Micronized Progesterone for Menopause

Primary Indication and Endometrial Protection

• The American College of Obstetricians and Gynecologists recommends micronized progesterone as an effective and safer progestogen option for endometrial protection in postmenopausal women with an intact uterus receiving estrogen therapy, with a more favorable breast cancer risk profile compared to synthetic progestins like medroxyprogesterone acetate 1

Breast Safety Advantage

• The National Comprehensive Cancer Network guidelines note that micronized progestin may be preferred over medroxyprogesterone acetate due to lower rates of venous thromboembolism and breast cancer risk 1

Contraindications and Special Populations

• The National Comprehensive Cancer Network recommends that micronized progesterone is contraindicated in patients with a history of hormone-sensitive cancers, active or recent thromboembolic events, abnormal vaginal bleeding, active liver disease, and pregnancy 1
• The Cancer Treatment Reviews guidelines suggest that micronized progesterone may be safe in cervical, vaginal, and vulvar cancer survivors (not hormone-dependent) 2

Common Adverse Effects

• The Journal of the National Comprehensive Cancer Network reports that the most frequently reported adverse reactions (≥10%) when combined with conjugated estrogens include breast tenderness (27%) 1
• The Annals of Internal Medicine reports that joint pain (20%) and dizziness (15%) are common adverse effects 4

Important Clinical Considerations

• The US Preventive Services Task Force recommends against using hormone therapy (including progesterone combinations) for primary prevention of chronic conditions in postmenopausal women 4
• The Journal of the National Comprehensive Cancer Network recommends using the lowest effective dose for the shortest duration necessary and annual clinical review once therapy is established 1