Prometrium: Natural Progesterone Support for Hormonal Balance
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Synonyms
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Prometrium is a bioidentical progesterone capsule, FDA-approved for use in hormone replacement therapy and the management of specific gynecological conditions. It contains micronized progesterone identical to the hormone naturally produced by the ovaries, ensuring optimal bioavailability and physiological action. This formulation is designed to support endometrial health, regulate menstrual cycles, and alleviate symptoms associated with progesterone deficiency, offering a trusted option for patients and clinicians seeking evidence-based hormonal support.
Features
- Contains 100 mg or 200 mg micronized progesterone per soft gelatin capsule
- Bioidentical structure matches endogenous human progesterone
- Formulated in peanut oil for enhanced absorption
- Available in oral and vaginal administration routes
- FDA-approved for hormone replacement and secondary amenorrhea
- Packaged in light-resistant bottles to maintain stability
Benefits
- Supports endometrial protection against estrogen-induced hyperplasia
- Helps regulate menstrual cycles in women with ovulatory dysfunction
- Reduces the frequency and severity of vasomotor symptoms in menopause
- May improve sleep quality due to progesterone’s neurosteroid effects
- Provides luteal phase support in assisted reproductive technology
- Mimics natural hormonal activity with predictable pharmacokinetics
Common use
Prometrium is commonly prescribed as part of hormone replacement therapy (HRT) in postmenopausal women with an intact uterus to oppose estrogen and prevent endometrial hyperplasia. It is also indicated for the treatment of secondary amenorrhea, helping to restore regular menstrual cycles. In reproductive medicine, it is used for luteal phase support following assisted reproductive techniques such as in vitro fertilization. Off-label uses may include managing premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and preventing preterm birth in certain high-risk pregnancies, though these applications require careful clinical evaluation.
Dosage and direction
Dosage varies based on indication and patient-specific factors. For postmenopausal HRT, the typical dose is 200 mg orally daily for 12 sequential days per 28-day cycle, combined with an estrogen. For secondary amenorrhea, 400 mg orally once daily at bedtime for 10 days is standard. In fertility treatments, doses range from 200–400 mg daily, often administered vaginally for localized effect. Administration with food may enhance absorption and reduce dizziness. Always follow the prescribing clinician’s instructions; do not crush or chew capsules.
Precautions
Patients should be monitored for signs of depression, thromboembolic events, or visual disturbances. Use with caution in individuals with a history of hepatic impairment, asthma, diabetes, cardiovascular disease, or seizures. Prometrium may cause drowsiness—avoid driving or operating machinery until response is known. Regular gynecological exams, including breast and pelvic assessments, are recommended during prolonged therapy. Not intended for use as a contraceptive.
Contraindications
Prometrium is contraindicated in patients with known hypersensitivity to progesterone or any components of the formulation (including peanut oil). Avoid use in individuals with current or history of thrombophlebitis, thromboembolic disorders, cerebral hemorrhage, liver dysfunction or disease, known or suspected progesterone-sensitive malignancies (e.g., breast cancer), undiagnosed abnormal genital bleeding, or missed abortion. Do not use during pregnancy for non-indicated purposes unless specifically directed in a supervised fertility context.
Possible side effects
Common side effects include drowsiness, dizziness, breast tenderness, headache, and mood changes. Gastrointestinal symptoms such as nausea, bloating, or abdominal cramping may occur. Less frequently, patients may experience hot flashes, fluid retention, weight changes, or rash. Serious but rare adverse effects include allergic reactions, thromboembolism, jaundice, depression, and changes in libido. Vaginal administration may cause local irritation or discharge.
Drug interactions
Prometrium may interact with drugs that induce hepatic enzymes (e.g., rifampin, carbamazepine, St. John’s wort), potentially reducing progesterone efficacy. Concurrent use with other CNS depressants (e.g., benzodiazepines, opioids, alcohol) may enhance sedative effects. Progesterone can alter the metabolism of cyclosporine, ketoconazole, and some antiretroviral drugs. Monitor patients on warfarin or other anticoagulants for potential changes in prothrombin time.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to catch up. Consistent timing supports stable hormone levels, especially in cyclic regimens. For specific guidance, refer to the prescribing information or consult a healthcare provider, particularly in fertility or HRT contexts where timing is critical.
Overdose
Acute overdose may exacerbate common side effects, such as severe drowsiness, nausea, or dizziness. There is no specific antidote. Treatment is supportive and symptomatic; consider gastric lavage if ingestion was recent and the patient is conscious. Monitor vital signs and provide appropriate medical supervision. Chronic overdose could lead to intensified hormonal effects—medical review and dose adjustment are advised.
Storage
Store at controlled room temperature (20°–25°C or 68°–77°F). Keep the container tightly closed and protected from light and moisture. Do not freeze. Keep out of reach of children and pets. Discard any unused or expired medication safely, following local disposal guidelines—do not flush unless instructed.
Disclaimer
This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. Individual patient needs and risks must be evaluated by a clinician. The manufacturer’s prescribing information should be reviewed for complete details.
Reviews
Clinical studies and patient reports generally reflect positive outcomes with Prometrium, particularly regarding its tolerability and efficacy in hormone replacement and cycle regulation. Many users note improved sleep and reduced hot flashes. Some report initial drowsiness or mood changes, which often subside with continued use. Adherence to prescribed dosing and administration routes is frequently emphasized as key to achieving desired results with minimal side effects.