How do I come off progesterone cream?

Hi Catherine,

I have been on 350 mg per day of micronzed progesterone cream for 2years. It has done the job - the fibroids and uterus have shrunck the bleeding has been controlled. How do I come off of this cream?

I was told that there would be bleeding when I stop the cream. The ob/gyn doctor I have now says to just stop it all at once. But I have a feeling that might not be good for my body. If I am truly menopausal should there be any bleeding from stopping the cream?

Thank you,

Pamela

Dear Pamela,

If you are getting such positive results from progesterone, why are you being advised to ‘come off’ cream?

Admittedly, 350mg of progesterone per day is excessive via transdermal delivery, therefore, you might be wise bringing that dose back to within normal limits to correspond with your estrogen levels. Medications like progesterone delivered via transdermal delivery avoid liver metabolism and hence allow for lower doses of medications.

The progesterone dose you are aiming to achieve would be 200 to 300 times that of your estradiol level based on salivary assay results.

If a woman is menstruating, regularly or irregularly, this indicates that her body has enough estrogen to build up the uterine lining which is shed when hormone levels fluctuate. Therefore, technically, she would not consider herself estrogen deficient, requiring estrogen replacement therapy.

When a woman reaches her late 40s or early 50s her estrogen levels plummet and she will stop menstruating, signaling, in most cases, the end the of her reproductive years (menopause).

I make this point, Pamela, because if you are truly in menopause and your estrogen levels remain low, then stopping progesterone cream WILL NOT bring on a period.

Yes, you can stop progesterone ‘cold turkey’ and you may not experience any problems initially. At least not until your stores of progesterone begin to decline. Some women don’t need progesterone supplementation. But I’m a little concerned in your case because of your history of fibroids which tend to be estrogen-driven.

We now know that estrogen without progesterone is a setup for many reproductive cancers - including breast cancer.