Answer these questions to find which progesterone option best matches your priorities. Based on the article comparison, we'll recommend the most suitable choice for your situation.
When doctors prescribe Prometrium - a synthetic oral micronized progesterone, they expect a reliable source of Progesterone that mimics the body’s own hormone. But the market offers a mix of pills, gels, inserts, and compounded creams, each with its own pros and cons. If you’re juggling menopause symptoms, infertility treatment, or a hormone‑replacement plan, knowing how Prometrium stacks up against its alternatives can save you money, reduce side‑effects, and improve outcomes.
Prometrium is an FDA‑approved, oral micronized progesterone tablet. It contains 100 mg of progesterone per pill, derived from a plant source and processed to match the chemical structure of endogenous progesterone. Because it’s taken by mouth, it fits easily into a daily routine and is covered by most insurance plans for approved indications such as luteal‑phase support in IVF, prevention of endometrial hyperplasia, and hormone‑replacement therapy (HRT) for menopausal women.
Micronization creates tiny particles that dissolve quickly in the gastrointestinal tract, allowing the hormone to be absorbed into the bloodstream and travel to target tissues like the uterus, breast, and brain. Once inside cells, progesterone binds to progesterone receptors, triggering a cascade that prepares the uterine lining for implantation, stabilises mood, and reduces the risk of endometrial overgrowth.
Below are the most commonly prescribed or compounded progesterone options that patients compare with Prometrium.
Crinone is a 90 mg progesterone gel applied once daily directly into the vagina. Because it bypasses the liver, blood levels rise more steadily, often resulting in fewer systemic side‑effects like drowsiness. It’s FDA‑approved for luteal‑phase support in assisted reproductive technology.
Endometrin delivers 100 mg of progesterone via a small, dissolvable insert placed in the vagina. The gel‑like consistency offers a controlled release over 8-12 hours, making it convenient for night‑time dosing.
Utrogestan, popular in Europe and Canada, provides 200 mg of micronized progesterone per capsule. It’s taken orally like Prometrium but at a higher dose, which can be split for fine‑tuned therapy.
Many compounding pharmacies create custom creams (usually 10-20 mg/g) that patients apply to the skin twice daily. Because absorption varies with skin type and application site, blood levels can be inconsistent, but the topical route avoids first‑pass metabolism altogether.
MPA is a synthetic progestin found in products like Depo‑Provera and Prempro. It’s not bioidentical; its molecular structure is different, leading to a distinct side‑effect profile that includes weight gain and potential lipid changes.
Norethindrone is another synthetic progestin often used in combined oral contraceptives. While it provides reliable cycle control, it does not offer the same endometrial protective effects as true progesterone.
Side‑effects differ mainly by delivery route and whether the product is bioidentical.
| Product | Form | Bioidentical? | Typical Dose | Cost per Month (USD) | Common Side‑effects |
|---|---|---|---|---|---|
| Prometrium | Oral tablet | Yes | 100 mg daily | $45-$70 | Sleepiness, bloating |
| Crinone | Vaginal gel | Yes | 90 mg daily | $80-$120 | Local irritation, rare drowsiness |
| Endometrin | Vaginal insert | Yes | 100 mg nightly | $90-$130 | Discharge, discomfort |
| Utrogestan | Oral capsule | Yes | 200 mg daily (or split) | $55-$85 | Sleepiness, nausea |
| Compounded Cream | Topical | Yes (varies) | 10-20 mg/g twice daily | $60-$100 (depending on pharmacy) | Skin irritation, variable levels |
| Medroxyprogesterone Acetate | Oral/Injectable | No | 5-10 mg daily (oral) or 150 mg IM q3mo | $30-$50 | Weight gain, lipid changes |
| Norethindrone | Oral | No | 0.5-5 mg daily | $15-$35 | Mood swings, breakthrough bleeding |
Scenario 1 - IVF luteal support: A 34‑year‑old undergoing embryo transfer wants the most reliable blood levels. Many clinics start with Crinone because vaginal delivery avoids first‑pass metabolism, but if the patient has vaginal irritation, switching to oral Prometrium at 100 mg twice daily is an evidence‑backed alternative.
Scenario 2 - Menopause symptom relief: A 57‑year‑old prefers a simple nightly pill and wants insurance coverage. Prometrium at 100 mg nightly provides mood stability and protects the uterus, while avoiding the higher out‑of‑pocket cost of vaginal inserts.
Scenario 3 - Compounded cream user: A 42‑year‑old uses a 20 mg/g cream for perimenopause but reports erratic mood swings. Switching to a FDA‑approved oral tablet gives predictable serum progesterone and eliminates the guesswork of skin absorption.
There’s no one‑size‑fits‑all answer. If you value oral simplicity, solid insurance coverage, and proven bioidentical chemistry, Prometrium often edges out the others. For patients who experience pronounced sedation or have gastrointestinal sensitivity, a vaginal gel or insert like Crinone or Endometrin can deliver steadier hormone levels with fewer systemic effects. Synthetic progestins remain low‑cost options but sacrifice the natural hormone match and may carry different metabolic risks.
Ask your healthcare provider to weigh your medical history, cost considerations, and personal preferences against the comparison points above. The right choice is the one that aligns with your health goals while keeping side‑effects manageable.
Usually not. Combining a bioidentical progesterone with a synthetic progestin can lead to excess hormone levels and increase side‑effects like mood swings or weight gain. Always discuss combination therapy with your doctor.
Prometrium is often prescribed for luteal‑phase support in IVF, which involves early pregnancy. Outside of assisted reproduction, routine use in a confirmed pregnancy isn’t recommended without specialist guidance.
Yes. Compounded creams require a physician’s prescription because the formulation, concentration, and dosage must be tailored to your individual needs.
Peak serum levels appear 2-4 hours after taking a tablet. Clinical effects, like endometrial protection, usually require a few days of consistent dosing.
Because both deliver progesterone, a short overlap isn’t harmful, but it may raise hormone levels temporarily. Most clinicians advise a 24‑hour gap to avoid excess sedation.
Written by Diana Fieldstone
View all posts by: Diana Fieldstone