Progesterone pessaries are inserted vaginally rather than swallowed. They are used most often in fertility treatment and to support early pregnancy in some circumstances, and sometimes as part of hormone replacement therapy.
The vaginal route has one clear advantage: far less of the drowsiness and dizziness that oral progesterone commonly causes, because it is absorbed locally rather than passing through the whole body in the same way. For people who find oral progesterone too sedating, this is often the reason a pessary is suggested.
Common hormonal medicine side effects
- Vaginal discharge, which is expected and is mostly the pessary base itself rather than a problem
- Local irritation, itching or mild soreness
- Bloating
- Breast tenderness
- Mild cramping
- Headache and mood changes
- Some drowsiness, though usually less than with tablets
The discharge worries people more than it should. Seeing residue is normal and does not mean the pessary has fallen out or failed to work. Absorption happens quickly, so what appears later is usually the leftover base. Using them at bedtime, where the schedule allows, reduces the nuisance.
Bleeding, mood, skin, weight and cycle changes
Light spotting can occur. In fertility treatment or early pregnancy, any bleeding should be reported to the team who prescribed them, even if you have been told some spotting is common, because they will want to assess it rather than have you decide.
Mood changes and bloating are reported and usually mild.
Serious warning signs that need medical attention
- Vaginal bleeding, particularly during fertility treatment or early pregnancy
- Severe abdominal or pelvic pain
- Discharge that is foul-smelling, green or accompanied by fever, suggesting infection rather than the pessary itself
- Severe local irritation or an allergic reaction
- Pain or swelling in one calf, sudden breathlessness, or chest pain
Do not stop pessaries prescribed for fertility treatment or early pregnancy without speaking to your team, even if you are having side effects, and even if you experience bleeding. Contact them instead.
Who may be at higher risk?
Tell your clinician about a history of blood clots, liver conditions, a history of hormone-sensitive cancer, recurrent vaginal infections, or an allergy to any pessary ingredient including peanut oil where relevant.
Ask whether other vaginal products, including lubricants and treatments for thrush, can be used at the same time, since they may affect absorption.
What to discuss with your doctor, pharmacist or clinic
- How much discharge is normal, and when would it concern you?
- Does it matter what time of day I use them?
- What do I do if one comes out soon after insertion?
- How long will I be using them?
- Who do I contact about bleeding, and how quickly?
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 progesterone in early pregnancy and fertility medication 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.