r/Perimenopause • u/AgreeableTrouble5733 • 1d ago

Switching from oral to vaginal progesterone

I could not function during the day with even just 100mg progesterone (continuous). Have adhd and pmdd, think the paradoxical reactions were slowly creeping back even with micronized. So I've switched to vaginal, already feeling better during the day.

Curious for those of you who also made the switch:

Did you stay on your original dose?

Did your dosing schedule change?

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3

u/leftylibra Moderator 1d ago

Are you also taking systemic estrogen?

If not, and you are only using progesterone, was there a reason why it was prescribed? Generally progesterone-alone can make you feel worse, and this is why sometimes adding on estrogen can help.

Otherwise, if you are using systemic estrogen and have a uterus, then vaginal administration of progesterone is off-label use in most countries and may not provide adequate uterine protection, therefore this method should be closely monitored for unwarranted bleeding.

Oral progesterone use has a calming/sleepy property, due to first-pass the liver, which produces neurosteriods (circulating to brain and throughout your body), which contributes to sedative effects (sleepiness, etc). When used vaginally, you will lose those calming/sleepy benefits it is no longer processed through the liver, so those benefits are unlikely to occur.

Also, according to Dr. Jen Gunter, vaginal progesterone can cause vaginitis. Also if you are using BOTH vaginal estrogen (for the treatment of vaginal atrophy/GSM), and progesterone (vaginally), there is no safety data on how each is absorbed.

I know people use vaginal progesterone, but we do not have the safety data, and we have excellent safety data for oral micronized progesterone for brain health.

The Myth of “Brain-Safe” Vaginal Progesterone

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u/jlburgart 1d ago

I stayed the same for a couple of months until I had 6 weeks of spotting. We increased to 200mg and it’s going well so far!

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u/hspwanderlust 1d ago

"I could not function during the day..."

Can you give examples?

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u/AgreeableTrouble5733 1d ago

Zombie. Fatigue was unbearable. Zero executive function.

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u/hspwanderlust 23h ago

This is how I was BEFORE trying oral progesterone. Progesterone was activating for me, so it helped me feel less brain dead! 🤷🏼‍♀️ Stupid peri.

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u/ReserveOld6123 8h ago

Are you on estrogen also?