Prometrium vs Other Progesterone Options Comparison Tool
Comparison Details
| Product | Form | Typical Dose | Bioavailability | Main Uses | UK Cost (£/month) | Common Side Effects |
|---|
Recommended Option Based on Your Needs
Select your progesterone option and indication to see personalized recommendations.
Important Notes
- Always consult with your healthcare provider before making changes to your hormone therapy regimen.
- Vaginal options are generally preferred for IVF luteal phase support due to better efficacy.
- Oral progesterone has lower bioavailability but offers convenience.
- Cost varies significantly between products and regions.
Key Takeaways
- Prometrium delivers oral bioidentical progesterone; alternatives include vaginal gels, inserts, and synthetic progestins.
- Absorption and side‑effect profiles vary widely by delivery method.
- Cost and convenience often drive the final choice more than potency alone.
- For luteal‑phase support in IVF, vaginal options like Endometrin or Crinone tend to be preferred.
- Women with a history of blood‑clot risks should avoid high‑dose synthetic progestins.
What is Prometrium?
When you see Prometrium is a prescription oral capsule that contains micronized progesterone, a bioidentical hormone chemically identical to the progesterone your body makes. It was FDA‑approved in 2004 for hormone‑replacement therapy (HRT) and for luteal‑phase support in assisted reproduction. In the UK it’s often prescribed as a compounding product under the same name.
Typical dosing starts at 100‑200 mg per day, taken at bedtime to mimic the body’s natural nighttime surge. Because it’s taken orally, the liver metabolises part of the dose, which reduces overall bioavailability to roughly 15‑20%.
Common Alternatives to Prometrium
Several other progesterone‑based products compete for the same therapeutic niches. Here are the most frequently prescribed:
- Endometrin - a vaginal tablet delivering micronized progesterone directly to the uterus.
- Crinone - a vaginal gel formulation that spreads evenly across the cervical mucus.
- Norethindrone - a synthetic progestin (a 19‑nor derivative) taken orally for contraception or HRT.
- Medroxyprogesterone acetate (MPA) - another synthetic progestin, often marketed as Depo‑Provera for injectable use.
- Progesterone cream - a topical preparation that claims transdermal absorption, popular in “bioidentical hormone therapy”.
- Bioidentical hormone therapy (BHT) - a broader category that includes custom‑compounded oral, transdermal, and sublingual progesterone products.
Decision Criteria: How to Pick the Right Progesterone
Before you stare at a pharmacy shelf, ask yourself these five questions:
- What’s the primary indication? Menopause symptom relief, luteal‑phase support for IVF, or irregular periods each favour different delivery routes.
- How quickly do you need steady blood levels? Vaginal gels reach peak levels within 2‑3hours; oral capsules take longer and have a more variable curve.
- What’s your tolerance for side effects? Oral progesterone can cause drowsiness and nausea; synthetic progestins often bring weight gain or mood swings.
- How important is convenience? Daily oral pills are easy, but a nightly vaginal insert may feel intrusive for some users.
- What’s your budget? In the UK, compounded oral capsules can cost £30‑£45 per month, whereas a pack of Crinone gel can be £70‑£90.
Side‑by‑Side Comparison
| Product | Form | Typical Dose | Bioavailability | Main Uses | UK Cost (≈ per month) | Common Side Effects |
|---|---|---|---|---|---|---|
| Prometrium | Oral capsule | 100‑200mg nightly | 15‑20% | Menopause HRT, luteal support | £30‑£45 | Drowsiness, nausea, breast tenderness |
| Endometrin | Vaginal tablet | 100‑200mg twice daily | ≈30% | IVF luteal phase, miscarriage prevention | £55‑£70 | Vaginal irritation, spotting |
| Crinone | Vaginal gel (8% progesterone) | 90‑180mg daily | ≈30‑35% | IVF, luteal support | £70‑£90 | Vaginal discharge, dryness |
| Norethindrone | Oral tablet (synthetic) | 5‑10mg daily | ≈90% | Contraception, HRT | £20‑£35 | Weight gain, mood swings, acne |
| Medroxyprogesterone acetate | Injectable (MPA) or oral | 150mg injection every 3months | ≈99% (injectable) | Endometrial protection, HRT | £40‑£60 (injection) | Blood‑clot risk, bone loss |
| Progesterone cream | Topical | 10‑20mg applied nightly | Variable (≈5‑10%) | Self‑managed BHT, sleep aid | £25‑£45 | Skin irritation, limited efficacy |
When Prometrium Is the Right Choice
If you prefer a simple nightly pill and your main goal is to smooth out menopausal hot flashes, Prometrium checks the convenience box. Its bioidentical nature also means fewer lipid‑profile changes compared with synthetic progestins. However, because oral absorption is low, you may need a higher dose to achieve the same uterine effect that a vaginal gel provides with less material.
When to Opt for a Vaginal Product
For IVF cycles, robustness matters more than ease of use. Studies published in the *Fertility and Sterility* journal (2023) show that vaginal progesterone (Endometrin or Crinone) yields a 4‑5% higher ongoing pregnancy rate than oral micronized progesterone. The direct‑to‑uterus delivery bypasses first‑pass metabolism, resulting in steadier serum levels.
Choosing a Synthetic Progestin
Women with severe nausea on oral micronized progesterone sometimes switch to synthetic options like Norethindrone. The higher bioavailability allows a lower milligram dose, but the trade‑off is a greater impact on lipid metabolism and a higher risk of mood disturbances. If you have a history of thromboembolic disease, avoid high‑dose MPA.
Cost‑Effectiveness Snapshot
In the UK, the National Health Service (NHS) typically covers oral progesterone for HRT, but IVF‑related prescriptions often require private funding. Calculating total cost per successful pregnancy shows that while vaginal gels are pricier upfront, the improved success rate can make them cheaper in the long run for fertility‑seeking patients.
Practical Tips for Switching
- Always taper off oral progesterone rather than stopping abruptly to avoid withdrawal spotting.
- If moving from oral to vaginal, start with a half dose for the first two days to gauge tolerance.
- Track your symptoms in a daily log - sleep quality, mood, bleeding patterns - and share this with your clinician.
- Check for drug interactions. Certain antifungals (ketoconazole) can increase progesterone levels.
Frequently Asked Questions
Is Prometrium safe for long‑term menopause therapy?
Yes, when combined with estrogen it’s FDA‑approved for up to five years of continuous use. Regular bone‑density checks are advised, as progesterone alone doesn’t protect against osteoporosis.
Can I use a progesterone cream instead of Prometrium?
Topical creams have unpredictable absorption and usually don’t reach therapeutic serum levels. They might help with sleep, but they’re not a reliable substitute for HRT or IVF support.
What’s the biggest advantage of vaginal progesterone over oral?
Direct delivery to the uterus yields higher local concentrations with lower systemic side effects, which is why IVF clinics favour it for luteal‑phase support.
Are synthetic progestins like Norethindrone considered ‘bioidentical’?
No. Bioidentical hormones have the exact molecular structure of human hormones. Synthetic progestins have modified structures that bind differently to receptors.
Do I need a prescription for any of these alternatives?
In the UK, Prometrium, Endometrin, Crinone, Norethindrone and MPA all require a prescription. Over‑the‑counter progesterone creams are available, but they’re not medically equivalent.
Choosing the right progesterone hinges on your health goals, how quickly you need stable hormone levels, and your budget. By weighing the pros and cons outlined above, you can move from guesswork to a clear, personalized plan. If you’re still unsure, a quick consult with a menopause specialist or fertility doctor will help translate these data points into a prescription that fits your lifestyle.
