If you have a womb and take oestrogen for menopausal symptoms, you will also be prescribed a progestogen. It is not there to treat symptoms. Its job is to protect the lining of the womb, because oestrogen taken on its own thickens that lining and increases the risk of endometrial cancer.
That is worth knowing, because the progestogen is often the part people find hardest to tolerate, and understanding why it is there makes the conversation about alternatives more useful than simply stopping it.
People who have had a hysterectomy usually do not need it.
Common hormonal medicine side effects
- Bloating and fluid retention
- Breast tenderness
- Mood changes, low mood or irritability
- Headache
- Drowsiness, particularly with micronised progesterone taken at night
- Spotting or bleeding
Effects vary considerably between different progestogens, which matters: someone who does badly on one may be fine on another.
Bleeding, mood, skin, weight and cycle changes
There are two regimens, and which you are on determines your bleeding:
- Cyclical, where the progestogen is taken for part of each month and produces a monthly bleed. Usually used closer to the menopause when periods have not fully stopped.
- Continuous, where it is taken every day and aims for no bleeding at all. Usually used once periods have been absent for a while.
Irregular bleeding is common in the first months of a continuous regimen and usually settles. Bleeding that starts after a settled pattern, or persists beyond the early months, needs investigating rather than waiting out. See HRT bleeding and spotting.
If the low mood comes cyclically, arriving predictably during the progestogen days each month, say so specifically. That pattern points towards a change of regimen or preparation rather than a general problem with HRT.
There are options: a different progestogen, a change between cyclical and continuous, or a hormonal intrauterine system, which delivers the progestogen locally and is used by some people specifically because it avoids systemic effects. See Mirena.
Serious warning signs that need medical attention
Get emergency help for pain or swelling in one calf, sudden breathlessness or chest pain, a sudden severe headache, one-sided weakness or difficulty speaking, or yellowing of the eyes or skin. See hormonal medicine and blood clot symptoms.
Contact a doctor promptly for unexpected or heavy vaginal bleeding, severe low mood, or a new breast lump.
Do not stop the progestogen while continuing oestrogen. That leaves the womb lining unprotected, which is the situation the progestogen exists to prevent. If you cannot tolerate it, ask for an alternative rather than dropping it.
Who may be at higher risk?
Tell your clinician about a history of blood clots, liver conditions, a history of breast or other hormone-sensitive cancer, depression, or unexplained vaginal bleeding not yet investigated. Mention a peanut allergy if micronised progesterone capsules are being considered.
What to discuss with your doctor, pharmacist or clinic
- Am I on a cyclical or continuous regimen, and why that one?
- My low mood follows the progestogen days. What are the alternatives?
- Would a different progestogen, or an intrauterine system, suit me better?
- What bleeding is expected, and what should I report?
- When should this be reviewed?
Related contraception, HRT and hormonal medicine guides
- Hormonal medicine side effects
- Progesterone tablets side effects
- Women’s health and hormonal medicine side effects
- When to see a doctor about hormonal medicine
- Report a hormonal medicine side effect
See also HRT side effects, Utrogestan and oestrogen side effects.
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.