The risks and side effects of progestogens depends on the specific type you are taking. At times, side effects may be significant enough that a change in progestogen is needed. For those who cannot tolerate any progestogen, other approaches can be used.
Type of Progestogen
(1) Oral micronized progesterone
Risks
None.
Side Effects
Oral micronized progesterone is rapidly metabolized to substances called “neurosteroids” (for example, allopregnanolone) that act on the GABA receptor in the brain to (usually) cause sedation and a sense of calm. For some individuals, this effect is exaggerated and intense sleepiness can result; in these cases, it is important to dose oral micronized progesterone at night before bed, and one should avoid operating heavy machinery after taking it.
With all progestogens, some people also experience physical symptoms that are similar to those seen across the menstrual cycle, including bloating, cramps, or breast tenderness.
(2) Medroxyprogesterone Acetate (MPA)
Risks
Associated with an increased risk of breast cancer and coronary heart disease over the long-term in natural menopause studies. It also appears to have a negative impact on blood lipids.
Side Effects
With all progestogens, some people also experience physical symptoms that are similar to those seen across the menstrual cycle, including bloating, cramps, or breast tenderness.
(3) Levonorgestrel-containing Intrauterine system (IUS/IUD)
Risks
One study demonstrated a possible increased risk of breast cancer when used with or without estrogen.
Rarely, insertion of the IUD can cause perforation of the uterus.
Side Effects
With all progestogens, some people also experience physical symptoms that are similar to those seen across the menstrual cycle, including bloating, cramps, or breast tenderness.
(4) Other progestins, including Norethindrone acetate, Norgestimate, levonorgestrel, and Drospirenone
Risks
Associated with increased risk for blood clots (particularly drospirenone), although overall risk is low if otherwise healthy.
Not studied as well as MPA, but may be associated with small increases in risk for cardiovascular disease and breast cancer over the long term.
Side effects
With all progestogens, some people also experience physical symptoms that are similar to those seen across the menstrual cycle, including bloating, cramps, or breast tenderness.
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