For menopause hormone therapy, commonly discussed oral micronized progesterone regimens are 100 mg daily when used continuously or 200 mg for 12–14 days in a 28-day cycle. The right plan depends on estrogen use, whether you have a uterus, your bleeding pattern, menopause stage, side effects, and a clinician’s safety review 1.
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See if you qualify →What is the usual progesterone dose for menopause?
There is no one usual dose that fits every patient. Still, oral micronized progesterone 100 mg daily for continuous use and 200 mg for 12–14 days per cycle for sequential use are well-known reference regimens in menopause care 1. They are not personal dosing instructions.
Why 100 mg daily and 200 mg cyclic schedules are commonly discussed
Micronized progesterone is progesterone processed into small particles to improve absorption when taken by mouth. The North American Menopause Society lists 100 mg daily as a continuous option and 200 mg for 12–14 days per cycle as a sequential option when systemic estrogen is used in someone with a uterus 1.
The FDA-approved Prometrium label describes a specific regimen of 200 mg daily for 12 days per 28-day cycle for prevention of endometrial hyperplasia in postmenopausal women receiving conjugated estrogens 2. That label regimen applies to the studied product and indication, not automatically to every estrogen product, route, or patient.
Why dose depends on the estrogen regimen and the uterus
The first question is whether you have a uterus. For people with a uterus using systemic estrogen, a progestogen is generally needed to reduce the risk of endometrial hyperplasia, or abnormal thickening of the uterine lining 1. Estrogen dose, route, bleeding, and personal risks can all affect the clinician’s plan.
| Schedule discussed in menopause care | Dose cited in guideline or label | How it is used | Bleeding pattern to discuss |
|---|---|---|---|
| Continuous oral micronized progesterone | 100 mg daily in NAMS guidance | Taken every day alongside systemic estrogen | The goal is often no scheduled bleeding, though spotting may occur early 1. |
| Cyclic or sequential oral micronized progesterone | 200 mg for 12–14 days per cycle in NAMS guidance | Taken for part of the month with estrogen | A predictable withdrawal bleed can occur 1. |
| Prometrium label regimen | 200 mg daily for 12 days per 28-day cycle | FDA-labeled with conjugated estrogens for endometrial hyperplasia prevention | The regimen is specific to the labeled product and population 2. |
Why is progesterone used with menopause hormone therapy?
Progesterone is mainly used with systemic estrogen to protect the endometrium in people who have a uterus. Without enough progesterone-like effect, unopposed estrogen can raise the risk of endometrial hyperplasia and endometrial cancer over time 1.
How estrogen affects the uterine lining
Estrogen is an effective treatment for vasomotor symptoms, including hot flashes and night sweats, but it can also stimulate endometrial growth 1. The PEPI trial found more endometrial hyperplasia among participants receiving estrogen alone than among those receiving estrogen plus a progestational agent 3.
When progesterone may not be needed after hysterectomy
After a total hysterectomy, progesterone is often not needed for endometrial protection because there is no endometrium. However, the reason for surgery, whether any uterine tissue remains, and an individual’s medical history can matter, so this still needs clinician review 1.
What is the difference between continuous and cyclic progesterone dosing?
Continuous progesterone dosing means using progesterone every day with estrogen. Cyclic progesterone dosing means using it for only part of the month, often 12–14 days, and the biggest practical difference is often the expected bleeding pattern 1.
Continuous combined therapy in postmenopause
Continuous combined therapy is often considered after menopause, when avoiding a planned monthly bleed may be a priority. Spotting or irregular bleeding can happen after starting therapy, but persistent or new bleeding needs clinical follow-up 1.
Cyclic or sequential therapy in perimenopause and early menopause
Cyclic therapy may be considered during perimenopause or early menopause, when ovarian hormone activity and periods may still be changing. Stopping progesterone after its scheduled phase can lead to a withdrawal bleed 1.
When bleeding needs prompt attention
Heavy bleeding, bleeding after sex, or bleeding that starts after menopause should not be assumed to be a normal hormone effect. ACOG recommends timely evaluation of postmenopausal bleeding because it can be a sign of endometrial cancer or another condition that needs care 4.
Is 100 mg or 200 mg progesterone more common for menopause?
Both numbers are common because they refer to different schedules, not because one is always stronger or better. 100 mg is often discussed for continuous oral micronized progesterone, while 200 mg is commonly discussed for cyclic use 1.
Why higher estrogen doses or bleeding can change the plan
A clinician may reassess the regimen if the estrogen plan changes, bleeding continues, side effects are difficult, or risk factors emerge. Evaluation can include a health history, pelvic exam, ultrasound, endometrial sampling, or other testing based on the person’s age, symptoms, and risk profile 4.
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At Chia, you can start an online visit for progesterone or our HRT for Women protocol. A licensed US provider reviews your health information and prescribes only when clinically appropriate; a prescription is not guaranteed. When prescribed, medications are compounded by state-licensed US 503A pharmacies and shipped to your door. Compounded drugs are not FDA-approved.
What forms of progesterone are used in menopause care?
Progesterone forms include oral micronized progesterone, vaginal products, creams, injections, and synthetic progestins. The evidence and FDA labeling are not the same across routes, and oral micronized progesterone has the clearest role in published menopause dosing guidance 1.
Oral micronized progesterone and Prometrium
Prometrium is an FDA-approved oral micronized progesterone product. Its label includes prevention of endometrial hyperplasia in postmenopausal women with a uterus who use conjugated estrogens 2. This is also the form usually meant when people ask about 100 mg versus 200 mg progesterone in menopause care.
Vaginal progesterone and endometrial protection
Vaginal progesterone may deliver hormone close to the uterus, but many vaginal products are FDA-approved for fertility-related uses rather than menopause hormone therapy. A clinician should explain whether a vaginal product is being used off-label and whether the proposed regimen provides adequate endometrial protection 1.
Progesterone creams and injections
Creams and injections are different routes from oral micronized progesterone, so evidence from oral regimens cannot simply be transferred to them. ACOG states that compounded bioidentical menopause hormone therapy should not be routinely prescribed over FDA-approved options when an approved product is available, in part because compounded products can have variable potency and limited evidence 5.
Synthetic progestins and levonorgestrel IUDs
Synthetic progestins, such as medroxyprogesterone acetate, act on progesterone receptors but are not the same compound as micronized progesterone. A levonorgestrel IUD may be part of an endometrial-protection plan for some patients, but its use with menopause hormone therapy should be individualized 1.
How should patients think about progesterone side effects?
Progesterone side effects can be manageable, but they should be part of the treatment decision from the start. The Prometrium label reports effects including dizziness, drowsiness, headache, breast tenderness, abdominal discomfort, and bleeding changes 2.
Sleepiness and dizziness
Oral micronized progesterone can make some people sleepy or dizzy. The FDA label cautions patients to use care with driving or machinery if they are affected 2. Sleep disturbance is common in menopause, but progesterone should be considered as part of the full hormone and safety picture rather than used as a stand-alone sleep plan.
Bloating, breast tenderness, mood changes, and bleeding
Bloating, breast tenderness, headache, mood symptoms, and changes in bleeding can occur 2. Tracking when symptoms occur in relation to estrogen and progesterone use can help a clinician decide whether the schedule, route, or overall plan needs review.
How does progesterone treatment work at Chia?
At Chia, progesterone care begins with an online health questionnaire and review by a licensed US provider. We offer progesterone cream and injection, with plans currently starting at $109/mo, when a provider determines a compounded plan is clinically appropriate.
We also offer an HRT for Women protocol with Estradiol Oral + Progesterone IR, currently from $119/mo. Our providers review symptoms, menopause stage, uterus status, bleeding history, current estrogen use, medications, and relevant risks before deciding whether treatment is appropriate.
When prescribed, Chia medications are compounded in the US by state-licensed 503A compounding pharmacies and shipped to the patient’s door. Dosing is provider-guided and may be adjusted over time, with care-team messaging available through the patient portal.
| Chia option | Catalog forms | Current starting price | What the clinical review considers |
|---|---|---|---|
| Progesterone | Cream or injection | From $109/mo | Symptoms, uterus status, estrogen use, bleeding, and health history |
| HRT for Women | Estradiol Oral + Progesterone IR | From $119/mo | Whether combined menopause hormone care is clinically appropriate |
| Estradiol | Cream, injection, or transdermal patch | Injection from $109/mo | Whether estrogen may be appropriate and what endometrial protection is needed |
Because estrogen and progesterone decisions are connected, our providers consider both sides of the plan. You can review Chia’s estradiol options and start the online eligibility quiz if you would like a licensed provider to assess your situation.
How do clinicians decide whether a progesterone dose is right?
Clinicians look beyond the number on the prescription. A progesterone dose is reviewed alongside estrogen exposure, uterus status, bleeding, symptoms, medical history, and follow-up response 1.
Menopause stage, symptoms, and bleeding history
Perimenopause, menopause, and postmenopause are different hormone settings. Irregular cycles can be common in perimenopause, while bleeding after menopause needs a more careful evaluation pathway 4.
Estrogen route and risk review
Systemic estrogen includes oral and transdermal forms that circulate throughout the body. By contrast, low-dose vaginal estrogen used for genitourinary symptoms generally does not require a progestogen for endometrial protection, though any unexpected bleeding still needs evaluation 6.
A safety review can include unexplained vaginal bleeding, breast or other hormone-sensitive cancers, blood clots, stroke, liver disease, cardiovascular risk, pregnancy possibility, and medication interactions. The Endocrine Society recommends individualized menopause hormone therapy decisions based on symptoms, baseline risks, and patient preferences 7.
What questions should you ask before starting progesterone?
The most useful questions connect your uterus status with your estrogen plan, bleeding, and safety history. The goal is not simply to find the lowest dose; it is to find an appropriate plan for endometrial protection and tolerability 1.
- Do I need progesterone based on whether I have a uterus and use systemic estrogen?
- Is my estrogen route systemic or local, and how does that affect progesterone need?
- Would continuous or cyclic treatment fit my menopause stage and bleeding pattern?
- What bleeding is expected, and what bleeding should I report promptly?
- What side effects should I watch for, including dizziness, sleepiness, mood changes, breast tenderness, or bloating?
- Do I have reasons to avoid or delay hormone therapy, such as unexplained bleeding, blood clots, liver disease, cancer history, or pregnancy possibility?
- How will we follow up if my symptoms, bleeding, or health history changes?
FAQ about progesterone dose for menopause
There is no single lowest dose that is right for everyone. A 100 mg oral micronized progesterone daily schedule is commonly discussed for continuous use with systemic estrogen, but the appropriate plan depends on uterus status, estrogen exposure, bleeding, symptoms, and risks 1.
Not necessarily. A 200 mg oral micronized progesterone schedule is commonly discussed for cyclic use for 12–14 days per cycle 1. Whether it is appropriate depends on the estrogen regimen, bleeding pattern, side effects, and clinician review.
Sleepiness is a known effect of oral micronized progesterone, so some people notice it affects sleep 2. It can be helpful for some and bothersome for others. A clinician should assess the whole menopause plan rather than choosing progesterone only as a sleep treatment.
Sometimes progesterone may be considered without estrogen, but that is a different clinical question from using it to protect the uterine lining during estrogen therapy 1. A clinician should review symptoms, bleeding, cycle stage, pregnancy possibility, and health risks first.
If you have a uterus and use a systemic estrogen patch, progesterone or another progestogen is usually needed for endometrial protection 1. If you do not have a uterus, it may not be needed for that reason, but your clinician should confirm based on your history.
No. Progesterone is the hormone made by the body. Progestins are synthetic compounds that act on progesterone receptors 1. Both can be used in hormone therapy, but their labeling, side effects, and evidence are not identical.
You should not assume they are interchangeable. Oral micronized progesterone has clearer menopause dosing guidance, while compounded creams may have variable absorption and limited evidence for endometrial protection 1 5. A clinician should explain the evidence for the specific route being considered.
No. Compounded medications are not FDA-approved, and FDA does not review them for safety, efficacy, or quality in the same way as FDA-approved products. At Chia, a licensed provider prescribes compounded medication only when clinically appropriate after reviewing your health information.
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Start an online hormone evaluation
If you are considering menopause hormone therapy, Chia can review your symptoms, uterus status, estrogen use, bleeding history, and safety factors through an online visit. Explore progesterone or HRT for Women. A licensed US provider prescribes only when clinically appropriate, and a prescription is not guaranteed.
References
- 1.The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022.
- 2.U.S. Food and Drug Administration. Prometrium (progesterone) capsules prescribing information. 2023.
- 3.The Writing Group for the PEPI Trial. Effects of hormone replacement therapy on endometrial histology in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions Trial. JAMA. 1996.
- 4.American College of Obstetricians and Gynecologists. The role of transvaginal ultrasonography in evaluating the endometrium of women with postmenopausal bleeding. Committee Opinion No. 734. 2018.
- 5.American College of Obstetricians and Gynecologists. Compounded bioidentical menopausal hormone therapy. Clinical Consensus No. 6. 2023.
- 6.The North American Menopause Society. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020.
- 7.Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2015.
- 8.Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002.
About this article
Chia Health Editorial Team — Evidence-reviewed health education
This article is for educational purposes only and is not a substitute for individualized medical advice. Talk to a licensed clinician before starting, stopping, or changing any prescription.
AI tools may assist with research and drafting. Chia's editorial team reviews source use, clarity, treatment information, and safety framing before publication. A clinician is named only after explicit sign-off. Read our editorial standards.
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