Utrogestan is micronised progesterone, in 100 mg and 200 mg capsules. It is used in hormone replacement therapy to protect the womb lining, in fertility treatment to support early pregnancy, and to treat irregular or absent periods. It is body-identical progesterone, which distinguishes it from the synthetic progestogens.
What is Utrogestan?
The South African Medicine Price Registry lists Utrogestan as Schedule 4 capsules containing progesterone at 100 mg and 200 mg.
It is “body-identical” progesterone — molecularly the same as the progesterone your own ovaries produce, derived from plant sterols and then micronised, ground into very fine particles so it can be absorbed from the gut. Without micronisation, progesterone taken by mouth is barely absorbed at all.
This distinguishes it from synthetic progestogens such as medroxyprogesterone, norethisterone and levonorgestrel. Those are chemically modified molecules that act on the progesterone receptor but differ in their other effects.
The distinction has become clinically important. In hormone replacement therapy, large observational studies have found micronised progesterone carries a lower breast cancer risk than synthetic progestogens, and a more favourable effect on blood clotting, blood pressure and lipids. The evidence is observational rather than from randomised trials, so it is suggestive rather than settled — but it is the reason micronised progesterone has become the preferred progestogen in HRT in many guidelines.
Two practical points about how it is taken.
Vaginal use is common and often preferred. Although licensed for oral use, Utrogestan is very frequently used vaginally — particularly in fertility treatment — because that delivers progesterone directly to the uterus with far less reaching the rest of the body, and correspondingly less drowsiness. Follow your prescriber’s instructions on route, since the same capsule is used both ways.
Take it at night. Progesterone is sedating — it is broken down into compounds that act on the same brain receptors as benzodiazepines. Taken at bedtime, that sedation is an advantage, and many women find it improves sleep, which is often disturbed in menopause.
What is Utrogestan commonly used for?
- Endometrial protection in HRT. This is its commonest use. Any woman with a uterus taking oestrogen must also take a progestogen — oestrogen alone thickens the womb lining and substantially raises the risk of endometrial cancer. Progesterone prevents that. Women who have had a hysterectomy do not need it.
- Luteal phase support in IVF and fertility treatment, maintaining the womb lining so an embryo can implant. Usually vaginal.
- Preventing preterm birth in women with a short cervix or a previous preterm delivery — vaginal progesterone has good evidence here.
- Recurrent miscarriage, in specific circumstances and with a specialist.
- Irregular, absent or infrequent periods, to induce a withdrawal bleed and regulate the cycle.
- Abnormal uterine bleeding, once the cause is established, and endometrial hyperplasia, to reverse thickening of the lining.
Two ways of taking it in HRT, both legitimate:
Cyclical — usually 200 mg for 12 to 14 nights a month, producing a monthly bleed. Suits women still having periods or recently through menopause.
Continuous — usually 100 mg every night, aiming for no bleeding at all. Suits women more than a year past their last period. Irregular spotting is common in the first three to six months and usually settles.
On HRT more broadly. The risks were widely overstated for two decades after the initial Women’s Health Initiative reporting. For most healthy women under 60, or within ten years of menopause, the benefits outweigh the risks — and HRT remains by a wide margin the most effective treatment for hot flushes and night sweats. Worth a proper conversation rather than being ruled out by reputation.
How Utrogestan fits into this medicine category
| Group | Examples | Notes |
|---|---|---|
| Micronised progesterone | Utrogestan | Body-identical; preferred in HRT |
| Synthetic progestogens | Medroxyprogesterone, norethisterone, dydrogesterone | Effective; different risk profile |
| Oestrogens | Estradiol patches, gels, tablets | Need a progestogen if you have a uterus |
| Combined HRT | Various | Both hormones in one product |
| Hormonal IUD | Mirena | Provides endometrial protection locally |
| Contraceptives | Combined pill, progestogen-only pill | HRT is not contraception |
One point worth stating clearly: HRT does not prevent pregnancy. Women in perimenopause can still conceive, and contraception is needed until 12 months after the last period (or 24 months if under 50).
A note on placement: Utrogestan is a women’s health and hormone medicine rather than a general one. This page’s category is being corrected. For other guides here, see HP553 and K-Fenak OTC.
See the general medicines hub.
What to check before using Utrogestan
Tell your doctor if you have a peanut allergy. Utrogestan capsules contain peanut oil, which is a genuine and specific contraindication. This catches people out.
Also tell them if you:
- Have or have had breast cancer or another hormone-dependent cancer.
- Have unexplained vaginal bleeding, which needs investigating first.
- Have had a blood clot, stroke or heart attack, or have a clotting disorder.
- Have liver disease or a liver tumour.
- Have porphyria.
- Have severe depression, or a history of it.
- Have epilepsy, migraine, asthma, diabetes, or kidney or heart disease.
- Are pregnant — it is used in early pregnancy for specific indications, so this needs your prescriber’s direction, not assumption.
- Take rifampicin, carbamazepine, phenytoin, phenobarbital, some HIV medicines, or St John’s Wort, which reduce its levels.
- Take ketoconazole, which raises them.
Practical points:
- Take it at bedtime, whether oral or vaginal — the sedation is real.
- Take oral capsules on an empty stomach, or at least an hour after eating; food increases absorption unpredictably.
- Do not drive shortly after an oral dose until you know how it affects you.
- Follow the route prescribed. Oral and vaginal are not interchangeable without advice.
- Keep your reviews. HRT should be reviewed at least annually, and breast screening kept up to date.
- Do not skip the progesterone if you take oestrogen and have a uterus. This is not the optional half.
Possible cautions and when to ask a pharmacist or doctor
Common effects: drowsiness, dizziness, headache, breast tenderness, bloating, mood changes and irregular bleeding or spotting, particularly in the first months. Vaginal use may cause local irritation or discharge.
Get emergency help for:
- Calf pain, swelling, redness or warmth, or sudden breathlessness or chest pain — possible blood clot.
- Sudden severe headache, weakness or numbness on one side, difficulty speaking, or sudden vision loss.
- Yellowing of the skin or eyes.
- Swelling of the face, lips or tongue, or difficulty breathing — particularly relevant given the peanut oil.
Seek prompt advice for:
- Any bleeding after menopause, or heavy, prolonged or unexpected bleeding. This always needs assessment.
- A new breast lump or change.
- Persistent low mood since starting.
- Severe abdominal pain.
- Migraine that is new, or worse than usual.
Contact your doctor if:
- Bleeding on continuous HRT has not settled after six months.
- Menopausal symptoms are not controlled — the dose or route may need adjusting.
- You want to stop or change HRT.
- You are perimenopausal and need contraception, which HRT does not provide.
- You are trying to conceive, or are pregnant while taking it.
Related medicine guides
Frequently asked questions
What is Utrogestan 200 mg used for? Protecting the womb lining in HRT, supporting the luteal phase in fertility treatment, preventing preterm birth, and regulating irregular or absent periods. It contains micronised progesterone.
What is Utrogestan 100 mg used for? The same purposes at a lower dose — commonly continuous daily HRT, where 100 mg nightly aims for no bleeding.
What are Utrogestan tablets used for? They are capsules rather than tablets, and the uses are as above.
Why do I need progesterone with my oestrogen? Because oestrogen alone thickens the womb lining and substantially raises the risk of endometrial cancer. If you have a uterus, this is not the optional half of HRT.
Why does it make me sleepy? Progesterone is broken down into compounds acting on the same brain receptors as benzodiazepines. Taken at bedtime that becomes an advantage, and many women find it improves sleep.
Can I use the capsules vaginally? They are very commonly used that way, particularly in fertility treatment — but follow the route your prescriber specified.
Is it different from other progestogens? Yes. It is body-identical, and observational evidence suggests a lower breast cancer risk and more favourable effects on clotting and blood pressure than synthetic progestogens.
Can I take it with a peanut allergy? No. The capsules contain peanut oil. Tell your doctor.
Does HRT prevent pregnancy? No. Contraception is still needed until 12 months after your last period, or 24 months if you are under 50.