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    Includes Expert Content
    Question on Progesterone Dosage
    Cindy_DF posted:
    I have been given Progesterone 200MG capsules
    to take twice a day for 7 days. This is suppose to
    help me shed the lining in my uterus (start my period).
    I am 54 and thought I was done with periods until I
    got a light one last month. Ultrasound, endometrial
    biopsy, and other exams were normal. My question
    is how is it determined how much progesterone to
    prescribe to each individual woman? Dizzy and drowsy
    are my side effects for about 40 minutes. I don't feel it
    at night but I sure do during the AM hours that I take it.
    Anon_6061 responded:
    I can't answer your question but I'm curious why they want to force a period when the ultrasound and biopsy were normal. It sounds like you're just going through the typical irregular cycles of peri-menopause which oftentimes includes missed periods.
    Cindy_DF replied to Anon_6061's response:
    Is a missed period of 1 whole year considered an "irregular cycle" of peri-menopause? Without checking for hormonal levels, he said I was producing some estrogen (endometrial lining is at 1.28cm) and not enough progesterone to shed it. I am looking to have a work up to consider Bioidentical Hormone Treatment. I am interested in your response! Thank you!
    Mary Jane Minkin, MD responded:
    Dear Cindy,
    A couple of thoughts. Natural progesterone can certainly make you dizzy and drowsy; I usually try folks on 200 mg at night for 12 nights, to see if that gives you enough of a cleanout of the lining of your uterus. If your uterus were cleaned out (say, a lining of the uterus of 5 mm or less) I think you would be good to go; and you could do it every three months or so to clear things out. Another option would be to take a synthetic hormone like Aygestin; it is a bit more potent (at cleaning things out), and would tend not to fatigue you (and you don't have to take it at night). Again, if you got a good bleed, then I'd keep doing it every three months or so, to keep the lining of the uterus cleared out of there, in the perimenopausal state.
    if the lining remained thick, one could repeat a sampling of the lining of the uterus (from what you're saying, I assume the endometrial biopsy was a while back?)
    I hate to ask the question: but are you overweight? the reason I ask is that women who are heavy do make extra estrogen, and that can stimulate the lining of the uterus-so cleaning it out periodically isn't a bad idea, to prevent overgrowth.
    Good luck,
    Mary Jane
    Cindy_DF replied to Mary Jane Minkin, MD's response:
    Thank you Dr. Minkin! I will keep Aygestin in mind. Just to answer your question, I am not overweight. I eat healthy and
    exercise except for the last year I have not had much energy
    to exercise. The endometrial biopsy was done 2 weeks ago, which was normal.
    Either way I have seen another ob-gyn and has ordered a thyroid ultrasound and lab work. I will also be receiving a kit
    to test for hormone levels. It's early in the game to say "400mg of Progesterone per day was an overkill" but I really
    believe it was. I took 5 pills (1000mg total) in 2 1/2 days and stopped there.

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