How & When to Use Progesterone Pills (Prometrium): Pros & Cons & More
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How & When to Use Progesterone Pills (Prometrium): Pros & Cons & More

Are you suffering from the symptoms of progesterone deficiency?

Have you recently been prescribed progesterone pills?

Are you wondering if you should use progesterone cream or progesterone pills?

Learn everything you need to know about progesterone pills in this guide, including how and when to use progesterone, the differences between progesterone cream and progesterone pills, side effects associated with progesterone use and more

More...

What are Progesterone Pills?

Progesterone pills are simply a way to deliver the steroid hormone progesterone into your body. 

But before we talk about why progesterone pills may be beneficial, you need to have a basic understanding of how progesterone works. 

If you understand how progesterone works then you'll better understand why taking oral progesterone (progesterone pills) may be beneficial and necessary in your body. 

So what is progesterone?

Progesterone is one of the two major female sex hormones in women, the other being estrogen. 

Progesterone is so named because in the 1930's it was found to be necessary for pregnancy

The term "pro" means it is required for and the term "gesterone" is short for "gestation" which means pregnancy. 

So when you break down the word progesterone it literally means a hormone that is required for pregnancy. 

And it is definitely required for pregnancy! But it has so many other benefits as well. 

Progesterone helps to balance out the powerful effects of estrogens in your body. 

In scientific terms progesterone helps to balance fluid levels in your body (reduces bloating), triggers the catabolism (the breakdown of molecules such as fat cells), relaxes smooth muscles (helps calm down the body), raises your body temperature, has sedative and analgesic effects (helps relax the body and provide tolerance to pain) and improves your memory

These benefits are important to understand because understanding what progesterone does in your body will help you know if you have a deficiency of this important hormone. 

Progesterone is absolutely required in optimal amounts to help balance the effects of estrogen which tend to cause the exact opposite effects on the body. 

You can think of estrogen as a hormone which helps to build and grow tissues (such as menstrual lining, breast cells, fat cells, etc.) while progesterone helps to counteract these effects by helping to shed the menstrual lining (during menses), calm down the stimulating effects of estrogen on breast tissue and help maintain body weight. 

There are many conditions and disease states which may alter the concentration and ratio of progesterone to estrogen in the female body. 

When this ratio is altered women may present with symptoms such as depression, weight gain, menstrual irregularity, infertility and so on. 

Progesterone pills are often used as a way to help treat this imbalance, especially in states which result in progesterone DEFICIENCY or low progesterone. 

Low progesterone is a very common condition which is occurring more frequently, especially among women who are older than 35 years old

Progesterone Pills vs Progesterone Cream

It turns out that there are actually several ways to put progesterone into your body. 

Remember:

Progesterone is simply a hormone and how we put the hormone into your body may impact how your body metabolizes it and uses it. 

Hormones tend to be more difficult to get into the body when compared to other more water-soluble medications (meaning medications that dissolve in water). 

The reason for this is that they are not as readily as absorbed in the intestinal tract. 

Because of this, doses of hormones taken by mouth tend to be very high (much higher than what your body would produce normally)

This is required because only a small percentage of hormone is actually absorbed.

Hormones taken by mouth also have to pass through the liver, before they reach arterial circulation, which may further break them down and inactive them. 

These problems lead to the development of micronized progesterone pills which help to dramatically increase absorption. 

Taking micronized progesterone, such as Prometrium, can bypass the problem associated with absorption issues in the GI tract

But is taking progesterone by mouth preferred to taking progesterone through the transdermal route (through the skin)?

This question is more difficult to answer. 

In general, when we are using hormones, we want to make sure that we follow 3 very important rules:

#1. Always try to emulate or copy the way that the body produces the hormones. 

#2. Always use identical copies of the hormone we are supplementing with. 

#3. Never take more than is necessary (don't use too much).

Following these rules will help reduce unwanted side effects and help improve the efficacy of the hormone that you are supplementing with. 

These rules apply to progesterone as well. 

The first rule mentions that we should always try to copy the way that the body produces hormones naturally. 

In the case of progesterone, it is produced directly from ovarian follicles (in your ovaries) and in the cortical area of your adrenal glands. 

From there it is then secreted into the blood where it is taken to all of the necessary tissues that need it (brain cells, breast tissue, uterine lining, etc.). 

Does taking progesterone by mouth (progesterone pills) mimic this pathway?

Not really. 

Progesterone which is taken by mouth is first absorbed directly into the venous portal system where it is FIRST taken to the liver. 

In the liver, it is broken down into many different metabolites such as pregnandiol, pregnanolone, pregnandione and 17-OH-progesterone

It is well known that taking oral progesterone results in a large increase in progesterone metabolites, especially pregnandiol, which is not how it would normally occur in your body. 

Does this mean that oral progesterone should not be taken?

No, but it does mean that you should take caution when using progesterone pills and be sure to consider the alternatives such as progesterone cream. 

The good news is that progesterone cream offers an alternative way to take the medication and can be used if you do not see the desired beneficial effects of oral progesterone. 

You can learn more about using progesterone cream including dosing and pros and cons in this guide

I've also outlined some of the basic pros and cons of using progesterone pills when compared to progesterone cream below: 

PROS

  • May be better for women suffering from insomnia
  • May be more potent compared to progesterone cream
  • Ideal for women who don't respond to progesterone creams
  • Better safety profile when compared to progestins

CONS

  • Require a prescription from a Doctor
  • Cause an increase in progesterone metabolites compared to progesterone cream
  • More difficult to dose (fewer dosing options)

You can use these as a rough outline to help you determine if progesterone pills would be better for you over progesterone cream. 

Bio-Identical Progesterone vs Progestins & Progestagins

When we talk about progesterone it's important to focus on the different types of progesterone formulations available. 

The best type of progesterone to use is the bio-identical version which is the EXACT same as the hormone that your body produces naturally (assuming normal function). 

Believe it or not, there are actually many other synthetic forms of progesterone available as well. 

These different forms can be difficult to distinguish (some of this is probably on purpose) so it's important that you understand the basics. 

Use this information as a quick guide to help you:

Progesterone = the hormone that your body produces naturally from the ovaries and your adrenal glands. 

Progesterone USP = the bio-identical form of progesterone created and used in progesterone creams and progesterone. The best example of this is Prometrium which is a bio-identical progesterone pill. 

ProgestinProgestogens = Synthetic versions of progesterone but these are NOT the same as what your body produces naturally. These are commonly found in birth control pills and other "progesterone" medications. 

Why is this important?

It's important because studies have shown that the use of progesterone (bio-identical) results in a reduced risk of breast cancer when compared to progestins

In addition, synthetic progesterone may also cause depression, weight gain and other side effects which are not seen with bio-identical progesterone use. 

And this makes sense if you think about it. 

Would you rather put an identical and exact replica of a hormone into your body (bio-identical hormones) or would rather put a synthetic not-quite-the-same version which acts similarly but not the same as the real hormone?

The answer should be obvious, you should be seeking out the identical version. 

Your body already knows what to do with the identical version and it knows how to get rid of it and how to balance it. 

Your body doesn't necessarily know how to eliminate the new synthetic hormone. 

And it may be that the unintended byproducts created when your body tries to eliminate these hormones may be the reason for the higher risk of breast cancer and other symptoms seen with synthetic progesterone use

Because of these very important differences, it's necessary that you understand what type of progesterone you are taking. 

Bottom Line: Whenever possible try to use bio-identical progesterone (such as Prometrium) and avoid synthetic versions of progesterone such as progestins and progestogens. Synthetic progesterone may carry an increased risk of negative side effects compared to bio-identical progesterone. 

Do you need to use Progesterone Pills? 

So how do you know if you need to use progesterone pills?

The first step is to identify that you have some condition in which you are either progesterone deficient or in which you have an abnormally high amount of estrogen in your body. 

Conditions that meet these criteria include:

  • Infertility
  • Endometriosis
  • PCOS
  • Progesterone deficiency
  • Estrogen dominance
  • Primary or secondary amenorrhea
  • Menopause
  • Supporting IVF
  • PMS/PMDD
  • Age relate-decline in progesterone
  • Women with low serum progesterone

These are documented medical conditions in which the use of progesterone (pills or creams) may be indicated and in which progesterone would be considered a treatment or therapy. 

If you notice these are all conditions which cause one of two problems:

#1. Progesterone deficiency (meaning you don't naturally produce enough progesterone for your age).

Conditions that meet these criteria include menopause, age-related decline in progesterone, primary amenorrhea and infertility.  

#2. Excess estrogen (meaning you have excess estrogen production related to progesterone production)

Conditions that meet these criteria include: PCOS, endometriosis and estrogen dominance

Progesterone is ideal for conditions such as these. 

But remember:

Progesterone is a powerful hormone and one that may cause side effects if not used correctly. 

Side Effects of using Progesterone (Including Weight Gain)

The good news about progesterone is that, as long as it is used correctly, negative side effects should be minimal. 

The idea with progesterone supplementation is to provide your body with only the exact amount of hormone that you are deficient in. 

What do I mean?

Each woman who needs progesterone (based on her condition) will require a DIFFERENT amount when compared to other women. 

This is completely normal and to be expected. 

If we lined up 100 HEALTHY women and we checked their progesterone, do you think they would all be the same?

The answer is definitely no. 

Your sex hormones help to define your physiology, body mass index, size of your breasts, muscle mass and so on. 

What is considered "normal" for you may not be considered "normal" for another woman. 

So how do we approach treatment?

The idea is to use the smallest possible amount of progesterone (and by the way, this applies to all hormone replacement therapies) necessary to reduce your symptoms and treat the condition you are aiming for

Following this advice will help reduce the number of negative symptoms that you experience. 

Most of the time the symptoms related to progesterone pill use are secondary to either using too much hormone or using the wrong type of progesterone (for instance using cream instead of pills). 

But how do you know if your dosing is insufficient?

The best way is to monitor your symptoms when taking progesterone. 

I've provided a list of symptoms below which may indicate that your dosing is "off" if you are using progesterone pills:

  • Weight gain (you should never experience weight gain when using progesterone)
  • Increase in fluid retention or bloating (progesterone use should normalize fluid levels in your body)
  • Depression or anxiety (progesterone should help balance your mood)
  • Menstrual irregularities (progesterone should help regulate your cycle)
  • Dizziness or loss of balance (may be an indication that your dose is too high)
  • Memory problems (may be a dosing problem)
  • Not feeling like yourself (many women will experience symptoms that are hard to pinpoint but they know they don't feel "normal")

If you experience any of these symptoms be sure to evaluate your serum progesterone level in addition to your serum estradiol level. 

Evaluating these labs will help determine if you are responding appropriately to the progesterone you are taking. 

Final Thoughts

Progesterone is a necessary and important hormone for optimal health in women. 

Progesterone can be replaced using progesterone creams or progesterone pills, but it should be used cautiously and only in the necessary amount. 

If you opt to use progesterone pills make sure that you follow your symptoms and your serum progesterone levels. 

By taking this approach you should be able to reduce any negative side effects while experiencing balance in your hormones. 

Whenever possible stick to bio-identical progesterone (known as progesterone-USP) and avoid synthetic versions of progesterone. 

Bio-identical progesterone (such as Prometrium) is preferred as a replacement medication to other forms of progesterone and may cause fewer side effects

Now I want to hear from you:

Are you suffering from progesterone deficiency?

Are you supplementing with progesterone pills or Prometrium?

Is it working for you? Why or why not?

Have you experienced weight gain while taking progesterone?

Leave your comments below! 

Westin Childs
 

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders. He is trained in Internal Medicine, Functional Medicine and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances. You can read more about his own personal journey here.

Click Here to Leave a Comment Below 17 comments
RoseMarie - April 14, 2018

Hello Dr Childs,

First time writing you, and begin with a compliment and gratitude for what you do and how you explain information. I read a post saying the reader was glued to your site/page. This is perhaps my 4th return and realize that applies to me as well.

Was beginning to think I am losing a battle of sorts but maybe not after reading through your advice and thoughts about Nature Throid and Progesterone.

I will continue to visit/read and hoping you are in the US and if lucky enough in Dallas. I am 55, look 47-50 – has always been the case. Good genes. I know myself well. Physical appearance has always been the case of looking younger than. My father is 83, looks early 70s. My life has always been stressful. I’ve been mindful since my mid/late 30s the effects of stress would come to haunt me later in life. I can and need to better manage that.

At 50 I had a hysterectomy (was necessary/uterine fibroids / nearly made the record book for size). The growth was sudden for the size and there was no cancer. I insisted on keeping my ovaries. I read that post-menopause they continue to produce hormones that are heart healthy. I believe I take more from my father’s side of the family. He had a sextuple by-pass w aorta heart valve replacement 8 years ago. Felt keeping my ovaries would be beneficial to me long term.

For the past 3 years, I’ve been getting my blood work done to monitor hormones because w/o the ability to menstruate have no idea where I am in the menopause scale…. my mother experienced menopause around 52. She passed last Feb from ovarian cancer. (Yes, I know… ) I now get a CA125 test 1-2x year and ultrasound them 1x year to keep an eye on them.

With my blood work, I get BioT pelleting through my gynecologist.

As a result of my blood work, I asked for Nature Throid Rx taken 2x 65mg mornings + 3rd 2hrs or more after lunch. I also take 1x 200MG Progesterone (TV A19) before bed.

I’m shocked to read it can cause weight gain! I feel like I need it in that while I do not have, never have experienced hot flashes, never had signs of menopause side effects, I swear I feel I still ovulate unless it’s in my mind.

A reason beyond fact my Thyroid was producing near 0 traces (crashed T3 T4) was that I noticed my mind was foggy and was increasing in weight w/o justification.

Stress affects my blood pressure and my doctor prescribed a statin that caused my heart to slow to 36bpm/ felt like I was going to die at night – weird/spooky feeling I did not like, cause me anxiety. Took a month to wean off of it yet in the time I took it gained 12lbs. Haven’t been able to lose it either.

Was hoping the weight was water retention, would go with a few months off the Rx. Not so.

While I don’t know/proof wise, I am certain my cortisol levels must be high due to my stress. My jaw it often clenched, sleep with a clenched jaw and when I notice that, open jaw to relax it. So, for this reason, I think the progesterone should be beneficial!

If I’m stuck w the weight gain, well I guess I’m getting my menopausal body yet it simply isn’t fair given the work and time/care I put into myself, blood work, pelleting (not inexpensive), and taking the Nature Throid + Progesterone.

I am confident my blood pressure would be back to normal sans stress and of course weight loss. I should be 25-30 lighter as my normal feeling my best weight. The last 12 lbs gain came in 6-8 weeks thanks to the statin.

In this past 6-8 months, there are times I don’t recognize myself in the mirror. I wake with puffy eyes/bags, look and feel tired.

I don’t believe I should take more Nature Throid as I sometimes have palpitations.

A problem I think I encounter/feeling it is the Nature Throid is sometimes out of stock in Dallas, all pharmacies are sometimes out and I can go 5-7+ days w/o.

I’ve been switched to Armor. I swear I it feels like a placebo. I prefer Nature Throid.

I hate the way I feel: tired, stressed, worried, displeased w my appearance and being mindful of all of the above, in my mind coach myself to help counter effects all this will cause me regardless. Hence the feeling of losing a battle.

You gave me a reason to wonder about the Progesterone yet I still feel the benefits outweigh the potential weight gain because I know for sure 12 lbs piled on in under 8 wks while I too the statin I felt was about to stop my heart.

The Nature Throid irregularity and dosage matter could be it as well. Yet I can’t control pharma, or my body simply aging.

More than anything, I want water and fat weight to come off.

When I’m happy, life going my way, I can eat, drink, be merry and weight is off, look and feel great.

When I’m stressed (work related), battling an upstream swim to keep steady, doesn’t matter how much I exercise, how little I eat, take water or diet pills, I gain weight/ bloat. My weight can fluctuate 2-3 lbs morning to night to next day. I weigh myself every morning.

I used to not weigh myself. I do not for the feeling I have to. I’m shocked every few weeks for the daily weigh-ins aren’t showing any progress and the mirror doesn’t lie either.

Any insights you can offer I’d be forever grateful. Will read your links and learn. Thank you again.

Reply
Hannah Cotan - May 22, 2018

Hello,

I have low progesterone from past adrenal fatigue and Hashimoto’s. A year and a half ago I was prescribed bio-identical progesterone and it almost immediately started giving me anxiety and panic attacks. They continued to get worse, so I stopped, and after a year of not taking it I finally stopped feeling anxious during my luteal phase.

I take vitex, and that is actually working well to get my progesterone levels up, however, I’m concerned about pregnancy. If my body doesn’t make adequate levels of progesterone I’m worried I’ll get anxiety again if I have to do something like a progesterone cream. That is NOT how I want to do pregnancy and post-partum, although I absolutely will if it’s my only option. Any advice? Are you familiar with those symptoms? I have yet to get a good explanation from any doctor/naturopath.

Thank you!

Reply
Demarie - May 30, 2018

Hi Dr. Childs. Thank you for your wonderful blogs. I know a doctor who will increase Nature Throid as high as 9 or 10 grains. Would that cause too much t4 and cause too much rt3?? I realize the medication loses effectiveness after a while and you have to keep increasing. How high do you go before you lower Nature Throid and add t3 medication? Also I have been on 225 mg of oral progesterone instead of cream due to my insomnia,an am on 20 mg testosterone for 3 months. It is like taking a placebo. Still have insomnia, still have 55 lb weight gain. Have not lost anything. How long does it take for progesterone to work? Btw…been on Nature throid for 6 months. Symptoms went away but also no weight loss. I am vegan, no grains but eat avocado and olive oil daily. I do not know what else to do.

Reply
    Westin Childs - June 6, 2018

    Hi Demarie,

    Increasing naturethroid up to 9-10 grains would cause much more harm than good and probably not lead to weight loss. It’s better to try and find the ideal amount of T3 and T4 that your body needs and to use that.

    Reply
Jen - June 6, 2018

Hi, I have swallowing issues and the Akorn Progesterone (generic Prometrium) pill is hard and round and isn’t feasible. I’ve been inserting vaginally since I started the Rx a few nights ago. My question: is there any reason why this wouldn’t be ok? I am 47 and was prescribed Prometrium for severe endometriosis pain. I am hoping it will stop my periods, halt the growth of small-ish cysts and most of all alleviate the endo pain and symptoms.

I understand the progesterone may be MORE absorbable if used vaginally vs orally/digestive and I probably won’t increase to 200mg at least until some time has passed and I can see how things are. I have severe chronic fatigue and my usual fatigue+dizziness seems to have increased but I’m willing to give it some time to even out. However, anything that increases fatigue long term is a no-go for me.

Reply
    Westin Childs - June 6, 2018

    Hi Jen,

    It would be better absorbed to use a cream/gel as opposed to a pill. The way you take it (through the skin or via your mouth) alters the dose you would need so it probably isn’t a good idea to use a pill transdermally.

    Reply
      Jen - June 9, 2018

      Ok great, thank you!

      Reply
Savannah - June 19, 2018

I don’t know if my progesterone is bioidentical or not. the prescription says progesterone. The pill is small pink and has SV on it. How do I know if that is prometrium or synthetic progesterone? I take 100 mg every other day and that has eliminated the migraines that I was getting when I was taking 100 mg daily. That has stop the bleeding with very few breakthroughs and reduced hot flashes to almost nothing. But I do have weight gain and no amount of exercise or changing of eating seems to change it. I still get migraines a day or two before my. Starts but that has happened the last 10 years. My blood work confirms I am in perimenopause. I’m considering switching to a cream if I can get one that Is bioidentical because The dosage I need seems to be a very small o fix everything and I would prefer it not going through my liver.

Reply
    Westin Childs - June 21, 2018

    Hi Savannah,

    Bio-identical progesterone is usually labeled as Progesterone USP.

    Reply
Shawna - July 4, 2018

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Thank you for this article!! I am 35 and after a tubal ligation at 31 I started having changes in my cycle but last year at 34 I started to experience irregularities starting 10 days early spotting and cramping during ovulation then having 15 day cycles to 24 day cycles, much heavier and longer, So I had a hysteroscopy and ultrasound everything looked ok a couple of small fibroids hormone level looked “normal” then we tried a Mirena for 6 weeks was all I could stand now I’m 3 cycles out and PMS seems to start about a week after my cycle ends so I was prescribed progesterone pill at 400mg at night on day 12-25 of my cycle I’m just a little concerned that maybe a bit much to start and am concerned about side effects…. do you have any suggestions I feel like that is a high dose to start I do have them in 200 mg pills. I would appreciate any insight. Thank you!!

Reply
Sharon Preston - July 12, 2018

Hello, I’m 51 years old (turning 52 in October) and have very high muscle tone. I started taking 100 mg of Prometrium about 1.5 years ago. It was to help me with my sleep (no hot flashes), I noticed that my body was changing – clothing tight around my rib cage (no fat but bigger) so I went off it late March 2018 since I thought it would help with my tight clothing. I got even more bloated (the same dress I wore last summer looked like I was pregnant). I have just got back on 100 mg again starting 2.5 weeks ago (when I went off it, I started getting acne), still, my clothing still feels tight like I’m bloated. Is this normal?

Also, strange question but I read how muscle mass gets lost at this age; however, does it ever get bigger? If I do quick workouts 3 x a week, my thighs get larger, my bum larger, it just seems I get bigger. I’m not sure what to do but it’s so frustrating. The last few times I have checked my blood, my estriol was 672 while my progesterone was 71 – all in “normal range”. My doctor has told me I’m perimenopause. Any advice would be so appreciated. Sharon.

Reply
Michelle Louise White - July 12, 2018

I am taking progesterone pills am still experiencing night sweats and some hot flashes also have weight gain bloating headaches and depression.

Reply
    Westin Childs - July 17, 2018

    Hi Michelle,

    To relieve some of those symptoms you may need to consider using estrogen replacement therapy. Progesterone is really only half of the equation.

    Reply
Kerry G - August 13, 2018

I feel like the 100 mg of Prometrium pill is too much (my hot flashes seem worse), and there’s no smaller dose. Can I squeeze the liquid out and take half orally? (I’m also on EstroGel). TY.

Reply
    Westin Childs - August 16, 2018

    Hi Kerry,

    You should be able to get a smaller dose compounded by a compounding pharmacy which is probably safer and more efficacious than breaking the capsule.

    Reply
Julia Bennett - September 13, 2018

Hi Dr. Childs,

I’m in perimenopause and have been prescribed bioidentical progesterone as my level was very low. I’ve been told to take it at night (as it can cause you to feel sleepy/help you sleep better), yet on various websites, I’ve heard that in terms of the rhythm of the body and when it naturally produces progesterone, it should be taken in the morning.

Could you please provide your thoughts on when it should be taken.

Thank you!

Reply
    Westin Childs - September 14, 2018

    Hi Julia,

    It can be taken at night or in the morning, it just depends on the person. I’ve had many patients take it at night without any issues at all.

    Reply

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