When Your Progesterone Prescription Can't Be Filled

Being told your pharmacy doesn't have Progesterone in stock is more than inconvenient — it can feel alarming. Whether you take it to prevent endometrial hyperplasia during menopause, to manage amenorrhea, or as part of a fertility treatment, missing doses isn't something you want to do.

If you're dealing with the ongoing Progesterone shortage, you might be wondering: are there alternatives? The short answer is yes — but it depends on why you take Progesterone and which form you use. Let's break it down.

What Is Progesterone and How Does It Work?

Progesterone is a bioidentical hormone — meaning it's chemically identical to the Progesterone your body naturally produces. It belongs to a class of medications called progestins (or progestogens), which are hormones that act on the uterus, breasts, and other tissues.

In the body, Progesterone does several important things:

• Transforms the uterine lining from a growth phase (proliferative) to a secretory phase, preparing it for a potential pregnancy
• Counteracts the effects of estrogen on the uterine lining, which helps prevent endometrial hyperplasia and cancer
• Supports early pregnancy by maintaining the uterine lining after implantation
• Helps regulate the menstrual cycle

As a medication, Progesterone is available in oral capsules (Prometrium), vaginal gels (Crinone), vaginal inserts (Endometrin), and intramuscular injections. For a complete overview, see our guide on what Progesterone is and how it's used.

Important: Not All Alternatives Work for Every Situation

Before we get into specific alternatives, here's a critical point: the right alternative depends entirely on why you're taking Progesterone.

• If you take Progesterone for menopausal hormone therapy or amenorrhea, synthetic progestins may be reasonable alternatives.
• If you use vaginal Progesterone for IVF or fertility support, switching to a different medication is more complicated and may not be appropriate. Your reproductive endocrinologist should guide this decision.
• If you take Progesterone for preterm birth prevention, alternatives are limited and should be discussed with your OB/GYN.

Never switch medications on your own. Always talk to your prescribing doctor before changing your Progesterone regimen.

Alternative 1: Medroxyprogesterone (Provera)

Medroxyprogesterone acetate, sold under the brand name Provera, is one of the most commonly prescribed synthetic progestins. It's used for many of the same conditions as Progesterone:

• Secondary amenorrhea (typical dose: 5-10 mg daily for 5-10 days)
• Abnormal uterine bleeding
• Endometrial hyperplasia prevention during estrogen therapy (typical dose: 2.5-5 mg daily)

Key differences from Progesterone:

• Medroxyprogesterone is synthetic, not bioidentical. It has a slightly different side effect profile.
• Some studies suggest bioidentical Progesterone (Prometrium) may have a more favorable cardiovascular and breast cancer risk profile compared to synthetic progestins like Medroxyprogesterone, though more research is needed.
• Medroxyprogesterone is generally inexpensive — often under $15 for a month's supply with a coupon.
• It's widely available and not currently on shortage.

Alternative 2: Norethindrone (Aygestin)

Norethindrone acetate, sold as Aygestin (5 mg tablets), is another synthetic progestin. It's FDA-approved for:

• Amenorrhea
• Abnormal uterine bleeding
• Endometriosis

A lower-dose form of Norethindrone (0.35 mg) is used as a progestin-only birth control pill, but that's a different use.

Key differences:

• Norethindrone has mild androgenic properties, meaning it may cause side effects like acne or oily skin in some patients — something Progesterone typically doesn't do.
• It's a viable alternative for amenorrhea and some forms of hormone therapy.
• Not typically used as a substitute for vaginal Progesterone in fertility treatments.
• Generic versions are affordable, usually under $30 per month.

Alternative 3: A Different Progesterone Formulation

Sometimes the best "alternative" isn't a different medication — it's a different form of the same medication. If oral Progesterone capsules are unavailable, your doctor might consider:

• Vaginal Progesterone gel (Crinone) — available in 4% and 8% strengths
• Vaginal Progesterone inserts (Endometrin) — 100 mg inserts used 2-3 times daily
• Compounded Progesterone — suppositories, creams, or troches made by a compounding pharmacy
• Injectable Progesterone in oil — intramuscular injection, though this is also in shortage

Switching between formulations isn't always straightforward because different routes of administration deliver Progesterone to the body differently. Vaginal Progesterone, for example, produces higher concentrations in the uterus than oral Progesterone, which is why it's preferred for fertility support. Your doctor will know which form is most appropriate for your situation.

Alternative 4: Megestrol Acetate (Megace)

Megestrol acetate is a synthetic progestational agent that's primarily used for endometrial cancer and appetite stimulation in patients with cancer or AIDS. It's not a typical substitute for Progesterone in routine hormone therapy, but in rare cases, it may be considered for endometrial protection. This would only happen under close medical supervision.

What About "Natural" or Over-the-Counter Progesterone Creams?

You may have seen over-the-counter Progesterone creams marketed as "natural" hormone products. These are not the same as prescription Progesterone and should not be used as a substitute. OTC creams are not regulated by the FDA for hormone therapy, and their absorption and hormone levels are unpredictable. If you need Progesterone for a medical condition, you need a prescription product.

Final Thoughts

If you can't find Progesterone, there are real alternatives worth discussing with your doctor — but the right choice depends on your specific medical situation. For menopausal hormone therapy and amenorrhea, Medroxyprogesterone (Provera) and Norethindrone (Aygestin) are the most common substitutes. For fertility support, switching formulations of Progesterone itself may be more appropriate than switching to a different drug entirely.

Before making any changes, always consult with your prescribing physician. And don't stop looking for Progesterone — use Medfinder to check real-time availability at pharmacies near you. For more strategies, read our guide on how to find Progesterone in stock.