What is progesterone, and how is it used in menopause treatment?

Micronized progesterone can help manage perimenopausal and menopausal symptoms (as well as symptoms of PMS and PMDD) and is often taken alongside estrogen as combined HRT.

• Micronized progesterone is natural, body-identical progesterone

• It comes in a capsule and is easily absorbed

• Micronized progesterone causes less side effects than older, synthetic progestogens

Progesterone is a hormone made in your ovaries, brain, and other tissues, which plays an important role in your menstrual cycle, supports pregnancy and works throughout your body reducing inflammation. During perimenopause, progesterone levels fluctuate and during menopause, levels decline, where they then remain low.

If you decide to take HRT and still have your womb (uterus), you need to take progesterone as well as estrogen. This is because taking estrogen can lead to a build­-up in the lining of your womb. Taking progesterone prevents this occurring and reduces associated risks.

Progesterone is also prescribed to relieve perimenopausal and menopausal symptoms such as sleeping problems, low mood and anxiety, which are associated with declining levels of progesterone during the perimenopause and menopause. It can also be taken by women who have had a hysterectomy as part of an individualized consultation if needed for their symptom control.

What is Micronized progesterone?

Micronized progesterone is a soft capsule that contains ‘micronized progesterone’. Progesterone is hard to absorb through the skin and gut – by micronizing it (reducing the particles to a very fine powder and suspending in an oil) and putting it in capsule form it is more easily absorbed.

The progesterone in Micronized progesterone is derived from plants, including yam, a root vegetable and soy. It is identical in structure to the progesterone produced in our bodies. Because of this, it is often referred to as ‘body identical’. This is different to synthetic hormones which have been chemically altered.

How do I take Micronized progesterone?

Micronized progesterone is usually prescribed as a 100mg oral capsule. There are two ways of taking Micronized progesterone.

– For women who have had periods in the last 6­-12 months, the usual recommended dose is two 100mg capsules, taken together each evening, for two out of four weeks, on a repeating basis.

– For women who have not had a period for around 6 to 12 months, the usual recommended dose is taking one 100mg capsule every evening, without a break.

The dosage information that comes with the medication differs slightly to this, but it is usually more straightforward to take it in this way and easier to remember.

Sequential and continuous HRT: what’s the difference?

Micronized progesterone can be a natural sedative so can cause drowsiness in some women. It is therefore recommended you take it at bedtime.

It is best to take Micronized progesterone on an empty stomach because eating food can actually increase its absorption. Aim to take it at least two hours after food, but if this is not practically possible then you can just take it before you go to sleep.

Does Micronized progesterone cause side effects?

Some women experience side ­effects initially, which can include vaginal bleeding, abdominal bloating, lower abdominal pain or discomfort and breast tenderness. Bleeding can be intermittent or continual and last for three to six months after starting HRT. If your bleeding worsens or does not improve with time, you should seek guidance from your menopause doctor or a healthcare professional.

Some women find that their mood is lower when they take Micronized progesterone. This side­ effect often improves with time but sometimes the dose or way that it is given is altered (changing it to a vaginal pessary than an oral capsule). This side effect is less common nowadays as medication improves.

Progesterone intolerance can affect around 10-20% of women. If you experience this side effect and it does not improve, there are alternative ways of taking Micronized progesterone, which you can discuss with your healthcare professional.

What are the benefits of Micronized progesterone?

As Micronized progesterone is a natural, body identical hormone, women usually experience less side­ effects compared to the older types of progestogens.

The older types of progestogens, given as tablets or as a combination patch, can be associated with a slightly higher risk of blood clot and heart disease.

Studies have shown that women who take Micronized progesterone however, do not have a higher risk of clot or heart disease.

The small increased risk of breast cancer in women who take HRT, is related to the type of progestogen in the HRT. According to a systematic review, there is limited evidence that estrogens combined with oral micronized progesterone applied for more than five years are associated with an increased breast cancer risk.

Even for women taking the older types of progestogens, the risk of breast cancer is very low. The level of increased risk with the older types of progestogens is less than the level of risk of breast cancer in women who are overweight, or women that drink around two glasses of wine every day.