We use cookies to analyze site usage and improve your experience. You can accept all, reject non-essential, or customize. See our Privacy Policy.
Progestogen Comparison · All 50 States
Progesterone options in HRT compared: micronized progesterone, medroxyprogesterone, norethindrone, and the levonorgestrel IUD — dosing, sleep effects, breast-risk signal, and bleeding patterns.
Start your visit — $79/mo →← Hormone replacement therapy pillar
DIRECT ANSWER
If you have a uterus and take systemic estrogen, you need a progestogen to protect the endometrium. Micronized progesterone (100 mg nightly continuously, or 200 mg for 12 days cyclically) is the usual first choice: it is bioidentical, often improves sleep, and cohort data suggest a smaller breast-risk signal than older synthetic progestins. A levonorgestrel IUD provides local protection with minimal systemic exposure and is a strong option for women who cannot tolerate oral progesterone.
| Option | Route | Typical dose | Best suited to | Trade-off |
|---|---|---|---|---|
| Micronized progesterone | Oral capsule at bedtime | 100 mg nightly, or 200 mg × 12 days/month | Most women needing endometrial protection; poor sleep | Sedation, dizziness if taken during the day; peanut-oil formulations exist |
| Vaginal micronized progesterone (off-label) | Vaginal capsule | 100 mg nightly | Women who feel over-sedated or nauseated by oral dosing | Off-label for endometrial protection; less outcome data |
| Levonorgestrel IUD | Intrauterine, replaced every 5–8 years | 52 mg device | Heavy perimenopausal bleeding; contraception still needed | Requires an in-person insertion procedure |
| Norethindrone acetate | Oral tablet | 0.35–5 mg/day depending on indication | Bleeding control; fixed-dose combination patches | Synthetic progestin; mood or bloating in some women |
| Medroxyprogesterone acetate | Oral tablet | 2.5–10 mg/day | Legacy regimens and formulary-limited plans | The progestin used in WHI; less favorable breast-risk signal in cohort data |
Doses shown are typical starting ranges for context only. Your clinician sets your dose based on your history.
No. Progestogens in HRT exist to protect the uterine lining. Without a uterus, estrogen-only therapy is standard, which also avoids the progestogen-associated breast-risk signal.
Large cohort studies, including the French E3N cohort, associate micronized progesterone with a smaller breast-cancer risk signal than synthetic progestins such as medroxyprogesterone acetate. This is observational evidence rather than randomized data, but it is why micronized progesterone is generally preferred.
Oral micronized progesterone has sedating metabolites. Nighttime dosing turns that into a benefit for sleep and avoids daytime grogginess.
Not for endometrial protection. Transdermal progesterone creams do not achieve reliable endometrial levels and are not endorsed by NAMS for that purpose.
A board-certified clinician licensed in your state reviews your intake within one business day and recommends the route that fits your history — not a template.
Start your visit — $79/mo →Comparing providers first? How to choose an HRT telehealth provider →
WRITTEN & MEDICALLY REVIEWED BY
Kindr Health Inc. — Editorial & Clinical Team (physician-supervised)
Kindr’s clinical content is written and reviewed by board-certified clinicians who prescribe hormone therapy every day across all 50 states — menopause-focused physicians, nurse practitioners, and pharmacists working under Kindr Health, Inc.’s organizational clinical oversight. Every page is checked against current NAMS and ACOG guidance, FDA labeling, and the primary literature before publication, then re-reviewed on a rolling schedule when guidance changes.
Organizational NPI 1609792902 · Last reviewed July 3, 2026 · Editorial policy
Educational content only — not a substitute for individual medical advice, diagnosis, or treatment.
SOURCES & REFERENCES
Information on this page is for educational purposes only. Prescription medications require clinical evaluation and provider approval. Individual results vary. Not an emergency service.