Can I Take Progesterone Continuously in Perimenopause?
The short answer is maybe. Here’s what you need to know.
The options for menopause hormone replacement therapy (HRT) can be confusing, and there’s no one-size-fits-all approach. That’s especially true for progesterone, which can be taken continuously or cyclically to ease perimenopause symptoms like insomnia and mood swings. 1
During perimenopause, when you’re still getting regular-ish periods, your doctor may suggest taking progesterone cyclically, meaning just during the second half of your cycle when symptoms like mood swings, anxiety, and sleep issues tend to ramp up.
As you move into late perimenopause and your periods get more spaced out or unpredictable, it can be harder to know when that “second half” of your cycle actually is. At that point, your doctor might recommend taking progesterone continuously (every day), on its own or with estrogen, to keep your hormones more balanced.
About the Experts
Jerilynn C. Prior BA, M.D., FRCPC is a Professor of Endocrinology and Metabolism at the University of British Columbia and founder and Scientific Director of the Centre for Menstrual Cycle and Ovulation Research (CeMCOR).
Joanne Pinkerton, M.D., is the Mamie A. Jessup Professor of Obstetrics and Gynecology and division director of Midlife Health at the University of Virginia. She has published in more than 90 peer-reviewed journals and has frequently been the principal investigator in research on treating vasomotor symptoms with hormonal and non-hormonal therapies.
Natalie Kunsman, M.D., is a functional medicine physician who specializes in menopause care, anti-aging, and regenerative medicine.
Cyclic Progesterone vs Continuous Progesterone
Whether you’re prescribed continuous or cyclic progesterone depends on factors including what stage of menopause you’re in, your menstrual bleeding patterns, and your symptoms. You’re more likely to be prescribed cyclic progesterone during perimenopause and continuous progesterone after menopause.
Cyclic progesterone
Cyclic progesterone, also known as sequential HRT, is a treatment in which progesterone is taken only during certain parts of the menstrual cycle—typically for about 10 to 14 days during the second half of your menstrual cycle—rather than every day.
Most women take progesterone cyclically in the earlier phases of perimenopause when they’re still getting periods, even if they’re irregular. It’s typically taken during the luteal phase to mimic the natural rise and fall of progesterone during your cycle.
“Early on, most people’s symptoms are in the second half of their cycle, so we give them progesterone then,” says OB-GYN JoAnn Pinkerton, M.D. This approach can help keep periods regular with less breakthrough bleeding and may support sleep. 2
The standard dose for cyclic progesterone is 200 mg daily during the last two weeks of your cycle. 3 Some doctors recommend taking 300 mg of oral progesterone daily during the last two weeks of your cycle, as this dose is more likely to help hot flashes and has been shown to be safe for most women.4
Continuous progesterone
Continuous progesterone is when progesterone HRT is taken daily. It’s meant for women nearing menopause and after menopause (meaning they haven’t had a period in a year), whose symptoms are consistent throughout the month.
“As soon as night sweats start occurring throughout the month, or the period becomes very erratic, I switch to continuous progesterone,” says endocrinologist Jerilynn Prior, M.D.
There’s no recommended timeframe for switching from cyclic to continuous progesterone. It’s very individual, depending on your symptoms and how infrequent your periods are, Dr. Prior says.
Once you’re taking continuous progesterone, your doctor will likely reduce the dose from 200 mg to 100 mg. If you’re taking it every day, you don’t need the higher dose to protect the endometrium from too much estrogen, Pinkerton says.
When you first start taking continuous progesterone, it’s not unusual to have some spotting. That’s just your body adjusting as the uterine lining responds to the new hormone balance. The spotting usually settles down within three to six months. 5 But if the bleeding is heavy or goes on for more than a week, check in with your health care provider to make sure everything’s on track.
| Cyclic Progesterone | Continuous Progesterone | |
| Menopausal Stage | Perimenopause | Late perimenopause and postmenopause |
| Dosage Schedule | Days 14–28 | Every day |
| Average Dosage | 200 mg of progesterone or 10 mg of progestin | 100 mg of progesterone or 0.5–2.5 mg of progestin |
| Side Effects | Synthetic progestin may cause mild spotting, breast tenderness, and dizziness | May have some spotting |
How to Take Cyclic Progesterone
There are no official guidelines on how and when to take cyclic progesterone for perimenopause, but doctors typically advise the following:
- If you have a 28-day cycle, you’ll typically start taking 200 mg of progesterone daily from days 14 through 28 (your doctor may adjust this if your cycle is longer or shorter).
- Take progesterone before bed. Research shows progesterone improves sleep, which is often interrupted during perimenopause. 6
- If you are taking estrogen, it should be taken daily throughout the month.
- If you experience ongoing side effects, you may be able to take progesterone once every three months for 14 days. However, there’s no definitive research on whether this offers adequate protection against endometrial cancer, Pinkerton notes.
Cyclic Progesterone’s Impact on Your Period
Most women have lighter periods, fewer perimenopause cramps, and less spotting when taking cyclic progesterone.
Cyclic progesterone can help regulate your cycle, especially if a blood test shows your natural progesterone levels are low, says Natalie Kunsman, M.D., a functional medicine doctor who specializes in hormone health.
Oral micronized progesterone is commonly prescribed, but if your bleeding is very heavy or irregular, your provider may recommend taking a synthetic progestin (such as medroxyprogesterone (MPA)). This more potent form has a more consistent effect on the uterine lining, so it results in lighter, more regular periods; however, it is more likely to cause side effects.
How many days after taking progesterone will you get your period?
Your period is likely to begin 2 to 7 days after stopping a typical 10- to 14-day course of progesterone, as the drop in hormones triggers withdrawal bleeding. 7
Kunsman offers this additional guidance for cyclic progesterone:
- If your period starts before you finish the progesterone, keep taking it as prescribed until the full course is complete.
- If this happens regularly, your provider may adjust the timing of when you start the progesterone.
- In women with highly irregular cycles, Pinkerton recommends starting progesterone on day 7 (day 1 is when your period starts) and stopping it when you get your next period.
Types of Progesterone
There are two main types of progesterone, together called progestogens: bioidentical progesterone (such as micronized progesterone) and synthetic progestins. Both types can be taken cyclically or continuously.
- Micronized progesterone, is an FDA-approved, bioidentical oral pill that mimics the way your natural progesterone works in the body. It’s considered a gentler and safer option than progestin to treat perimenopause symptoms with mild, if any, side effects, says Pinkerton. Progesterone creams, gels, and suppositories are also available, but may not be as effective at endometrial protection.
- Progestins are synthetic progesterones. “Progestins are more potent, and more likely to cause moodiness and irregular bleeding,” says Pinkerton. Progestin can also prevent pregnancy in women who are still ovulating.8 Some evidence shows that using progestins with estrogen slightly increases breast cancer risk, raising the five-year risk from 4 in 50 women to 5 in 50 women. 9 Combining estrogen with progesterone does not increase breast cancer risk.
The Bottom Line
During perimenopause, when you’re still having periods, your doctor may recommend taking progesterone cyclically—typically 200 mg daily during the second half of your cycle. After menopause, your doctor may recommend taking progesterone continuously at a lower dose, usually around 100mg. Progesterone is an important part of hormone therapy because it balances estrogen’s effects, reducing the risk of uterine cancer.
Memi E, Pavli P, et al. (2024). Diagnostic and therapeutic use of oral micronized progesterone in endocrinology.
↑Nolan BJ, Liang B, Cheung AS. (2021) Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data.
↑Memi E, Pavli P, et al. (2024). Diagnostic and therapeutic use of oral micronized progesterone in endocrinology.
↑Prior JC, Cameron A, et. al. (2023). Oral micronized progesterone for perimenopausal night sweats and hot flushes a Phase III Canada-wide randomized placebo-controlled 4 month trial.
↑Harper-Harrison G; Carlson K, et. al. (2024). Hormone Replacement Therapy.
↑Memi E, Pavli P, et al. (2024). Diagnostic and therapeutic use of oral micronized progesterone in endocrinology.
↑(generated 2019). Progestin Challenge
↑NAMS Position Statement (2022). The 2022 hormone therapy position statement of The North American Menopause Society.
↑Hamoda, Haitham et al. (2020) BMS, IMS, EMAS, RCOG and AMS Joint Statement on menopausal hormone therapy (MHT) and breast cancer risk in response to EMA Pharmacovigilance Risk Assessment Committee recommendations
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About the author
Laurie Tarkan is an award-winning health journalist. She covered health regularly for The New York Times for a decade and has been a staff member or contributor to health sites including Northwell, GoodRx, Buoy Health, Montefiore Medical Center, NYU Langone Health, MarijuanaDoctors.com, Elysium, and Change Healthcare.
About the reviewer
Dr. Shelly Chvotzkin, D.O., F.A.C.O.O.G., is a physician board certified in obstetrics and gynecology. She is a member of the American College of Osteopathic Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Menopause Society (formerly known as the North American Menopause Society or NAMS).
