Prometrium is the only body identical progesterone available as a prescription.
Prometrium is used as alone or combined with oestrogen (patches, gels, tablets). It is used during perimenopause to control irregular and heavy bleeding and counterbalance the effects of oestrogen dominance. It is used after menopause in females with a uterus to prevent overgrowth of the endometrial lining (to protect from endometrial cancer) and for the benefit progesterone itself has on many symptoms of the menopause and bone health.
How to use Prometrium
You take the capsule by mouth with a glass of water and no food, 1-2 hours before bedtime as progesterone can help sleep disturbance.
Postmenopause- continuous treatment
1 capsule by mouth every night
Females on continuous treatment should not get monthly bleeding when stable.
Perimenopause – cyclic treatment
2 capsules by mouth on days 1 to 12 of the calendar month if your period has been very irregular or
2 capsules on days 15 to 26 of your cycle (where day one is the first day of bleeding)
Females on cyclic treatment will get monthly bleeding.
Wait to start taking Prometrium so it coincides with your natural cycle unless instructed by your doctor.
There are other regimes and doses tailored to specific symptoms which your doctor may have advised.
Prometrium can also be used by placing the tablet high in the vagina with your finger before bed. Speak with your doctor about this as the dosage may need to be reduced (this is not the typical way to use Prometrium in Australia but it is used this way elsewhere in the world)
Risks of using HRT
Thrombosis
There is NO increased risk of blood clots with Prometrium.
A thrombosis is the formation of a blood clot which may block a blood vessel.
A thrombosis sometimes occurs in the deep veins of the legs (deep venous thrombosis). If this blood clot breaks away from the veins where it is formed, it may reach and block the arteries of the lungs, causing a so-called “pulmonary embolism”. Deep venous thrombosis is a rare occurrence. It can develop whether or not you are taking oestrogen. The risk is higher in oestrogen-users than in non-users. The increased risk has been seen with tablet or oral oestrogen use and not when used through the skin. There is no current evidence that Prometrium causes an increased risk of thrombosis.
Breast cancer
Some females using HRT will be diagnosed with breast cancer slightly more often than those not using HRT. The studies showing this were using old style formulations in certain groups of females and the risk is very small. There is no increased risk of dying from breast cancer nor any increased risk of dying from any cause (all cause mortality).
It is not clear whether this is caused by the HRT. It may be that the women were examined more often because they were on HRT, or that early cancers grew more quickly.
Studies show that about one extra case of breast cancer in 1000 women is diagnosed when women use combined HRT – oestrogen AND progesterone (old style non-body-identical formulations of progesterone). Studies show that women using oestrogen alone (without progesterone) have lower rates of breast cancer diagnosis – also about one less diagnosis in 1000 women. The risk may be lower with Prometrium that in studies which used non-body-identical progesterone (“progestogens”).
Please talk to your doctor about how these risks weigh up against the benefits for you personally.
Reasons not to start Prometrium
Allergies to Prometrium
Unexplained vaginal bleeding
Severe liver disease
You are pregnant or breast feeding
Speak with your doctor about any risks because you have…
Blood clots
Cancer
Migraines
Postnatal depression
Severe premenstrual mood disorder
Side effects of Prometrium
Side effects are uncommon and you may not experience any. Most are not serious and will settle over a few months.
Drowsiness, headache, vivid dreams, breakthrough vaginal bleeding or spotting, acne, breast pain or tenderness, changes in mood, libido or sleep, constipation or other gastric upset.
Stop taking Prometrium and seek medical advice if…
Migraines are getting worse
The skin or eyes are becoming yellow
Depression is worsening
Pain in your calves or chest, sudden shortness of breath indicating possible clots*
Severe headache, vomiting, dizziness, changes in vision, speech, numbness, weakness of an arm or leg*
* go to emergency as these need immediate assessment.
