Progesterone for Hot Flashes

Following the publication of the Women’s Health Initiative report in 2002, there was a dramatic drop in the use of hormone-replacement therapy (HRT) due to concerns about increased risk of heart disease, breast cancer, and stroke. Since that time, various non-hormonal alternatives have been utilized for the treatment of menopausal symptoms, including gabapentin and various serotonin reuptake inhibitors.

While it seems that many women have shied away from hormonal interventions, several studies have explored the use of progesterone to treat vasomotor symptoms (VMS). In a randomized placebo-controlled trial of 133 healthy women with VMS, oral micronized progesterone (300 mg daily) was more effective than placebo for the treatment of vasomotor symptoms.

However, synthetic progestins have been linked with cardiovascular risk, and concerns regarding safety have limited their use. Researchers hypothesize that natural progesterone (marketed in the US as Prometrium) may be a safer option. A controlled trial assessed 112 women at baseline and after 12 weeks of progesterone treatment in order to assess the impact of progesterone on various cardiovascular risk factors. Progesterone did not affect endothelial function, weight, blood pressure, waist circumference, inflammation, or coagulation.

While these results are encouraging and support the short-term cardiovascular safety of progesterone, we need more data, collected in a larger sample of women and over a longer period of time, in order to support long-term treatment with progesterone for the management of menopausal vasomotor symptoms.

Ruta Nonacs, MD PhD