Drugs Q & A

Why is Progesterone Taken Night?

What is Progesterone?

Progesterone is a steroid and a hormone used as a part of hormone replacement therapy in women who have passed menopause (the change of life) and have not had a hysterectomy (surgery to remove the uterus). Hormone replacement therapy usually includes estrogen, which is used to treat symptoms of menopause and reduce the risk of developing certain diseases. However, estrogen can also cause abnormal thickening of the lining of the uterus and increase the risk of developing uterine cancer.

Progesterone helps to prevent this thickening and decreases the risk of developing uterine cancer. Progesterone is also used to bring on menstruation (period) in women of childbearing age who have had normal periods and then stopped menstruating. Progesterone is in a class of medications called progestins (female hormones). It works as part of hormone replacement therapy by decreasing the amount of estrogen in the uterus. It works to bring on menstruation by replacing the natural progesterone that some women are missing.

How should Progesterone be used?

Progesterone comes as a capsule to take by mouth. It is usually taken once a day in the evening or at bedtime. You will probably take progesterone on a rotating schedule that alternates 10 to 12 days when you take progesterone with 16 to 18 days when you do not take the medication.

Your doctor will tell you exactly when to take progesterone. To help you remember to take progesterone, take it around the same time in the evening.

The recommended dosing for progesterone (Prometrium) is as follows

  • Abnormal bleeding from the uterus (injection): Inject 5 mg to 10 mg into a muscle once a day for 6 days. Vaginal bleeding should stop within 6 days.
  • Lack of menstrual periods (injection): Inject 5 mg to 10 mg into a muscle once a day for 6 to 8 days in a row. You should expect a period about 2 to 3 days after your last injection. Your provider will tell you how often you should use this medication.
  • Lack of menstrual periods (oral capsule): Take 400 mg by mouth once a day at bedtime for 10 days. You should expect a period within 7 days of your last capsule. Your provider will tell you how often you should take this medication.
  • Uterus protection (oral capsule): Take 200 mg by mouth once a day at bedtime for 12 days in a row. Repeat these directions every 28 days.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take progesterone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Continue to take progesterone as directed even if you feel well. Do not stop taking progesterone without talking to your doctor.

Why take progesterone at night?

Doctors recommend that you take progesterone at night before bed because it has a sedative effect and helps resume normal sleep cycles. Studies indicate that, although the effects are modest and not simply related to plasma concentrations, progesterone and its metabolites can produce sedative-like effects in both men and women. In addition, it also eases anxiety and promotes memory.

How long before bed should I take progesterone?

When physicians prescribe pills that can cause sedation in patients, they usually advise that these pills be taken 30 min before bedtime. Experts recommend progesterone be given before bedtime for 2 nights. If a person falls asleep and stays asleep those two nights, the prescribed dose is effective.

Some studies have reported that the administration of sleeping pills 30 min before bedtime shortens sleep latency and increases total sleep time.

Why do progesterone pills make me sleepy?

Progesterone makes you sleepy because it stimulates your brain to produce a neurotransmitter called gamma-aminobutyric acid (GABA) — which helps you ‘switch off’ and sleep. This explains why it is sometimes called a ‘sleepy hormone’. Oral progesterone’s effect on sleep is very quick and occurs within 30 to 60 minutes.

However, while it promotes daytime sleepiness, progesterone can also cause nocturnal sleep fragmentation and insomnia.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Progesterone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • headache
  • breast tenderness or pain
  • upset stomach
  • vomiting
  • diarrhea
  • constipation
  • tiredness
  • muscle, joint, or bone pain
  • mood swings
  • irritability
  • excessive worrying
  • runny nose
  • sneezing
  • cough
  • vaginal discharge
  • problems urinating

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

  • breast lumps
  • migraine headache
  • severe dizziness or faintness
  • slow or difficult speech
  • weakness or numbness of an arm or leg
  • lack of coordination or loss of balance
  • shortness of breath
  • fast heartbeat
  • sharp chest pain
  • coughing up blood
  • leg swelling or pain
  • loss of vision or blurred vision
  • bulging eyes
  • double vision
  • unexpected vaginal bleeding
  • shaking hands that you cannot control
  • seizures
  • stomach pain or swelling
  • depression
  • hives
  • skin rash
  • itching
  • difficulty breathing or swallowing
  • swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • hoarseness

Laboratory animals who were given progesterone developed tumors. It is not known if progesterone increases the risk of tumors in humans. Talk to your doctor about the risks of taking this medication.

Medications like progesterone may cause abnormal blood clotting. This may cut off the blood supply to the brain, heart, lungs, or eyes and cause serious problems. Call your doctor if you experience any of the symptoms listed above as serious side effects. Talk to your doctor about the risks of taking this medication.

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