Progesterone in menopause: why it's in HRT, side effects and sleep
If you still have a womb and take estrogen, you also need a progestogen to protect the womb lining. Micronised progesterone is identical to the hormone your ovaries make. Side effects are usually mild and settle within a few months.
See a doctor if bleeding is heavy, carries on for more than 6 months after starting HRT, or starts after your periods had stopped. Also see one for a breast lump, or pain and swelling in one leg. Call 999 for chest pain with breathlessness or signs of a stroke.1,3
Why progesterone is part of HRT
Estrogen makes the lining of the womb thicker. Over time, estrogen on its own can cause the lining to overgrow, which raises the risk of womb cancer.2
A progestogen protects the lining, so anyone with a womb who takes estrogen also needs one.2,4 If you have had a hysterectomy, you usually need estrogen only.2
Micronised progesterone and other options
Micronised progesterone is sold as Utrogestan in the UK and Prometrium in the US. It is made from plants and is identical to the progesterone your ovaries produce.2
Other options include synthetic progestogens in tablets or combined patches, and the hormonal coil, which also works as contraception.5 If one type gives you side effects, another may suit you better.5
Progesterone creams sold online are not licensed to protect the womb during HRT. Do not rely on them with estrogen.
How it is taken
Utrogestan comes as capsules. If you still have periods, or they stopped recently, you usually take it for part of each month, with a bleed afterwards. If your periods stopped over a year ago, you usually take it every day.2,3
Take the capsules at least 2 hours after eating, as food affects how well they are absorbed.2 Because they can make you sleepy or dizzy, they are usually taken at bedtime.1
Side effects
Common side effects include spotting or bleeding between periods, headaches, breast tenderness, tiredness or dizziness, and mood changes. Less often, people get nausea, a mild rash or acne.1
Most side effects settle in the first 3 to 6 months. If they don't, your doctor may change the dose, the type of progestogen or how you take it.1,3
Some women feel low or irritable on progestogens, a bit like premenstrual symptoms. Tell your prescriber, as there are several alternatives.5
Breast cancer risk
Combined HRT, with estrogen and a progestogen, raises breast cancer risk slightly more than estrogen-only HRT. The large 2019 analysis behind UK advice found the risk was the same whichever progestogen was used, including progesterone itself.6
For most women under 60 with symptoms, the benefits of HRT outweigh the risks.7 See our page on HRT and breast cancer risk for the numbers.
Does progesterone help sleep or hot flashes?
Progesterone can make you drowsy, and some women feel they sleep better taking it at night. It is not licensed as a sleep treatment.1,2
In one trial of 133 women in early menopause, progesterone 300 mg at bedtime reduced hot flashes and night sweats more than a placebo. A later trial in women still in perimenopause did not find a clear benefit.8
Progesterone on its own is not a standard treatment for hot flashes. Estrogen, or the newer non-hormonal medicines, work better for most women.4
Common questions
Can I take progesterone without estrogen?
Yes, some women do, and one trial found it reduced hot flashes in early menopause.8 But it is not the standard treatment, and it does not replace estrogen's other effects. Discuss it with your prescriber.4
Why is Utrogestan taken at night?
It can cause sleepiness or dizziness, so bedtime is usually best. Take it at least 2 hours after eating.1,2
Is Utrogestan 'bioidentical'?
Yes. Its progesterone is identical to the hormone your ovaries make.2 Unlike compounded 'bioidentical' hormones, it is a licensed medicine with tested doses. See compounded bioidentical hormones.
Is micronised progesterone safer for the breasts than synthetic progestogens?
The 2019 analysis used by UK regulators found breast cancer risk was similar whichever progestogen was used, including progesterone.6
What it is used for: evidence rated
| Option | Evidence | What the research shows |
|---|---|---|
| Protecting the womb lining during estrogen HRT | The main reason it is prescribed. Anyone with a womb taking estrogen needs a progestogen.2,4 | |
| Hot flashes and night sweats (progesterone alone) | One trial in early menopause found a benefit, but a trial in perimenopause did not.8 | |
| Sleep | Can cause drowsiness, so it is taken at bedtime. Not tested or licensed as a sleep treatment.1 | |
| Progesterone creams bought online | Not licensed to protect the womb lining with estrogen HRT. |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- Side effects of Utrogestan (micronised progesterone), NHS
- Common questions about Utrogestan (micronised progesterone), NHS
- Side effects of hormone replacement therapy (HRT), NHS
- Menopause: identification and management (NG23), recommendations, NICE (updated November 2024)
- HRT: practical prescribing, tool for clinicians, British Menopause Society (amended August 2026)
- HRT: further information on the known increased risk of breast cancer with HRT and its persistence after stopping, MHRA Drug Safety Update (August 2019)
- Benefits and risks of hormone replacement therapy (HRT), NHS
- In brief: does micronized progesterone relieve perimenopausal symptoms? (on Hitchcock and Prior 2012 and the ENDO 2018 trial), MGH Center for Women's Mental Health (2018)