?

From the Guidelines

Progesterone can be an effective treatment to stop abnormal uterine bleeding, particularly when the bleeding is due to hormonal imbalances, as supported by the American College of Obstetricians and Gynecologists (ACOG) guidelines 1. When considering the use of progesterone to stop bleeding, it's essential to understand the underlying cause of the bleeding, as progesterone is most effective for bleeding caused by hormonal imbalances, such as anovulatory cycles.

• The ACOG guidelines suggest that medical treatments for abnormal uterine bleeding associated with ovulatory dysfunction include progestin-only contraception and combined hormonal contraception 1.
• Progesterone treatments, such as medroxyprogesterone acetate (Provera) or micronized progesterone (Prometrium), can be used to stabilize the endometrial lining and reduce or stop bleeding.
• The dosage and duration of treatment may vary depending on the severity of the bleeding and the individual patient's needs, but common regimens include 5-10mg of medroxyprogesterone acetate daily for 5-10 days.
• It's crucial to note that progesterone may not be effective for bleeding due to structural problems like fibroids, polyps, or cancer, and in such cases, other treatment options, including surgery, may be necessary 1.
• Potential side effects of progesterone treatment include mood changes, breast tenderness, bloating, and headaches, and patients should be monitored for these effects.
• If bleeding is very heavy, accompanied by severe pain, or doesn't respond to progesterone treatment within a reasonable timeframe, medical attention should be sought promptly to rule out other underlying causes and determine the best course of treatment.

From the FDA Drug Label

In a single-center, randomized, double-blind clinical study that included premenopausal women with secondary amenorrhea for at least 90 days, administration of 10 days of progesterone capsules therapy resulted in 80 percent of women experiencing withdrawal bleeding within 7 days of the last dose of progesterone capsules, 300 mg per day (n=20), compared to 10 percent of women experiencing withdrawal bleeding in the placebo group (n=21)

Progesterone may stop bleeding by inducing withdrawal bleeding in women with secondary amenorrhea. In the study, 80% of women experienced withdrawal bleeding within 7 days of the last dose of progesterone capsules, compared to 10% in the placebo group 2.

• Key points:
  • Progesterone capsules induced withdrawal bleeding in 80% of women with secondary amenorrhea.
  • The study compared progesterone capsules to a placebo group.
  • The results suggest that progesterone may be effective in stopping bleeding in women with secondary amenorrhea.

From the Research

Progesterone and Bleeding

• Progesterone is used to regulate intermenstrual bleeding and decrease heavy menstrual bleeding (HMB) in women of reproductive age or who are perimenopausal 3.
• Progesterone acts in concert with other hormones to affect the endometrium and can help reduce menstrual blood loss 4.
• However, the effectiveness of progesterone in stopping bleeding may depend on the individual and the specific circumstances, such as the presence of underlying pathology or the type and dosage of progesterone used 5.

Effectiveness of Progesterone in Reducing Menstrual Blood Loss

• Studies have shown that progesterone can be effective in reducing menstrual blood loss, but its effectiveness may be inferior to other medical therapies, such as tranexamic acid or the levonorgestrel-releasing intrauterine system (LNG-IUS) 5.
• A review of 15 randomized controlled trials found that short-cycle progestogen therapy was inferior to other medical therapy in reducing menstrual blood loss, while long-cycle progestogen therapy may be similar to the combined vaginal ring in reducing menstrual blood loss 5.

Progesterone in Early Pregnancy Bleeding

• Progesterone has been studied as a potential treatment to prevent miscarriage in women with early pregnancy bleeding, but its effectiveness is still uncertain 6.
• A large randomized controlled trial found that progesterone therapy did not result in a significantly higher rate of live births among women with threatened miscarriage overall, but an important subgroup effect was identified in women with a history of previous miscarriages 6.

Regulation of Menstrual Bleeding

• Progesterone plays a crucial role in the coordination of endometrial breakdown and the determination and regulation of menstrual blood loss 4.
• The relative concentrations of estrogen and progesterone appear to have important effects on bleeding patterns, and further research is needed to understand the complex interactions between these hormones and endometrial bleeding 4.