Different delivery systems

What to be aware of with your Natural Progesterone and the different deliverance systems

Oral (Prometrium):

Research has shown that progesterone is most effectively absorbed and utilised by the human body when applied transdermally as a cream. It is not as effective when taken in capsule form because the liver breaks it down before it can exert an effect in the body.

For example, you would need to ingest 100mg of natural progesterone in capsule form (not available in Australia) to get the equivalent dosage of 10mg topically. The remaining 90% is rendered inactive by the liver and excreted in the bile.

Alternatively, direct transdermal application is taken up immediately by the body and used before being excreted through the liver.

Please note: If you live in Australia and are taking ‘oral progesterone’, it may be a synthetic progestogen (unless you have ordered it yourself from overseas and have a guarantee of your product).

Creams Used Topically:

Progesterone cream is applied directly onto the skin surface where it is absorbed and taken up by the blood vessels. This also bypasses the liver.

There is NO patch to date that contains natural progesterone, possibly due in part because research has shown that natural progesterone is most effectively absorbed and utilised by the human body when applied as a cream.

Creams Used Vaginally:

Not a standard procedure. We qualify certain guidelines here because the manufacturers of progesterone creams will tell you they have NO indication for usage in this manner.

There are few drug company endorsements of this unique approach to cream application as opposed to gel and suppositories. Most creams will have instructions for EXTERNAL USE ONLY. Dr Lee recommends topical application since evidence suggests it offers a more sustained delivery. However, if you choose to work with natural progesterone cream applied vaginally, this is strictly a personal choice and one you must be prepared to take full responsibility for, always erring on the side of absolute caution.

We are NOT making reference to the product ‘Crinone Gel’ which is specifically designed for vaginal use.

Disclaimer: We are not medical professionals and this information came from various sources in our own research. It is for information purposes only and is not a prescription for your particular needs. Consult with your health care professional if in doubt or if you have questions. We do not diagnose or try to overrule the advice of your health care professional. We refer you to our ‘Medical Reference’ page.

Common guidelines we suggest women adhere to:

• Ensure the cream is of the highest quality. Vaginal tissue is very delicate and sensitive, and can be thin, dry and atrophied, particularly for post-menopausal women. So check with your cream manufacturer or compounding pharmacist that there are no irritants or ingredients that contraindicate this form of usage. Be very gentle using an applicator as it may traumatise vaginal tissue because of the above reasons.
• Always insert with a clean, sterile applicator. Many market products come with reusable applicators such as the anti-fungal creams and estrogen vaginal creams. If you do not have an applicator, massaging cream up into the vagina with finger insertion will also have some good results and be more effective than topical application, but certainly will not have the impact of a deep vaginal deliverance. This is often a good way to start using progesterone (vaginally) to test sensitivity and skin irritation. Do not use before sexual activity. Best results are achieved at night-time because you are relaxed, lying still and the cream has time to be well absorbed.
• Insertion of cream vaginally may cause a slight burning sensation or internal throbbing. Discontinue if discomfort continues beyond a few minutes post application.
• Sensation of vaginal burning seems to correlate with the time of the month, and vaginal secretions and mucosal health. Particularly pronounced in the latter stage of your cycle.
• Because of it’s effective route of absorption, vaginal application should be very gradual (small dosage to start with, and alternate your days). Suggested starting dosage should be no more than 10-15mg of progesterone vaginally and assess your body’s reaction. If you’re getting a favourable response, we suggest you apply cream once or twice a week, building up to alternate days and, if need be, progress to daily doses. We also note that women prefer to alternate between vaginal and transdermal delivery for optimal site receptability.
• Some of the reported feedback from women using this delivery of progesterone include severe estrogen dominance wake up, even after being stabilised using topical delivery but not having optimal effects. Our observation is that we feel it delivers higher levels of progesterone and turns on more receptors thus stimulating estrogen dominance wake up.
• Note: This form of usage may result in a change of vaginal lubrication and discharge (usually within 24 hrs). You may notice vaginal secretions to be somewhat similar to that of ovulation - thick, sticky, odourless discharge, clear to slightly yellow in appearance. This discharge IS NOT always present after cream application. And make sure you DO NOT mistake this discharge for ovulation.

• When women reach a plateau and cream becomes ineffective, vaginal application has worked very well where topical delivery has rendered the progesterone therapy ineffective. These women have followed all the rules, taken their appropriate breaks from cream, but progesterone stopped delivering results. Because of the conditions they are trying to treat / control with progesterone, they require higher levels of progesterone dosage and maintenance. It is more economical to use less cream and derive the same dosage as that of a topical application.
• This unique approach to progesterone application seems to have a greater impact on the specific conditions such as endometriosis, fibroids, cervical hyperplasia, thickening of the uterus, and polycystic ovarian syndrome. This is because it appears to target tissue in these areas, as well as being systemically available via the blood. We know for a fact that when a woman suffering fibrocystic breasts rubs progesterone cream on her breast tissue, the body responds favourably and very quickly to this direct application approach. So we apply the same principle for vaginal application when attempting to address conditions relating to organs within the pelvic cavity.
• Other benefits reported by women using cream this way is halting migraines, improving bladder function such a stress incontinence, thrush, normalising vaginal pH levels, secretions and vaginal dryness. Some women still need to use progesterone in conjunction with estriol cream but they may find they need less over time to maintain healthy tissue.
• Vaginal application can bring on endometrial activity resulting in a period within 24 hrs; unusual discharge and colour (not offensive in smell), shedding of fibrous matter as reported by women with fibroids, headaches can result, tender breasts, severe PMS. If this is the case, stop. Resort back to phytoestrogens and topical application until it settles and then try again on a lesser dose.
• Please do not attempt this approach without full knowledge of your condition, particularly if it’s of a bleeding nature. Or if you have not undergone a recent medical checkup that included an internal examination or ultrasound.
• Indications when NOT to use cream vaginally: recent surgery, signs of infection, active thrush, cystitis, you suspect you are pregnant, history of STDs, or any condition that is being treated by a doctor.

In summary, advantages / disadvantages include:

• doubles the absorbability rate


• higher levels of progesterone receptability


• may induce spiking of progesterone levels in the body that are not as sustained as transdermal delivery


• more cost effective because you use less


• ability to raise progesterone levels quickly, particularly in times of stress or an impending migraine, or where reserves are not there


• an alternative when topical absorption appears to be poor or women appear to not assimilate their cream effectively

Please note, this overview of vaginal usage of progesterone cream has uniquely evolved out of women’s experimentation and providing feedback to the Natural-Progesterone-Advisory-Network.com website using one specific manufactured cream. Prior to pursuing this form of progesterone therapy we did contact the manufacturer asking if there was any ingredient that might be harmful if applied vaginally. His response was, “No, but it was not designed to be used that way". Being the women that we are, and having come across articles supporting vaginal delivery, we endeavoured to experiment with our bodies once again. Results to date have been very encouraging.

Please refer to our ‘Medical References‘ section on Vaginal Progesterone Absorption. All these articles give evidence that vaginally administered progesterone is well absorbed, possibly better than transdermal. It also gives evidence that for those women who feel they must use an estrogen supplement, vaginal progesterone, in adequate doses will protect their endometrium from the estrogenic effects.

Lozenges / Troches:

Dissolved buccaly (between the teeth and the cheek), these are similar to the topical route in that it bypasses the liver, making it immediately available to the body. It will give you higher doses more quickly but might increase the side effects (break-through bleeding).

Troches administer a larger dose of progesterone relative to the cream because when the troche dissolves much of the saliva in which the contents of the troche are dispersed is swallowed. Progesterone taken orally is essentially inactived by the liver before it can achieve any beneficial effects.

Pessaries / Vaginal Suppositories / Vaginal Gel:

The amount absorbed is double that of transdermal delivery. This also bypasses the liver, and results are rapid. Australian pessaries, used predominantly in higher dosage for fertility purposes, are wax-coated and may compromise the delivery as opposed to cream or gel. To date, Crinone gel is not accessible to our Network so we cannot comment on its usage and performance, but we are looking forward to the opportunity.

Anal Suppositories:

Another form of deliverance, one that very few women adopt.