Progesterone Supplementation: Complete Guide to Pills, Suppositories & Creams

If you're dealing with low progesterone, your healthcare provider may recommend progesterone supplementation to help regulate your cycle, support fertility, or manage perimenopause symptoms. But with multiple forms available: pills, suppositories, creams, and injections, it can be confusing to understand which option is right for you.

Here's everything you need to know about progesterone supplementation, including the different types, when they're used, how they work, and what to expect.

Note: This content is for educational and informational purposes only. It is not intended as medical advice and should not replace consultation with a qualified healthcare provider. Always seek the guidance of your clinician before starting, changing, or stopping any medication or supplement, especially if you are pregnant, undergoing fertility treatment, or managing a hormone-related condition.

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What is progesterone supplementation?

Progesterone supplementation involves taking prescription progesterone to raise your body's progesterone levels when they're too low. Unlike your body's natural progesterone, which is produced by the ovaries after ovulation, supplemental progesterone comes from outside sources to make up for what your body isn't producing on its own.

Supplementation is commonly used to:

• Support fertility and improve chances of conception
• Prevent miscarriage in early pregnancy
• Regulate irregular periods
• Manage perimenopause symptoms
• Regulate hormones during hormone replacement therapy (HRT)
• Treat luteal phase defects

Your healthcare provider may recommend progesterone supplementation if blood or urine tests show your progesterone levels are consistently low and/or if you're experiencing symptoms like irregular cycles, difficulty conceiving, or recurrent miscarriages. Learn more about low progesterone symptoms. →

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When is progesterone supplementation needed?

For fertility and conception

If you're trying to conceive, progesterone supplementation may be recommended if:

• You have a luteal phase defect (when your luteal phase is shorter than 10 days)
• Your progesterone doesn't rise adequately after ovulation
• You have a history of early miscarriage
• You're undergoing fertility treatments like IUI or IVF
• You have irregular ovulation due to conditions like PCOS

Adequate progesterone is essential for preparing the uterine lining for implantation and maintaining early pregnancy. Without sufficient progesterone, a fertilized egg may not implant properly, or a pregnancy may not be sustained through the first trimester.

During early pregnancy

Progesterone supplementation is often prescribed in early pregnancy to:

• Support the uterine lining
• Prevent uterine contractions that could lead to miscarriage
• Maintain a pregnancy until the placenta takes over progesterone production (around week 10)
• Reduce miscarriage risk in women with a history of pregnancy loss

Research shows that progesterone supplementation can significantly reduce miscarriage risk in women with recurrent pregnancy loss or those who've had vaginal bleeding in early pregnancy.

For perimenopause symptoms

During perimenopause, progesterone often declines before estrogen does, creating an imbalance. Progesterone supplementation can help:

• Regulate heavy or irregular periods
• Reduce intense PMS symptoms
• Improve sleep quality
• Decrease anxiety and mood swings
• Protect the uterine lining if you're also taking estrogen

Learn more about progesterone during perimenopause →

For hormone replacement therapy

If you're taking estrogen as part of menopausal hormone therapy and still have your uterus, you must also take progesterone. Estrogen alone can cause the uterine lining to thicken excessively which can subsequently increase the risk for endometrial hyperplasia and cancer. Progesterone protects against this by keeping the uterine lining healthy and preventing overgrowth.

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Types of progesterone supplementation

Oral progesterone (pills/capsules)

Brand names: Prometrium (micronized progesterone), Utrogestan

How it works: Progesterone capsules are taken by mouth, typically once or twice daily. The progesterone is absorbed through your digestive system and metabolized by your liver before entering your bloodstream.

Common doses: 100-400mg daily, usually taken at bedtime

Often used for: 

• Perimenopause symptom management
• Hormone replacement therapy
• General hormone balance
• Women who prefer oral medication

Pros:

• Easy to take
• Non-invasive
• Good for systemic benefits (mood, sleep)
• Well-studied and widely available

Cons:

• Has to pass through digestive system and liver first (may reduce effectiveness)
• Can cause drowsiness (which is why it's taken at bedtime)
• May cause dizziness or headaches
• Takes longer to reach therapeutic levels
• Not always the best choice for fertility support

When to take: Usually at bedtime because the sedative effect can improve sleep. If taking twice daily, take once in the morning and once at night.

Vaginal progesterone (suppositories/gel)

Brand names: Crinone gel, Endometrin suppositories, compounded suppositories

How it works: Medication is inserted into the vagina where it's absorbed directly by the vaginal tissue. This allows progesterone to reach the uterus quickly without going through the digestive system or liver first.

Common doses:

• Suppositories: 100-200mg, 1-3 times daily
• Gel: 90mg (8% gel) once or twice daily

Often used for:

• Fertility treatments (IUI, IVF)
• Luteal phase support
• Early pregnancy support
• Threatened miscarriage
• Women who need targeted uterine effects

Pros:

• Delivers progesterone directly to uterus
• Bypasses liver metabolism (more effective for uterine effects)
• Higher progesterone concentration in uterus
• Lower systemic side effects
• Preferred for fertility treatments

Cons:

• Can be messy (leakage)
• May cause vaginal irritation or discharge
• Requires refrigeration (suppositories)
• More expensive than oral options
• Can interfere with intimacy
• Multiple daily doses can be inconvenient

When to use: Typically morning and evening, or as directed. Insert while lying down and remain lying down for 15-30 minutes for best absorption. Some women insert before bed to minimize leakage.

Progesterone cream (topical)

Brand names: Various over-the-counter and prescription options

How it works: Progesterone cream is applied to thin-skinned areas such as the inner arms, inner thighs, chest, or abdomen where it can be easily absorbed through the skin.

Common doses: Varies widely by product; typically 20-40mg daily

Best for:

• Mild perimenopause symptoms
• Women who can't tolerate oral or vaginal forms
• Complementary support (not primary treatment)

Pros:

• Easy to apply
• Non-invasive
• Can be used long-term
• Available over-the-counter (though prescription versions are more reliable)

Cons:

• Absorption can be inconsistent and hard to measure
• Blood tests may not accurately reflect progesterone levels from cream
• Less effective than oral or vaginal forms
• Quality varies significantly between products
• Not recommended for fertility treatment or pregnancy support
• Can transfer to partners or children through skin contact

When to use: Usually applied once or twice daily to clean, dry skin. Rotate application sites to improve absorption.

Important note: Over-the-counter progesterone creams are not regulated by the FDA and may not contain the amount of progesterone listed on the label. For fertility or medical conditions, prescription progesterone is strongly recommended.

Progesterone injections

Brand name: Progesterone in oil

How it works: Progesterone dissolved in oil is injected into muscle (usually the buttocks or hip) where it can be slowly absorbed into the bloodstream.

Common doses: 25 -100mg daily or every other day

Commonly used for: 

• IVF cycles (when very precise progesterone levels are needed)
• Women who can't tolerate other forms
• Threatened miscarriage requiring immediate high levels

Pros:

• Most reliable absorption
• Provides steady, predictable progesterone levels
• Effective for fertility treatments

Cons:

• Requires injections (painful for many)
• Can cause injection site pain, bruising, or lumps
• Usually requires help from partner or nurse
• More expensive
• Inconvenient for long-term use

When to use: Typically given daily or every other day, often at the same time each day for consistency.

Bioidentical progesterone (micronized progesterone)

Bioidentical progesterone is molecularly identical to the progesterone your body naturally produces. It's synthesized from plant sources (usually yams or soy) but has the exact same chemical structure as human progesterone.

Brand names: Prometrium, Utrogestan, Crinone, compounded bioidentical progesterone

Benefits:

• Fewer side effects than synthetic versions
• Lower risk of blood clots
• Better safety profile for cardiovascular health
• May be better tolerated

Important: "Bioidentical" doesn't automatically mean "natural" or "safer" in all contexts. FDA-approved bioidentical progesterone (like Prometrium) is well-studied and standardized. Custom-compounded bioidentical hormones are less regulated and may have inconsistent quality.

Synthetic progestins

Synthetic progestins are lab-created compounds that mimic progesterone's effects but have a different molecular structure. They're used in birth control pills and some hormone replacement therapies.

Examples: Medroxyprogesterone acetate (Provera), norethindrone, levonorgestrel

Key differences:

• More potent than natural progesterone
• Different side effect profile (may cause more mood changes, bloating, breast tenderness)
• Higher risk of blood clots compared to bioidentical progesterone
• Not recommended for fertility support or early pregnancy
• Often used in birth control because they're more effective at preventing ovulation

For fertility, pregnancy support, and perimenopause management, bioidentical progesterone is generally preferred over synthetic progestins due to its better safety profile and tolerability.

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How to choose the right progesterone supplement

The best progesterone supplementation method depends on several factors:

Your specific situation:

• Trying to conceive or IVF: Vaginal suppositories or gel are usually preferred
• Early pregnancy support: Vaginal suppositories or oral capsules
• Perimenopause/HRT: Oral capsules are usually sufficient
• Irregular cycles: Oral capsules or vaginal suppositories

Your preferences:

• If you want convenience: Oral pills
• If you want targeted uterine effects: Vaginal suppositories
• If you want to avoid systemic side effects: Vaginal suppositories
• If you can't tolerate other forms: Cream (though less effective)

Your provider's recommendation: 

Your healthcare provider will consider your medical history, hormone levels, symptoms, and treatment goals when prescribing progesterone. Always follow their specific instructions for dosing and timing.

Cost and insurance:

• Generic oral micronized progesterone is usually least expensive
• Vaginal suppositories and gels can be more expensive
• Some insurance plans cover certain forms better than others
• Compounded progesterone may not be covered by insurance

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Common side effects of progesterone supplementation

While progesterone supplementation is generally safe, it can cause side effects, especially if levels become too high. Understanding the difference between normal supplementation side effects and signs of progesterone imbalance is important. Compare low vs. high progesterone symptoms →

Oral progesterone side effects:

• Drowsiness or fatigue (often used therapeutically for sleep)
• Dizziness or lightheadedness
• Headaches
• Breast tenderness
• Bloating
• Mood changes
• Nausea (rare)

Tip: Taking oral progesterone at bedtime minimizes daytime drowsiness and can actually improve sleep quality.

Vaginal progesterone side effects:

• Vaginal discharge or leakage
• Vaginal irritation or itching
• Mild cramping
• Bloating
• Breast tenderness

Tip: Using a panty liner can help manage discharge. Alternating morning and evening doses between vaginal and rectal application (if your doctor approves) may reduce irritation.

Progesterone cream side effects:

• Skin irritation at application site
• Drowsiness
• Bloating
• Breast tenderness

When to contact your doctor:

• Contact your healthcare provider if you experience:
• Severe allergic reaction (rash, difficulty breathing, swelling)
• Heavy vaginal bleeding
• Severe abdominal pain
• Signs of blood clots (leg pain, chest pain, shortness of breath)
• Severe mood changes or depression
• Yellowing of skin or eyes (jaundice)

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How long does progesterone supplementation take to work?

The timeline varies depending on why you're taking it:

For fertility/luteal phase support: You should see progesterone levels rise within 24-48 hours of starting supplementation. Tracking with at-home hormone tests like Oova can help you confirm your levels are increasing appropriately.

For perimenopause symptoms: Most women notice improvement in sleep and mood within 1-2 weeks. Cycle regulation may take 1-3 cycles to stabilize.

For early pregnancy support: Progesterone begins working immediately to support the pregnancy. You'll typically continue supplementation through the first trimester (until weeks 10-12) when the placenta takes over progesterone production.

For endometrial protection during HRT: Progesterone begins protecting the uterine lining immediately, but you'll need to take it continuously or cyclically as prescribed to maintain protection.

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Monitoring your progesterone levels during supplementation

Testing your progesterone while supplementing is important to ensure:

• You're taking the right dose
• Your levels are in the therapeutic range
• The supplementation is working effectively
• You can adjust dosing if needed

Blood tests: Your doctor may periodically order blood tests to check progesterone levels. Note that results can vary depending on supplementation method (vaginal progesterone may not show up as well in blood tests).

Urine tests: At-home urine tests like Oova measure PdG (progesterone metabolite) and can track your progesterone throughout supplementation. This is especially helpful for:

• Confirming supplements are raising your levels
• Tracking patterns across multiple cycles
• Sharing comprehensive data with your healthcare provider
• Adjusting timing or dosage

Learn more about progesterone testing →

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How long will I need to take progesterone?

Duration depends on your treatment goals:

For fertility/luteal phase support: Usually taken from ovulation through early pregnancy (first trimester), or until your period starts if not pregnant. May be used for several cycles while trying to conceive.

For pregnancy support: Typically continued through weeks 10-12 of pregnancy, when the placenta takes over progesterone production. Some high-risk pregnancies may require longer supplementation.

For perimenopause: May be used for several months to years, depending on symptom severity and transition timeline. Many women use it throughout perimenopause and reduce or stop after reaching menopause. 

For HRT: If you're taking estrogen and still have your uterus, you'll need to continue progesterone as long as you're on estrogen therapy to protect your uterine lining.

Never stop progesterone supplementation suddenly, especially during pregnancy, without consulting your healthcare provider.

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Can you take progesterone naturally without supplementation?

While no foods contain progesterone directly, certain lifestyle changes and nutrients may help support your body's natural progesterone production:

Diet:

• Vitamin B6-rich foods (chickpeas, salmon, poultry, bananas)
• Vitamin C-rich foods (citrus, bell peppers, strawberries)
• Zinc-rich foods (pumpkin seeds, oysters, cashews)
• Magnesium-rich foods (leafy greens, almonds, dark chocolate)
• Healthy fats (avocados, nuts, olive oil, fatty fish)

Lifestyle:

• Maintain healthy body weight
• Manage stress through meditation, yoga, or therapy
• Get 7-9 hours of quality sleep
• Exercise regularly but avoid over-exercising
• Limit caffeine and alcohol

Learn more: How to Increase Progesterone Naturally: 8 Evidence-Based Ways →

Important: Natural methods may help with mild progesterone imbalances but typically aren't sufficient for significant deficiencies, fertility treatment, or pregnancy support. Always work with your healthcare provider to determine if supplementation is needed.

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Progesterone supplementation: The bottom line

Progesterone supplementation can be an effective solution for supporting fertility, preventing miscarriage, regulating cycles, and managing perimenopause symptoms. With multiple forms available (oral pills, vaginal suppositories, topical creams, and injections) you and your healthcare provider can choose the option that best fits your needs and lifestyle.

The most important factors are:

• Working with your healthcare provider to determine if you need supplementation
• Choosing the right form for your specific situation (vaginal for fertility, oral for perimenopause)
• Monitoring your levels to ensure effectiveness
• Taking it consistently as prescribed
• Reporting any side effects or concerns to your doctor

If you're considering progesterone supplementation or already taking it, tracking your hormone levels with Oova can help you and your provider ensure your treatment is working effectively and make adjustments as needed.

Talk to your healthcare provider if:

• You suspect you have low progesterone
• You're experiencing fertility challenges
• You have irregular cycles or heavy bleeding
• You're entering perimenopause and experiencing symptoms
• You're currently on progesterone and have questions about your dosing

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Frequently Asked Questions:

Should I take progesterone pills orally or vaginally?

For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.

Can I switch from pills to suppositories or vice versa?

Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.

What's better: progesterone cream or pills?

Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.

When should I start taking progesterone after ovulation?

Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.

Will progesterone supplementation delay my period?

Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.

Can progesterone supplementation cause weight gain?

Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.

Is it safe to take progesterone throughout pregnancy?

Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.

Can I take progesterone if I'm breastfeeding?

Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.