An Off-label Option for Cycles of Prometrium (progesterone)

Note: This information is not intended to take the place of your physician’s guidance. For information related to your own hormonal needs, check with your health-care provider. No matter if you have been prescribed high dose Prometrium because of previous miscarriages or low dose to prevent pregnancy, or if you are in treatment for fertility support, please do consult with your physician when it comes to your own personal hormonal therapy.

Originally written, April 2011

Post-menopausal women often cycle with 100-200 mg of Prometrium to protect their uterus. Depending on the dosage of estrogen their need for progesterone will vary from as infrequently as once every second or third month to much more often if a woman’s estrogen levels are high.

The need for progesterone, and then its withdrawal after 10-14-days of high dosage, is what causes the shedding of the uterine lining if there is a build-up of blood.

Women have different responses to Prometrium cycling but almost everyone notices the sleepiness it most often causes and that’s why it is taken at bedtime. Many women enjoy the benefit of the deep sleep that results from Prometrium. However, there are numerous reports regarding one of the disturbing side-effects discussed by women. The awful nightmares that occur, sometimes the nightmares are so disturbing that women will avoid cycling with it altogether.


Note: I experienced early ovarian failure. With very low estrogen levels I was pre-menopausal in my mid-thirties, my last period was at age forty. My estrogen was so low ( like that of a 10-year girl my doctor said) that I really did not need progesterone, rarely if at all. However, once, maybe twice a year, I would cycle progesterone, though I only did this a few times because I never had much estrogen build up, also, the side-effects were most uncomfortable. I was one of the women who suffered terrible nightmares when taking oral Prometrium. It was awful to experience 2-weeks of extreme fear that would grip me each night while cycling the hormone. It was on the advice of my doctor, once I told her I won’t go through it anymore, that I learned about the following off-label method. Thankfully it worked for me.

The Problem of Nightmares

Nightmares occur for many women when the oral  soft-gel Prometrium tablets are swallowed by mouth and have to pass through digestion and the liver. A solution for avoiding nightmares, reported to work by many women including myself, is to insert the tablets vaginally just before bedtime where they melt and are absorbed by the blood directly. This method provides the uterine benefits of the progesterone without the uncomfortable side-effect of the nightmares when the capsules are swallowed and have to pass through the digestive system.  The vaginal method also seems to reduce uncomfortable side-effects that can be experienced by some women when taking high doses of progesterone for 10-14 days.


Progesterone is one of the naturally occurring female sex hormones. It is prescribed for some women in combination with post-menopausal estrogen replacement therapy to prevent estrogen from building up and thickening the lining of the uterus.

The shedding of the lining which builds up with estrogen use for some women is required to protect the uterus and reduce the risk of endometrial cancer.

Prometrium is used for women who have a uterus. The vaginal use of Prometrium (instead of oral) eliminates the side-effect of nightmares that often accompany oral ingestion.

Everyone woman has her own experiences with hormonal fluctuations during pre and post menopause, it can take some time to figure out what works best for an individual. It’s a bit of a juggling act at first until it is known which hormones are best suited. There are many options of delivery and dosages to explore with creams, liquids, patches, and capsules to choose from. 

Everyone woman has her own experiences with hormonal fluctuations and symptoms associated with pre and post menopause. If you are a woman who has experienced nightmares while taking high doses of Prometrium capsules ask your doctor about vaginal insertion at bedtime as an alternative method. It may be a way for you to get the benefits without the side-effects.

Good luck!







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