Progesterone: All Your Options, Clearly Explained

If you’ve ever been told, “You need progesterone,” and then immediately felt overwhelmed by the how, which, what dose, and why does everyone do this differently — you’re not alone.

There are a lot of progesterone options. That’s both the good news and the confusing part.

Most prescribers will tell you about one option but I want you to know all your options, why you might choose one over another, and how having (or not having) a uterus changes the conversation.

One quick note before we begin:

Yes, progestins exist. They are synthetic. They are used in birth control and some hormone therapies. That is not what we’re talking about today.

This is about progesterone (like the kind in your body).

Option #1: Oral Progesterone (Prometrium®)

This is the most commonly prescribed form of progesterone in the U.S.

The pharmaceutical brand is Prometrium, and it comes in:

• 100 mg

• 200 mg

It is FDA-approved, which is reassuring for many women.

However, there are a few caveats:

• It contains peanut oil (still, in the U.S.)

• It contains red and blue food dye

• It is immediate release

For many women, oral progesterone works beautifully for:

• sleep

• anxiety

• calming a wired nervous system

• reducing heavy periods and cramps

• preventing uterine hyperplasia (thickening)

But if:

• you have a peanut allergy

• you react to food dyes

• you need a dose other than 100 or 200 mg

• you fall asleep but wake up at 2–3am

…then we often turn to compounded progesterone.

Compounded Oral Progesterone

This is made at a compounding pharmacy, where a pharmacist prepares it specifically for you.

That means:

• no peanut oil

• no food dye

• your exact dose

• immediate release or slow release

Because it’s customized, it’s not FDA-approved — but it allows us to tailor progesterone to your body instead of forcing your body to adapt to the pill.

Option #2: Sublingual Progesterone (Lozenge or Troche)

This option dissolves under your tongue or against your gum, like a mint.

It’s also compounded (so not FDA-approved), but many women love it because:

• it absorbs quickly

• it gets into the bloodstream fast

• it can feel more immediate

Some of the progesterone is absorbed directly through the oral tissue, and some is swallowed in saliva — so it ends up being a bit of a dual-action route.

Another perk:

Sublingual progesterone can be combined with other hormones, like estrogen or testosterone, if that makes sense for you.

Option #3: Topical Progesterone (Creams & Gels)

Topical progesterone comes in two main forms:

• over-the-counter creams (usually max out around 20 mg per serving)

• compounded creams or gels (any dose needed)

Here’s the honest truth: progesterone is a very large molecule.

That matters because topical progesterone:

• may absorb into fat tissue and stay there

• may not circulate well systemically

• can “sit” in tissue without giving consistent effects

Some women do fine with topical progesterone. Others feel nothing at all.

Important side note: Wild Yam Cream

Wild yam does not turn into progesterone in the human body.

Yes, in a laboratory — with high heat, pressure, and multiple chemical steps — wild yam can be converted into progesterone.

Your body does not do that.

Wild yam (Dioscorea) has its own traditional uses in women’s health, but it does not equal progesterone.

Patches?

At this time, there are no progesterone patches like estrogen patches.

Option #4: Vaginal Progesterone

Vaginal progesterone is most well-known from the fertility world, which is why there are a couple of pharmaceutical brands available.

It can also be compounded at any dose you need.

This route can be a great option if:

• oral progesterone causes bloating

• you notice constipation or heartburn with the oral route

• you like the calming effect but not the GI side effects

The downside?

• it can be messy

• insurance may consider it “fertility-related” and expensive

But physiologically, vaginal progesterone is very effective — especially when uterine protection matters.

Option #5: Progesterone Injections

This option also comes from the fertility space.

Progesterone injections:

• are typically subcutaneous, not large intramuscular shots

• use a very small needle

• are becoming more common, though still less popular than estrogen or testosterone injections

They haven’t fully caught on in perimenopause and menopause care yet, but I’m seeing them used more often.

If You Have a Uterus and Take Estrogen

This part is critical.

If you have a uterus and are using estradiol, you must use progesterone to protect the uterine lining.

Without it, estrogen can cause:

• endometrial thickening known as hyperplasia

• and in worst-case scenarios, uterine cancer

Based on research, the protective options are:

• Oral progesterone

  • 100 mg daily

  • or 200 mg for at least 12 days per month

• Vaginal progesterone

  • 100 mg

Topical and sublingual progesterone have not been adequately studied for uterine protection, which is why they’re not first-line options for this purpose.

If You Do Not Have a Uterus

If you’ve had a hysterectomy and are on estrogen, you’re often told you don’t need progesterone — and that’s technically true.

But progesterone receptors live all over your body, not just in the uterus.

So many women without a uterus still choose progesterone to support:

• sleep

• calm

• anxiety reduction

• nervous system regulation

In those cases, progesterone becomes a quality-of-life hormone, not a protection requirement.

The Bottom Line

Progesterone isn’t one-size-fits-all.

There are many options, many routes, and many reasons one might work better than another.

The goal isn’t to force progesterone into your body — it’s to work with your physiology, your symptoms, and your life.

And yes, it’s okay to try, adjust, and revisit. Thankfully, there are options!