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Bleeding and Progesterone

Using Progesterone Medicines to Manage Bleeding

Progesterone and progesterone-like medicines are used to control irregular and abnormal bleeding. There are different types of progesterone, different doses, and different ways to take progesterone (pill, shot, IUD). The actual medicine and dose will vary based on how well the bleeding is controlled by the medicine AND how each patient feels while taking the medicine. The goal is for a patient to take the LEAST amount of progesterone necessary to control the bleeding, and for that dose to be tolerable.

Side Effects

The list of side effects for women taking progesterone is long. In summary, some women just do not feel right when they are on progesterone. Our goal will be to find the Kind and Dose of progesterone that works, and that you can put up with.

When you stop progesterone – Whenever a patient stops taking progesterone she can expect bleeding. The bleeding usually comes 3-7 days after the last pill. The progesterone only works while you are taking it, and it does not cure the problem. Progesterone manages the bleeding only while you are taking it. There is no lasting effect of the medicine. Sometimes progesterone works better over time, and sometimes it does not work so well with time. There is no test to predict how well the progesterone will work, and there is no way to predict how long the progesterone will work.

Different Types of Progesterone

  • MPA: medroxyprogesterone acetate/Provera;  5 mg or 10 mg
  • NETA: norethindrone acetate/Aygestin;  2.5 gm or 5 mg
  • DMPA: medroxyprogesterone acetate injection/DepoProvera; 150 mg, every 2 to 3 months

How Progesterone Works

When taken daily, the progesterone effects should result in NO bleeding, with occasional spotting only. The spotting may last for up to six months, but eventually there should be NO bleeding at all.

  • Pills: Progesterone pills can be taken once or twice a day; MPA (5 or 10 mg) or NETA (2.5 or 5 mg). This means taking a pill 30/30 days each month and perhaps taking 30 or 60 pills per month. When first starting the daily progesterone there may be MANY days of bleeding, but the bleeding should slowly get less in quantity. Over time this regimen leads to NO bleeding. If you are taking two pills per day, the first thing to try is decreasing to ONE pill per day. If the bleeding is controlled on one pill per day you can either decrease to the lower dose OR goto a regimen below.
  • depoProvera Shot: This is a shot given every three months. Your body gets progesterone every day, but you only have to get a shot every three months. After four shots more than 50% of women have NO periods. This is often better tolerated than the actual pills each day…[read more]   
  • IUD with Progesterone (Mirena): This is a form of contraception which can help regulate bleeding. Progesterone is the medicine in this IUD, the medicine in the depoProvera shot and it is ½ of the medicine in the birth control pill. Progesterone makes the cells which line the uterus STOP growing. The less they grow, the lighter the periods. Mirena may not work as well or as quickly as depoProvera or oral medication, but it has almost NO side effects…[read more]

Controlling Periods

Progesterone can make period bleeding lighter, and perhaps have periods less often than monthly.

  • Pills taken 10 or 15 days in a row every month: one pill per day, either MPA (5 or 10 mg) or NETA (2.5 or 5 mg). This regimen should lead to “withdrawal bleeding/a period” that begins, 3-7 days after stopping the pills. You can expect period-like bleeding, monthly. Typically, the periods should be lighter than before. They may continue to get lighter. The advantage to this method is that you are taking 10 or 15 pills per month rather than 30 or 60 pills per month…less progesterone is usually MORE tolerable. The question is whether this regimen will limit your bleeding to 5-7 days per month. If the number of days and the amount of bleeding is tolerable this regimen can be continued for a long time. If your periods are not good enough then we need to go back to daily Progesterone, or consider other options.
  • Pills taken 10 or 15 days every two (or three) months: If your periods become light and predictable while taking the progesterone 10 or 15 days in a row each month you can consider increasing the cycle from 30 days to 45 or 60 or 90 days. The limitation to this or any cyclic regimen is how much you bleed. If the bleeding is tolerable on less medicine then great! If not, you may need to stick with the monthly pill cycle.

ADDITIONAL TOPICS

Reversible Birth Control

Temporary contraceptions range from the patch, pill, and the ring vs. an IUD, depoProvera, Nexplanon, or the MINIpill. Each has benefits and other factors to weigh out before making your choice…[read more]

Permanent Birth Control

Permanent birth control or Sterilization is available for those who do not wish to worry about maintaining a contraceptive routine any longer…[read more]

Postpartum Contraception

After the birth of your child you will have several decisions to make from work to day care to strollers. Luckily, birth control isn’t a very difficult one. There are many options available to you when you are ready…[read more]