Understanding Progesterone Therapy: Choosing Between Vaginal and Oral Administration

When I first started to take HRT, officially, like the prescription stuff I HATED how I felt on micronized progesterone. Sure it was body identical, sure it was the weakest form but damn if it didn’t make me feel exhausted. I would take it at night, just like I was supposed to. I would absolutely sleep through the night but then drag my ass out of bed and have very little energy until mid day.  I couldn’t;t stop taking it, I needed it to balance/oppose the estrogen and make sure that my endometrial lining didn’t get too thick. Thick uterus can cause uterine cancer. I also loved the sleep and end of panic attacks at night. 

After extensive research and being part of a provider chat group out of the UK I came across a solution. Use a different set of lips. Yes, you know I’m cheeky. Instead of swallowing it, I could place the capsule in my vagina, take it to the source.  

This solution isn’t new. 

Understanding Micronized Progesterone Therapy

Progesterone is a key hormone in women's health, particularly in reproductive management and hormone therapy. Micronized progesterone, designed for better absorption, offers benefits in various therapeutic contexts, including fertility treatments, hormone replacement therapy, and menstrual irregularities. However, the route of administration—oral or vaginal—can significantly influence its effectiveness and side effects.

Vaginal vs. Oral Administration: What Research Shows

Studies have explored the differences in the bioavailability, efficacy, and side effects between vaginal and oral administration of micronized progesterone. For example, Nahoul, Dehennin, Jondet, and Roger (1993) highlighted that vaginal administration leads to higher circulating levels of progesterone and estradiol compared to oral routes, suggesting better hormone replacement therapy outcomes via the vaginal route [(Nahoul, Dehennin, Jondet, & Roger, 1993)](https://consensus.app/papers/profiles-plasma-estrogens-progesterone-metabolites-nahoul/e1aab6802d3a54059c115a4685dc8379/?utm_source=chatgpt).

The Case for Vaginal Administration

Vaginal application of micronized progesterone is shown to offer more stable serum levels with fewer metabolic byproducts, which could translate to reduced side effects. This route bypasses the liver's first-pass metabolism, presenting a more direct path to the bloodstream. In the context of fertility treatments, such as in vitro fertilization (IVF), Ganesh et al. (2011) found that vaginal progesterone provides effective luteal phase support, comparable to oral alternatives, without the common side effects associated with oral administration [(Ganesh, Chakravorty, Mukherjee, Goswami, Chaudhury, & Chakravarty, 2011)](https://consensus.app/papers/comparison-dydrogestrone-progesterone-micronized-ganesh/e9b88c6e30a55dd584019838ea6c6465/?utm_source=chatgpt).

Oral Administration and Its Discontents

Oral micronized progesterone, while effective for certain uses, has been associated with side effects such as dizziness, headaches, and mood alterations. These effects stem from the metabolic processes in the liver, altering the hormone's impact on the body. Freeman et al. (1992) noted that while oral progesterone can be prescribed at higher doses without significant risk, it may lead to transient behavioral effects in some individuals, underscoring the importance of careful dosage management [(Freeman, Weinstock, Rickels, Sondheimer, & Coutifaris, 1992)](https://consensus.app/papers/placebocontrolled-study-effects-progesterone-freeman/496c85c43cbd51a3b49655d01832ddb6/?utm_source=chatgpt).

Making an Informed Choice

For women and healthcare providers considering progesterone therapy, these findings underscore the importance of choosing the right administration route. Vaginal administration may offer a favorable profile with fewer systemic side effects, making it a preferred option for hormone therapy and reproductive treatments.

One alternative thought is, you are so low, deficient, in progesterone. Progesterone is the first hormone to decline, that once your levels are increased and stable the grogginess will go away. You can hear about this of a past Agelust episode here, with Dr. Damaris Grossman. 

This deficiently seemed to ring true for me because I now have no problems taking 200mg via my mouth for 12 days without incident. If I DO notice grogginess, I will then pop one in the honey pot without an issue. 

Consulting Healthcare Professionals: A Necessary Step

Before making any changes to your hormone therapy regimen, it’s important to consult with a healthcare provider. Individual responses to hormone therapy can vary significantly based on a multitude of factors, including age, health status, and specific medical conditions. A healthcare provider can offer personalized advice, taking into account your medical history and current health needs to determine the most appropriate route of administration for you. They can also monitor your progress and adjust your treatment plan as necessary to ensure optimal health outcomes. Remember, while personal experiences and research studies provide valuable insights, the guidance of a healthcare professional is essential in making informed decisions about your health.

The choice between vaginal and oral administration of micronized progesterone is a personal one, influenced by individual health objectives, treatment goals, and potential side effects. By consulting with a healthcare provider and considering all available information, you can make a choice that best supports your overall well-being.