35: Understanding Progestogens in Menopause Hormone Therapy
Ep. 35
Menopause hormone therapy (MHT) can feel like a maze—especially when you start hearing terms like progesterone, progestin, and progestogen used interchangeably. If you’ve ever thought, “Wait… are these all the same thing?” you’re not alone.
In this episode of Reset Recharge, Dr. Komal Patil-Sisodia breaks down one of the most important—and most confusing—parts of menopause care: progestogens. By the end, you’ll know what these hormones do, why they’re essential for many women, and how different options fit different bodies and risk profiles.
Let’s reset the confusion and recharge your hormone literacy.
Listen to the full episode:
By Dr. Komal Patil-Sisodia | Reset Recharge Podcast | November 23, 2025
Progestogens in Menopause Hormone Therapy: What They Are, Why They Matter, and How to Choose the Right One
Why Do We Even Need Progesterone in Menopause?
Estrogen usually gets the spotlight in menopause therapy because it’s the hormone most tied to classic symptoms like:
hot flashes and night sweats
sleep disruption
vaginal dryness
mood shifts
brain fog
joint aches
that “my body feels unfamiliar” feeling
For many women, estrogen is what helps them feel like themselves again.
But estrogen also has a powerful effect on one specific organ: the uterus.
If you still have your uterus (meaning you haven’t had a hysterectomy), estrogen on its own can stimulate the uterine lining—called the endometrium—to keep growing. In your cycling years, progesterone balances that growth and triggers the lining to shed. But in menopause, ovulation stops, progesterone drops, and estrogen without a counterbalance can lead to:
endometrial thickening
endometrial hyperplasia
increased risk of endometrial cancer
Even if you’ve had a uterine ablation, this risk still applies because your uterus remains intact.
Bottom line:
If you're taking systemic estrogen and you still have a uterus, you need endometrial protection. That’s what progestogens provide.
A simple way to remember it:
Estrogen helps symptoms.
Progestogens protect the uterus.
Progesterone vs. Progestin vs. Progestogen: The Vocabulary That Matters
These terms get tossed around a lot, but they don’t mean the same thing.
Progesterone
The natural hormone your body makes
Produced mostly after ovulation
Balances estrogen during your cycle
Progestin
A synthetic (lab-made) version designed to act like progesterone
Protects the uterus
Because it’s structurally different, it may have different side effects and risk patterns
Common in birth control and also used in MHT
Progestogen
The umbrella term
Means any compound that activates progesterone receptors
Includes both progesterone and progestins
Once you’ve got that language down, the rest becomes much easier to understand.
Types of Progestogens Used in Menopause Hormone Therapy
In menopause care, there are two main groups:
1. Micronized Progesterone
This is progesterone that is chemically identical to what your body naturally makes. “Micronized” just means it’s processed into a form your body absorbs well.
Why many clinicians prefer it:
often better tolerated
tends to have a more favorable profile for:
breast cancer risk
cardiovascular health
metabolic outcomes
2. Synthetic Progestins
These are highly effective for uterine protection but vary more widely because their chemical structures differ. In the U.S., common options include:
medroxyprogesterone acetate (MPA)
norethindrone acetate
levonorgestrel
drospirenone
Outside the U.S., you may also see:
dydrogesterone
trimegestone
Key point:
Not all progestins are equal. Their differences can affect:
breast cancer risk
blood clot risk
cardiovascular safety
metabolic health
side effects like mood or breast tenderness
So when someone says “a progestin,” it matters which one.
How Progestogens Are Taken (Routes of Therapy)
Progestogens aren’t one-size-fits-all. They can be delivered through multiple routes:
Oral
pills taken daily or part of the month
commonly used and easy to adjust
Transdermal
patches or gels absorbed through skin
may not be as effective for endometrial protection in some cases
Vaginal
can be local or systemic depending on formulation and dose
Intrauterine (IUD)
Most often the levonorgestrel IUD, which provides:
strong local uterine protection
minimal whole-body exposure
a great option for women who don’t tolerate oral progestogens or want to reduce systemic risks
Many women also notice lighter bleeding, and some stop periods entirely with this option.
Continuous vs. Sequential: Two Ways to Use Progestogens
Once route and hormone type are chosen, the next decision is how to take it.
Continuous Regimen
progestogen taken every day with estrogen
often preferred in post-menopause
Pros:
steady uterine protection
typically no withdrawal bleeding after adjustment
simpler routine
Sequential (Cyclic) Regimen
progestogen taken 10–14 days per month
mimics a natural cycle
often used in early perimenopause
Pros:
fits better when ovaries still fluctuate
can feel emotionally/physically smoother for some women
may help manage irregular perimenopausal bleeding
In general:
Perimenopause → sequential often fits best
Post-menopause → continuous often fits best
But personal preference matters a lot here.
How Do You Choose the Right Progestogen?
There’s no universal “best” progestogen. There’s only the best for you.
Your clinician will consider:
Do you have a uterus?
Have you had an ablation?
Are you perimenopausal or postmenopausal?
What symptoms matter most to you? (sleep, mood, bleeding control, breast tenderness, etc.)
Personal and family health history
Risk factors (cardiovascular, clotting, breast cancer, metabolic health)
How you’ve tolerated hormones before
And yes—your best option can change over time as you move through the menopause transition.
Common Myths About Progestogens (Let’s Clear These Up)
Myth #1: “If it says progesterone, it’s all the same.”
Nope. Progestogen is a whole category. Different types have different effects.
Myth #2: “Progestogens are just an annoying add-on.”
Actually, they are critical for safety if you have a uterus. They prevent endometrial cancer in women using estrogen.
Myth #3: “If I feel bad on one, I’ll feel bad on all.”
Not necessarily. Switching type, dose, or route can make a huge difference.
A Simple Example of Why Individualization Matters
Imagine two women, both 52 and using estrogen for hot flashes:
Woman #1
has a uterus
wants no bleeding
has some cardiovascular risk factors
→ A clinician may choose micronized progesterone daily (continuous) for steady protection and safety.
Woman #2
early perimenopause
still cycling occasionally
already frustrated by irregular bleeding
→ She may do better on a sequential regimen, or even an IUD for local protection if systemic options feel rough.
Same goal. Totally different strategy.
Recap: What You Should Remember
If you have a uterus and take systemic estrogen, you need a progestogen.
Progesterone = natural. Progestins = synthetic. Progestogen = umbrella term.
Main options include micronized progesterone and several synthetic progestins.
You can take them orally, vaginally, transdermally, or via IUD.
Continuous regimens = steady protection, minimal bleeding.
Sequential regimens = mimic cycling, often better for early perimenopause.
The right choice is personalized to your body, risks, and goals.
The Takeaway
If you’ve ever been handed a prescription for “progesterone” with no bigger explanation, you deserve more context.
You deserve to know:
what it is
why it’s there
and how it fits your health story
Because the quality of your care often rises with the quality of your questions.
If this post helped clarify things, share it with someone navigating hormone therapy—or bring these terms into your next medical visit. You’re not just taking hormones. You’re making informed, empowered choices.
Until next time, Reset. Recharge. Take control of your health.