Gillian Goddard

3 min Read Gillian Goddard

Gillian Goddard

Is There a Difference Between Oral and Topical Progesterone?

Q&A on HRT

Gillian Goddard

3 min Read

My doctor has prescribed me hormone replacement therapy. I take an estrogen patch, and 10 days per month I take progesterone. I am having a really hard time dealing with the side effects of the progesterone. In particular, my mood while I am taking the progesterone is terrible. As soon as I stop it, my mood improves. This surprised me, as when I took progesterone as part of fertility treatments over a decade ago, it was really helpful for my mood! The only difference is that while I was trying to conceive, the endocrinologist prescribed vaginal progesterone. My HRT progesterone (the same capsule!) is ingested, as prescribed. Do some HRT regimens call for vaginal progesterone, and if so, is the dosing the same? Alternatively, are there HRT regimens that add the progesterone less frequently? I know there are synthetic alternatives, but they all seem to have weight gain as a side effect, a nonstarter for me.

—moody

I am sorry you are having this experience, but take heart! There are often so many options for dealing with the symptoms we are having. Definitely talk to your doctor about your symptoms and discuss the possibilities. 

In my clinical experience, progesterone can make many women feel terrible. The natural progesterone in our body is responsible for many of our premenstrual symptoms, and taking progesterone can certainly impact mood. 

Progesterone patch on blue background
Reproductive Health Supplies Coalition / Pexels

Most women need progesterone as a part of their hormone replacement therapy regimen. If you have a uterus, taking estrogen alone can lead to a buildup of the uterine lining that increases your risk for uterine cancer. Taking progesterone prevents the uterine lining from becoming too thick.

The good news is there are many different ways to get the progesterone you need while taking HRT. Cyclic oral micronized progesterone is just one option. Women taking low-dose estrogen can take progesterone less frequently — only every six months. Other oral options include taking a smaller dose of progesterone daily. 

There are also several other ways to take progesterone. If you are using an estrogen patch, you could try switching to a combination patch that includes both estrogen and a progestin, like CombiPatch or Climara Pro.

Some women take micronized progesterone transvaginally. Many women tolerate progesterone better when they take it this way. When the progesterone is absorbed through the vagina, it goes straight into the bloodstream without passing through the liver, which may explain why it causes fewer side effects. 

Another common approach is to place a progestin-eluting IUD like Mirena. The progestin in the IUD protects your uterine lining but doesn’t circulate in high levels in the blood, so it is less likely to cause symptoms. 

The takeaway: In medicine, there are often many ways to treat your symptoms. This is definitely true of the options for taking progesterone as part of HRT. If your current method is not working for you, talk to your doctor about other options.

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