TREATMENT EXPLAINER · PROGESTERONE

Progesterone

Progesterone pairs with estrogen to protect the uterus from endometrial cancer. Oral micronized progesterone is the current first-line bioidentical option.

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Progesterone is prescribed alongside estrogen in women with an intact uterus to prevent endometrial hyperplasia and cancer. Unopposed estrogen on an intact endometrium raises cancer risk substantially — pairing it with a progestogen reverses that risk.

Formulation choices

Oral micronized progesterone (bioidentical):

  • Prometrium (US), Utrogestan (outside US)
  • Taken at bedtime (common side effect: drowsiness, sometimes used for sleep benefit)
  • Bioidentical — molecularly identical to human progesterone

Synthetic progestins:

  • Medroxyprogesterone acetate (Provera) — the WHI study drug
  • Norethindrone acetate — often in combination patches (CombiPatch) and oral formulations
  • Levonorgestrel IUD (Mirena) — off-label for endometrial protection in HRT

Cyclic vs continuous dosing

  • Continuous: Daily progesterone. Over time, produces no withdrawal bleed. Most common postmenopausal regimen.
  • Cyclic: Progesterone 12-14 days per month. Produces a scheduled withdrawal bleed. More common perimenopausally.

When the IUD fits

A levonorgestrel IUD (Mirena) can provide endometrial protection for women on systemic estrogen without requiring them to take a separate oral progestogen. Off-label for this use but well-supported.

FREQUENTLY ASKED

Do I need progesterone if I've had a hysterectomy? +

For endometrial protection, no — if the uterus is gone, there's no endometrium to protect. Some providers still prescribe progesterone after hysterectomy for its sleep, mood, or symptom-relief benefits, but the strict medical indication is absent.

Is micronized progesterone the same as synthetic progestins? +

No. Micronized progesterone (Prometrium, Utrogestan) is bioidentical — molecularly identical to human progesterone. Synthetic progestins (medroxyprogesterone acetate / Provera, norethindrone) are different molecules with different side-effect profiles. The WHI data that drove the breast-cancer conversation used synthetic medroxyprogesterone, which complicates direct extrapolation to bioidentical progesterone.

Cyclic or continuous progesterone? +

Depends on time since menopause and patient preference. Continuous (daily) is common in postmenopausal women and produces no withdrawal bleed over time. Cyclic (12-14 days per month) is sometimes used perimenopausally or for women who prefer a scheduled withdrawal bleed.

TELEHEALTH SERVICES OFFERING THIS TREATMENT

  • Midi Health

    Menopause-specialist clinicians; in-network with most major insurance.

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  • Alloy

    MSCP-heavy advisory board; curated FDA-approved formulary.

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  • Evernow

    Asynchronous HRT subscription, no insurance friction.

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