Progesterone alternatives: What can I take instead of progesterone?

In this article:

• Progesterone alternatives
• Prometrium
• Provera
• Mirena IUD
• Endometrin
• Duavee
• OTC progesterone
• Natural alternatives
• How to switch

In this article

• Progesterone alternatives
• Prometrium
• Provera
• Mirena IUD
• Endometrin
• Duavee
• OTC progesterone
• Natural alternatives
• How to switch

Oral progesterone tablets are prescribed as part of hormone replacement therapy (HRT) for some women who are experiencing menopausal symptoms like hot flashes. Specifically, progesterone is used alongside an estrogen hormone by postmenopausal women who have a uterus, i.e., have not had a hysterectomy. The hormone protects against endometrial hyperplasia, which is the overgrowth of the uterine lining, and resultant uterine or womb cancer in the setting of estrogen therapy. Although progesterone is the most commonly used option, side effects can be bad enough to make people look for alternatives.

What can I take instead of progesterone?

The most commonly used progesterone is a micronized product, meaning it is finely ground to a microscopic level, allowing for better absorption when taken as an oral capsule. It goes by the brand name Prometrium and is bioidentical to the progesterone hormone produced by the ovaries. Other options include medroxyprogesterone acetate, a synthetic progesterone, and alternatives such as the Mirena intrauterine device (IUD), Endometrin vaginal insert, and the oral selective estrogen receptor modulator (SERM) bazedoxifene combined with estrogen. 

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of November 5, 2025. The listed pri,ce without insuran,crefers toes the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see the latest drug prices.

Top 5 progesterone alternatives

The following are some of the most common alternatives to progesterone.

1. Prometrium

Prometrium is the brand-name version of oral micronized progesterone. Brand and generic versions are felt to have the same beneficial and adverse effects. Among the most common side effects, headache, breast pain, abdominal bloating, and dizziness could be bad enough to motivate a user to switch to another option altogether. Brand-name Prometrium comes at a SingleCare-discounted, 90-day price of over $1,400 compared to $33 for the generic version, so there may not be a compelling reason to choose it. Using a free SingleCare discount card or coupon is all that is needed for the discount.

2. Provera

Before the development of micronized progesterone, Provera or its generic formulation, medroxyprogesterone acetate, were the first-line options when a progesterone was needed to accompany estrogen for post-menopausal HRT. The generic product has a price advantage, based on costing $12 per 90, 10 mg tablets with a SingleCare discount, compared to micronized progesterone, which runs $33 per 90, 100 mg capsules. 

After the Women’s Health Initiative (WHI) study found the combination of oral conjugated estrogen and medroxyprogesterone acetate to be associated with cardiovascular disease, probable dementia, and invasive breast cancer, use of Provera and its generic dropped. Micronized progesterone may help mitigate some of these risks and has become a favored option. 

3. Mirena IUD

The side effects and daily dosing of oral progestins can make alternatives seem appealing. The Mirena coil contains levonorgestrel, a progestin hormone, that is slowly released over the typical 5-year timeframe that the IUD is in place in the uterus or womb. By being present locally within the uterus, levonorgestrel can prevent uterine lining thickening when a post-menopausal woman is taking oral estrogen for postmenopausal symptom control. The use of the Mirena IUD for this purpose is not unusual, but it is considered off-label, meaning it has not been approved by the Food and Drug Administration (FDA).

4. Endometrin

Another way to avoid taking progesterone orally and still have the effects of progesterone on the uterus is to use progesterone vaginal inserts, which go by the brand name Endometrin. Unfortunately, it is only approved for use as part of assisted reproductive technology programs and has not been studied enough in postmenopausal HRT.

5. Duavee

Duavee is approved by the FDA for the treatment of vasomotor symptoms of menopause (hot flashes) and prevention of postmenopausal osteoporosis. By combining estrogen with the SERM bazedoxifene, the benefits of estrogen on hot flashes can be realized without causing thickening of the uterine lining and without breast tenderness, making it an option for those with oral progesterone intolerance. Blood clots could still be a concern, though, and as a newer product, experience is more limited.

Over-the-counter progesterone

The primary progestin product that is available without a prescription is Opill (norgestrel). It is an over-the-counter (OTC) oral contraceptive to prevent pregnancy. Progestin-only pills (POPs) like Opill have a 99% effectiveness rate in preventing pregnancy, with fewer than 1 in 100 users becoming pregnant each year, if the pill is taken exactly as directed. The product is not used as part of menopausal symptom relief regimens.

Natural alternatives to progesterone

The incidence of menopause symptoms like hot flushes, mood changes, and vaginal dryness, coupled with the concerns over side effects of hormones, has driven interest higher in alternative medicine. Custom-compounded bioidentical hormone formulations have emerged but are not recommended by endocrinology experts. Herbal products, such as black cohosh, wild yam, and evening primrose, have been tried but still lack robust support from clinical trials. In addition, these remedies may have their own adverse effects.

How to switch to a progesterone alternative

The bottom line is that there are options besides progesterone when estrogen cannot be used alone for HRT. Changing from progesterone and selecting among the alternatives should not be done alone. Your healthcare provider can provide the necessary medical advice on what choice is best, based on side effects, drug interactions, and your history of medical conditions. After making a decision together, they can counsel you on how to make the changeover.