Can natural progesterone replace synthetic progestogens at menopause if I’m on HRT?

Yes, but there is a need for caution during this change-over phase.

There is considerable debate as to whether progesterone can actually prevent thickening of the endometrium. Although, based on observational experience, women do not suffer the same degree of tissue build up once they start progesterone. The medical fraternity are not convinced natural progesterone alone at physiological doses will adequately protect women from endometrial hyperplasia (excessive cell growth). Please refer to our ‘Medical References’ page as it explains why the medical fraternity hold this opinion.

Women who have an excessive build up of bloody uterine tissue, even after menopause, may have a shedding once they start progesterone upon initial stimulation of cell receptors activity in this area. But periods will not continue with regular progesterone application unless a woman is on estrogen therapy and taking breaks (as periods have stopped, ie., menopause).

In short, natural progesterone cannot be relied on to prevent endometrial hyperplasia if you are taking estrogen replacement therapy. We don’t know, at this stage, what dosage administration is required to oppose estrogen replacement therapy, specifically preventing thickening of the uterine lining. Chances are your doctor will insist you take a synthetic progestogen to compliment your ERT to protect you against thickening of the uterus. Compounding pharmacists are, therefore, matching natural progesterone therapy, usually in the form of troche, at doses that are equivalent to doses of progestagens. This approach appeases the doctor.

Of interest is the introduction of 10% natural progesterone creams that have perhaps been manufactured with this purpose in mind.

However, any bleeding that occurs during this stage of your life should be investigated.