Explaining Your Progesterone Options
Whether it’s time to start progesterone, you’re considering it, or just wondering about your options, you’re in the right place! Progesterone is a hormone made predominantly in your ovaries after ovulation. It does a lot in the body but it’s primarily known for its positive effects on your uterus and the calming effects on your brain. If you’re not ovulating anymore, or if you’re not ovulating as strongly as you once did, your progesterone levels can decline.
Generally speaking, most hormone societies and laboratories say a cycle day 21 blood test greater than 3 ng/mL indicates ovulation. Sometimes I’ll see 5 ng/mL.
Ideally, most experts tend to agree that you want your day 21 blood test to be 10 ng/mL or higher which indicates both ovulation AND strong progesterone production.
If you’re below those numbers (or your numbers are dropping because you’re in perimenopause), here are your progesterone therapy options if that’s the route you choose to go with your healthcare practitioner.
Side note - I’m only talking about progesterone, like the kind your ovaries make (or made). I’m not talking about the synthetic progestin. They are different.
Second side note - Compounding pharmacies use FDA approved product (progesterone) however the actual end product is not FDA approved. Compounding pharmacies are pharmacies with pharmacists that make medications/hormones as prescribed by your health practitioner. For example, if you are allergic to peanut oil, your practitioner might write you a prescription for oral micronized progesterone capsules in a hypoallergenic filler (see below).
Oral Capsules:
Prometrium - This is the FDA approved prescription version you can get at your local pharmacy. It’s known as oral micronized progesterone (OMP) and comes in 100mg or 200mg capsules. Warning, it does contain peanut oil and food dye if you’re sensitive or allergic to either.
Compounded oral micronized progesterone (OMP) capsules- This is the same progesterone but made at a compounding pharmacy to be any milligram amount you need and/or without peanut oil and food dyes. It can also be made in a slow release form. This requires a prescription.
Sublingual Progesterone:
Compounded oral micronized progesterone troche - This is the same progesterone but made at a compounding pharmacy with a prescription to be in any milligram amount you need. It’s a small, tablet type delivery system that dissolves in the mouth, under the tongue, or against the gum and cheek.
Progesterone Creams/Gels:
There are currently no FDA approved topical progesterone creams or gels BUT they are not FDA regulated according to 21 CFR 310.530. They are considered cosmetic.
Progesterone creams and gels have NOT been shown to be protective against endometrial hyperplasia if you’re also on estrogen therapy and have a uterus.
Over-the-counter creams/gels - usually found in various milligram amounts both online and in “natural” stores, such as Whole Foods. A small amount as recommended by the package is applied to the inner arm, wrist, elbow, etc. It does not require a prescription.
Compounded creams/gels - similar to OMP above, progesterone creams and gels can be compounded to a specific amount at a compounding pharmacy with a prescription. They have a variety of ways to dispense the progesterone which makes it easy to get the correct dose and not make a mess.
Vaginal Progesterone:
There are FDA approved prescription progesterone suppositories, gels and inserts that you can get at your local pharmacy with a prescription. As the name implies, these are inserted up into the vagina. They are commonly used with fertility however could be used in the menopausal transition.
Compounded vaginal progesterone - similar to other compounded progesterone, it can be made to a specific dosage and without the typical binders, fillers, or dyes if those are irritating to your vagina. It requires a prescription.
Progesterone Injections
Progesterone in oil intramuscular injections - commonly used in fertility, but could be used in the menopausal transition (although it’s not common). It requires a prescription.
Subcutaneous injections - also commonly used in fertility. I’m seeing this more in the menopausal transition as well. It requires a prescription.
At this time, there are no progesterone implants (there is a progestin IUD such as the Mirena) or a vaginal ring.
What do I see most commonly?
This can vary however if you’re NOT on estrogen therapy and ONLY looking for progesterone, I tend to see women use oral progesterone capsules or topical progesterone creams. If you are on estrogen therapy, I tend to see women use oral progesterone capsules with it if they have a uterus. Again, this is what I tend to see - it’s okay if you’re doing something differently and it’s working!
If you don’t have a uterus (whether or not you have your ovaries), the hormone societies state that you do not need to use progesterone when on estrogen therapy. I would argue that your body has progesterone receptors all over and you are more than your uterus. Progesterone may still really benefit your body!
I hope this helped clear up some confusion around progesterone options! Your practitioner will likely ask you several questions around your symptoms, allergies, and concerns in determining the route and dose that is best for you.