The benefits to prescription progesterone include greater reliability of contents (both quality and quantity), ability to specify strength of supply (the more concentrated, the less volume you have to take/apply), and lower cost. When you purchase an OTC progesterone, you are relying on an unregulated supplier, who may or may not be consistent in ingredients used, and an unregulated retailer, who may be similarly casual about how the product is handled and stored (freshness is very important with progesterone potency). On the other hand, if your doctor won't prescribe progesterone ("you don't need progesterone without a uterus") and you want to try it out, this may be the only feasible source. We look at OTC progesterones in a separate discussion.
Use these links below to go directly to a particular product, or peruse the entire list to look over the range available. This is not a definitive list, even for the US. New HRTs are being licensed all the time, and as older ones fall out of patent life, the generic versions come onto the market. We can't cover all of the generics, so you may need to figure out the proprietary form they are modeled on and work from that product information. Similarly, if you are having trouble opening an hrt link, try going to either drugstore.com or rxlist.com and doing a direct search there for either the brand or generic name. These sites generally publish the full FDA prescribing information accurately and fully.
Note: Most pharmaceutical companies limit access to product websites according to the country a woman is browsing from. Because of this, it can be difficult to get information from the manufacturers about HRTs not specifically sold in our home countries. Many companies have dropped publication of their prescribing information brochures or have hidden them behind restricted professional access. We have linked to other sites that publish this where we can find them, and provided several references for most HRTs because so many links are lost over time. Some of the brand names in the discussion are direct links to pdf brochure downloads; you will need a program capable of reading a pdf file to open them. Where actual prescribing information is not available, we have linked to reputable sites providing their own discussion of the HRT. The information linked to and provided here may not contain everything a woman needs to know to use any particular HRT safely and effectively; please review use instructions and characteristics with your physician and pharmacist when beginning any new HRT.
Oral progestins (synthetic):
Oral progesterone (human-identical):
Intrauterine progestin:
Transdermal/ Transbuccal Progesterone (human-identical):
Progestin injection (synthetic):
Aygestin is norethindrone acetate (often abbreviated as "NETA") and comes in 5 mg tablets. It is synthesized from testosterone (we don't know whose), and may raise your serum testosterone levels. Like any progestin, it has a higher rate of side effects and fewer progesterone effects than progesterone, but on the other hand it can't be converted into other hormones—which may be beneficial for some therapeutic applications. It has been demonstrated to enhance bone density and may be of some benefit (and some risk) to the cardiovascular system. It has a testosteronic effect on blood lipids, counteracting estrogen's benefits, and may contribute to male pattern baldness if you are already headed that way. (more information)Compounded USP (human-identical) progesterone can be made up to any dose in oil-filled gel caps, timed-release capsules, troches, gels, creams, or vaginal suppositories. It carries all the effects of progesterone, positive and negative. It can be combined into the same formulation with other hormones, but that is an option that may be best left for after you balance your HRT blend, as you otherwise are giving up the ability to tune the doses individually.
Cycrin is the progestin medroxyprogesterone acetate plus lactose, magnesium stearate, methylcellulose, and microcrystalline cellulose. Each dosage strength also contains the following: 5 mg-D&C Red #30 and FD&C Blue # 1, 10 mg-D&C Red #30 and D&C Yellow #10. It comes in 2.5, 5, or 10 mg oral doses and is scored such that it can be divided. It is synthesized from progesterone (we don't know whose). It is shown to be effective in reducing hot flashes and decreasing the rate of bone loss. It is less likely to cause your HDL (good) cholesterol to drop than other progestins. It also has an anti-testosterone effect and can decrease libido. Amen, Curretab and Provera are alternate generic forms of this HRT although some of them offer other dose strengths.
Depo-provera is injectable medroxyprogesterone acetate. In addition to all the aspects of synthetics, it carries the characteristics of this route as well. It is synthesized from progesterone (we don't know whose). It is shown to be effective in reducing hot flashes and decreasing the rate of bone loss. It is less likely to cause your HDL (good) cholesterol to drop than other progestins. It also has an anti-testosterone effect and can decrease libido.
Endometrin is a 100 mg human-identical progesterone vaginal "insert" described further as a "white to off-white oblong-shaped tablet" to be administered with a plastic applicator. The label indication is for fertility support, but, like Prochieve (ex-Crinone), the vaginal gel, it can presumably be used for other progesterone needs such as endo suppression or protection of a uterus. This hrt was approved in the summer of 2007 but given how few women use combined hrt these days, we don't have much user feedback on it yet. You can read our analysis of the prescribing information packet and what that implies for use elsewhere on this site. (more information)
Megace is an oral progestin containing 20 mg or 40 mg megestrol acetate. We find the fact that this is used as a cancer-fighting drug and carries this warning in the PDR very interesting:
Although the glucocorticoid activity of MEGACE tablets has not been fully evaluated, laboratory evidence of adrenal suppression has been observed. Clinical cases of new onset diabetes, exacerbation of pre-existing diabetes, and Cushing' syndrome have been reported in association with the use of MEGACE. Rare cases of clinically apparent adrenal insufficiency have also been reported in association with MEGACE. The possibility of adrenal suppression should be considered in any patient taking or withdrawing from chronic MEGACE therapy who presents with symptoms of adrenal insufficiency such as hypotension, nausea, vomiting, dizziness, or weakness. Laboratory evaluation for adrenal insufficiency and replacement stress doses of a rapidly acting glucocorticoid may be indicated for such patients.Weight gain from increased appetite is also cited as a side effect, although given the known effect of progesterone to increase insulin resistance, this may be a normal hormonal action rather than a side effect of being synthetic. (more information)
Mirena is an IUD developed for contraception that releases the progestin levonorgestrel. It is is intended to provide an initial release rate of 20 µg/day of levonorgestrel; this rate decreases progressively to half that value after 5 years. The device is made of polyethylene and silicone and must be inserted into the uterus by a health care practitioner. It is only suitable for use by women who have a uterus, but can be used to provide uterine protection in women without ovaries who want to minimize the systemic effects of the progestogen component of their combined hrt. (more information)
Ortho-Micronor contains 0.35 mg norethindrone. Inactive ingredients include D&C Green No. 5, D&C Yellow No. 10, lactose, magnesium stearate, povidone and starch. It is synthesized from testosterone (we don't know whose), and may raise your serum testosterone levels. Like any progestin, it has a higher rate of side effects and fewer progesterone effects than progesterone, but on the other hand it can't be converted into other hormones—which may be beneficial for some therapeutic applications. It has been demonstrated to enhance bone density and may be of some benefit (and some risk) to the cardiovascular system. It has a testosteronic effect on blood lipids, counteracting estrogen's benefits, and may contribute to male pattern baldness if you are already headed that way.
Nor-QD is contains 0.35 mg norethindrone plus D&C Yellow No. 10, FD&C Yellow No. 6, lactose, magnesium stearate, povidone, and starch. It is synthesized from testosterone (we don't know whose), and may raise your serum testosterone levels. Like any progestin, it has a higher rate of side effects and fewer progesterone effects than progesterone, but on the other hand it can't be converted into other hormones—which may be beneficial for some therapeutic applications. It has been demonstrated to enhance bone density and may be of some benefit (and some risk) to the cardiovascular system. It has a testosteronic effect on blood lipids, counteracting estrogen's benefits, and may contribute to male pattern baldness if you are already headed that way.
Prochieve (formerly marketed as Crinone) is a human-identical progesterone in adhesive gel form (in a base containing glycerin, mineral oil, polycarbophil, carbomer 934P, hydrogenated palm oil glyceride, sorbic acid, sodium hydroxide and purified water) used for vaginal administration. Women who have no luck with other routes of progesterone administration sometimes finds that this one works for them. The original product (Crinone) was off the market for a year or more due to manufacturing problems, but then was re-released under the name Prochieve with, one assumes, the problem dealt with. It comes in both a 4% (45mg) and 8% (90mg) per 1.125 grams strength, dispensed in a single-piece, one-time-use applicator. To use a lower dose than the full dispensed amount will require dividing the package, something users have said is not terribly difficult. This product is also suitable for women who have a uterus but no ovaries or women using progestogens for therapeutic purposes (disease treatment) who want to minimize the systemic impact and risks of the progestogen portion of their combined hrt.
Prometrium is micronized human-identical progesterone in an oil-filled gelcap. It comes in 100 or 200mg doses and also includes peanut oil NF, gelatin NF, glycerin USP, lecithin NF, titanium dioxide USP, D&C Yellow No. 10, and FD&C Red No. 40 (FD&C Yellow No. 6 in the 200mg). The oil is required to provide a timed-release function (if you are allergic to peanut oil, you can have a compounding pharmacist make you up a custom version with some other oil). This is a much larger dose than is normally taken transdermally because of first pass liver losses, even with the oil doing its best. It's also a larger dose than many women in surgical meno need, and some women must take it at night because it makes them so sleepy. Remember that progesterone has a sedative effect on the brain similar to that of Xanax or Valium, so this isn't really a side effect but rather a desired effect that may simply be too strong at the provided dose. Women who particularly want the sedation to counteract the stimulating effects of estrogen may find they get more sedating metabolites from oral progesterone than transdermal, although from a risk-management standpoint they might be better advised to better tune their estrogen. Because prometrium is human-identical, it can be converted into testosterone and estrogen as well as other adrenal hormones such as cortisol. In a pinch, women who wanted to try out the transdermal route (to distinguish between route-related and hormonal effects) have been known to puncture a gelcap and rub the oil on their skin. This should work (they report it does) but it's obviously difficult to measure accurately. Remember that taking a whole 100 mg cap transdermally is four to eight times the normal transdermal dose, so it would seem prudent to cut way back on the amount used if you try this. (more information)
Provera is medroxyprogesterone acetate in 2.5, 5, or 10 mg oral doses, plus calcium stearate, corn starch, lactose, mineral oil, sorbic acid, sucrose, talc. The 2.5 mg tablet contains FD&C Yellow no. 6. It is synthesized from progesterone (we don't know whose). It is shown to be effective in reducing hot flashes and decreasing the rate of bone loss. It is less likely to cause your HDL (good) cholesterol to drop than other progestins. It also has an anti-testosterone effect and can decrease libido. As with the estrogen/Premarin linking problem, some doctors hear only "Provera" when you say "progesterone." Provera is one of the hormones involved in the Women's Health Initiative study that was discontinued due to excessive risk and subsequent research is suggesting that some of the risks may have been due at least as much to the provera as the premarin. (more information)
