How to Use Progesterone and Progestogens for HRT

Q: Can I use the Mirena coil instead of taking tablets?

For many women, the Mirena IUS is an excellent alternative. It releases a small amount of progestogen directly into the womb and provides endometrial protection for up to 5 years in HRT. It also offers reliable contraception. We can discuss whether this is suitable for you and arrange a coil fitting at the clinic.

Published on: 2:18pm, 8 June 2026
Updated on: 2:28pm, 8 June 2026

Why Do I Need Progesterone with HRT?

If you still have your womb, taking oestrogen on its own can cause the lining of the womb (the endometrium) to thicken over time. Left unopposed, this increases the risk of endometrial hyperplasia and, in some cases, endometrial cancer.

Progesterone (or a synthetic progestogen) protects the womb lining by keeping it thin and stable. This is why it’s an essential part of HRT for anyone with a uterus, even if your main symptoms feel oestrogen-related.

If you’ve had a hysterectomy, you usually don’t need progesterone, though there are a few exceptions, such as a history of endometriosis. We’ll always discuss this with you on an individual basis.

Body-Identical vs Synthetic: What’s the Difference?

Body-identical progesterone (micronised progesterone, brand name Utrogestan) has the same molecular structure as the progesterone your ovaries produce. It’s plant-derived and considered the first-line choice for most women, with a favourable safety profile around breast health, mood, and cardiovascular risk.

Synthetic progestogens (such as norethisterone, medroxyprogesterone, drospirenone and desogestrel) are man-made compounds that mimic progesterone’s effect on the womb lining. They’re effective and well-tolerated for many women, and some have additional benefits, such as providing contraception or helping with heavy bleeding.

Neither option is universally “better”. The choice depends on your medical history, symptoms, contraceptive needs, and how you respond.

Photo by Ayush Kumar on Unsplash

How to Take Utrogestan (Micronised Progesterone)

Utrogestan is the most commonly prescribed progesterone in modern HRT. It comes as a 100mg soft capsule and can be taken in two main ways.

Cyclical (sequential) regimen: Usually for women who are still having periods or are in early perimenopause. You take 200mg at night for 12–14 days each month, which produces a monthly bleed similar to a period.
Continuous (combined) regimen: Usually for women who are at least 12 months post-menopausal. You take 100mg every night, which aims to keep you bleed-free over time.

A few practical tips:

Take it at bedtime. Utrogestan is mildly sedating for many women, which is often a welcome side effect if menopausal sleep has been disrupted.
Take it with or after food where possible, as this can help with absorption.
Vaginal use is sometimes prescribed off-license, particularly if oral progesterone causes significant side effects. We’ll only recommend this after a full discussion.
Don’t double up if you forget a dose. Skip the missed capsule and take the next one as planned.

How to Take Cyclogest (Micronised Progesterone Pessary)

Cyclogest contains the same body-identical micronised progesterone as Utrogestan, but it is formulated as a pessary for vaginal or rectal use rather than a capsule you swallow. It comes in 200mg and 400mg strengths.

Because it works locally and bypasses some of the absorption that happens when progesterone is taken by mouth, Cyclogest can be a helpful option if oral progesterone causes troublesome side effects such as drowsiness or low mood.

Insert vaginally or rectally, following the regimen your GP has given you. In a cyclical regimen this is often for 12–14 days each month; continuous use is also possible.
The rectal route is a useful alternative if vaginal use does not suit you, for example if you are also using vaginal oestrogen, or if vaginal dryness or irritation is a problem.
Wash your hands before and after inserting the pessary, and consider inserting it at bedtime so you can stay lying down for a while.
Using Cyclogest for endometrial protection as part of HRT is off-license. We will only recommend it after a full discussion, usually where oral progesterone has not been well tolerated.

How to Take Lutigest (Micronised Progesterone Vaginal Tablet)

Lutigest is another form of body-identical micronised progesterone, supplied as a 100mg vaginal tablet that you insert with the applicator provided.

Like Cyclogest, it delivers progesterone directly where it is needed and tends to be gentle on mood and alertness, which makes it a sensible choice for women who do not get on with oral progesterone.

Use the applicator provided and insert the tablet high into the vagina, ideally while lying down.
Follow the specific regimen your GP has prescribed. The dose and timing for HRT differ from the licensed fertility dose, so always go by your individual instructions.
A little leakage or discharge is common with vaginal tablets and is nothing to worry about. A panty liner can help.
As with vaginal Utrogestan and Cyclogest, using Lutigest for HRT endometrial protection is off-license, and we will talk this through with you first.

How to Take Norethisterone

Norethisterone is a synthetic progestogen used in some HRT regimens, often as part of a combined tablet (such as Kliovance, Kliofem or Elleste Duet) or as a separate tablet alongside transdermal oestrogen.

It’s usually taken once daily, either continuously or for 10–14 days each month, depending on your regimen.
Take it at the same time each day to keep blood levels stable.
Norethisterone is also sometimes prescribed short-term to delay a period or manage heavy bleeding. The dose for these uses is different and shouldn’t be combined with HRT use without guidance.
Some women find norethisterone can affect mood or cause breast tenderness more than micronised progesterone. If this is the case for you, switching to Utrogestan is often a good next step.

How to Take Medroxyprogesterone Acetate

Medroxyprogesterone acetate (brand name Provera) is a synthetic progestogen used in some HRT regimens and also to help manage heavy or irregular bleeding.

It is usually taken once daily, either continuously or for 10–14 days each month, depending on your regimen.
Take it at the same time each day to keep levels steady.
Some women notice mood changes, bloating or breast tenderness with synthetic progestogens. If this is the case for you, switching to micronised progesterone (Utrogestan) is often a good next step.
The dose used for bleeding problems is different from the HRT dose, so do not combine uses without guidance.

How to Take Nalvee (Dydrogesterone)

Nalvee is a brand of dydrogesterone, a synthetic progestogen whose structure is very close to your body’s own progesterone. It tends to be well tolerated, with a favourable profile on mood, weight and metabolic effects, which is why many women get on well with it. You may also come across dydrogesterone combined with oestrogen in products such as Femoston.

It is usually taken once daily, either cyclically for 10–14 days each month or continuously, depending on your regimen.
Take it at whichever time of day suits you, as long as you are consistent.
Dydrogesterone is often gentler on mood than older synthetic progestogens, so it can be a good alternative if norethisterone or medroxyprogesterone have not suited you.
As with all progestogens in HRT, a change in bleeding pattern is common in the first few months and usually settles.

How to Take Slynd (Drospirenone)

Slynd is a progestogen-only contraceptive pill containing drospirenone. It’s licensed as contraception, not HRT, but in perimenopause, it can play a useful dual role. For some patients, Slynd can provide reliable contraception while also offering some endometrial protection if used alongside oestrogen.

Take one tablet daily at the same time, ideally with a meal.
The pack contains 24 active tablets and 4 inactive tablets, so you take it every day without a break.
Slynd has a 24-hour missed pill window, which is more forgiving than older progestogen-only pills.
Many women appreciate that drospirenone tends to be weight-neutral and may help with fluid retention and acne.

If you’re using Slynd alongside oestrogen as part of a perimenopause regimen, this is an off-license use. We’ll discuss the rationale, monitoring, and alternatives with you so that you can make an informed choice.

How to Take Desogestrel

Desogestrel is a progestogen-only contraceptive pill (brands include Cerazette and Cerelle). Like Slynd, it’s primarily a contraceptive, but in perimenopause, it can sometimes be combined with transdermal oestrogen to manage symptoms while also providing contraception.

Take one tablet daily at the same time, with or without food.
The pack contains 28 active tablets and is taken without a break.
Desogestrel has a 12-hour missed pill window.
Common effects include changes to your bleeding pattern: some women stop bleeding altogether, while others experience irregular spotting, particularly in the first few months.

Using desogestrel for endometrial protection in HRT is also off-license, and we’ll always have a thorough conversation about whether it’s the right fit for you.

How to Use the Mirena Coil

The Mirena is an intrauterine system (IUS) that releases a small, steady amount of the progestogen levonorgestrel directly into the womb. For many women it is an excellent way to get the progesterone part of HRT without taking a daily tablet or pessary.

It provides endometrial protection for up to 5 years when used as part of HRT, and reliable contraception at the same time, which is particularly useful in perimenopause.
It is fitted at the clinic in a short appointment. We will talk you through what to expect and arrange a convenient time.
Because the progestogen acts mainly within the womb, systemic side effects such as mood changes tend to be less of an issue for many women.
Bleeding pattern changes are expected in the first 3–6 months, including irregular spotting, after which many women find their bleeding becomes very light or stops altogether.
The Mirena can be a particularly good choice if you also have heavy periods, or if you would simply rather not think about taking something every day.

What You Can Expect When Starting Progesterone

Most women tolerate progesterone and progestogens well, but it’s normal to notice some changes in the first few weeks as your body adjusts.

Mood changes: Some women feel a little low, weepy or irritable in the days they take progesterone, particularly in cyclical regimens. Utrogestan is generally the gentlest option for mood.
Breast tenderness: Often settles within 6–8 weeks.
Bloating or fluid retention: More common with synthetic progestogens than with Utrogestan.
Drowsiness: Common with Utrogestan, which is why we recommend taking it at bedtime.
Bleeding pattern changes: A monthly bleed is expected on cyclical regimens. On continuous regimens, irregular spotting is common in the first 3–6 months and usually settles. Persistent or heavy bleeding always needs review.

If side effects are troublesome or persistent, get in touch. There’s usually a way to adjust the type, dose, route or timing to suit you better.

Photo by Artem Beliaikin on Unsplash

Comparing Your Options

Option	Type	Typical role	Notes
Utrogestan	Body-identical micronised progesterone	First-line for most women on HRT	Often improves sleep; gentler on mood
Cyclogest	Body-identical micronised progesterone (pessary)	Alternative to oral progesterone where side effects are an issue	Vaginal or rectal use; off-license in HRT
Lutigest	Body-identical micronised progesterone (vaginal tablet)	Alternative to oral progesterone where side effects are an issue	Inserted with an applicator; off-license in HRT
Norethisterone	Synthetic progestogen	Used in combined HRT tablets and for heavy bleeding	Effective; some women experience mood or breast effects
Medroxyprogesterone acetate (Provera)	Synthetic progestogen	Used in some HRT regimens and for heavy bleeding	Effective; some women notice mood or bloating effects
Nalvee (dydrogesterone)	Synthetic progestogen	Endometrial protection in HRT, cyclical or continuous	Structurally close to natural progesterone; often gentle on mood
Slynd (drospirenone)	Progestogen-only contraceptive pill	Contraception in perimenopause; off-license endometrial cover with oestrogen	24-hour missed pill window; tends to be weight-neutral
Desogestrel	Progestogen-only contraceptive pill	Contraception in perimenopause; off-license endometrial cover with oestrogen	12-hour missed pill window; bleeding pattern often changes
Mirena coil	Levonorgestrel IUS	Endometrial protection plus contraception	Lasts up to 5 years; fitted at the clinic; bleeding settles over time

How to Store Progesterone and Progestogens

We recommend keeping all of these medications in their original packaging, at room temperature, away from direct sunlight and heat. Don’t use any tablet or capsule beyond its expiry date, and keep them out of reach of children.

Utrogestan capsules are soft and oil-filled, so avoid leaving them in a hot car or near a radiator, as the capsules can soften.

Frequently Asked Questions

Do I really need progesterone if I feel fine on oestrogen alone?

Yes, if you have a womb. Progesterone protects the lining of the womb, even if your symptoms are mainly related to oestrogen. Skipping it isn’t a safe option long-term.

Can I use the Mirena coil instead of taking tablets?

For many women, the Mirena IUS is an excellent alternative. It releases a small amount of progestogen directly into the womb and provides endometrial protection for up to 5 years in HRT. It also offers reliable contraception. We can discuss whether this is suitable for you and arrange a coil fitting at the clinic.

What if I forget to take my progesterone?

If you’re on a continuous regimen and miss a dose, take it as soon as you remember unless your next dose is nearly due. Don’t double up. If you’re on a cyclical regimen and miss several doses, please get in touch so we can advise on the safest way to get back on track.

Can I take progesterone in the morning instead of at night?

Utrogestan is best taken at night because of its sedating effect. Synthetic progestogens like norethisterone, drospirenone and desogestrel can be taken at whichever time of day suits you, as long as you’re consistent.

Will progesterone make me put on weight?

Progesterone itself isn’t a major driver of weight gain. Some women notice mild bloating or fluid retention, particularly with synthetic progestogens, which can settle within a few weeks. Drospirenone (Slynd) tends to be weight-neutral and may even help with fluid retention.

My bleeding has changed. Should I be worried?

A monthly bleed is expected on cyclical regimens. On continuous regimens, light spotting in the first 3–6 months is common. However, any heavy bleeding, prolonged bleeding, or new bleeding after 6 months of being settled should always be reviewed.

Doctor consulting with a patient, symbolising the importance of responsible oversight and collaboration in the use of GLP-1 weight loss medications.

Dr Natalie Summerhill MBBS RCGP (2015) DRCOG DFSRH

When to Contact the Clinic

Get in touch if:

Your symptoms aren’t improving after 8–12 weeks.
You’re experiencing troublesome mood changes, breast tenderness or bloating that isn’t settling.
Your bleeding pattern has changed or is heavier than expected.
You’re unsure whether your progesterone is the right type or dose for you.
You have any questions or concerns.

Please seek urgent medical advice if you experience sudden, severe headaches, chest pains, leg pains with swelling, or visual disturbances. These are rare but require immediate assessment.

Need to Discuss Your HRT?

If you have questions about your progesterone or progestogen, or feel your HRT might need adjusting, we’re here to help. Our same-day and evening appointments mean you don’t have to wait weeks for a review.

Related Information

Dr Natalie Summerhill

MBBS RCGP (2015) DRCOG DFSRH

Founder and GP
Member of the Royal College of General Practitioners, Member of the British Menopause Society (BMS)

Dr. Natalie Summerhill is a highly skilled GP who graduated from Guy’s, King’s and St Thomas’s School of Medical Education in 2007 and completed her GP training with the Royal College of General Practitioners in 2015. She founded her private clinic in 2021, focusing on advanced primary care diagnostics and health screening.

With expertise in women’s health, including menopause care, she holds specialist qualifications from the Royal College of Obstetricians and Gynaecologists and the British Menopause Society. Dr. Summerhill is also dedicated to educating employers, employees, and healthcare professionals, collaborating to ensure clinical excellence and optimal patient care.

Facebook

Instagram

Book a consultation.

New patients seeking longer-term health advice must book an initial consultation. This isn’t required for single-issue GP appointments, blood tests or contraception services.