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HRT in surgical menopause
How much progestogen do I need as add-back if I am using estrogen-therapy?
How much progestogen do I need as add-back if I am using estrogen-therapy?

Keywords: HRT. progesterone. Surgical menopause.

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Written by IAPMD
Updated over a week ago

Expert guidelines for hormone therapy in premature menopause (ACOG recommendations; ) recommend the following roughly equivalent doses for those in premature menopause who are taking estrogens and still have a uterus:

(If you had a total hysterectomy as well as bilateral oophorectomy then you do not require the protection of progesterone. If you only had ovary removal and are using estrogen HRT then you will require a progestogen add-back).

(1) Oral micronized progesterone (Recommended by all Expert Guidelines)


100 mg/daily (recommended) or 200mg for two weeks per month. If needed, higher doses can be given with no increased risks.

How you take it

Orally at night.

(2) Levonorgestrel-containing Intrauterine system (IUS/IUD) (Recommended by all Expert Guidelines)


20 micrograms/day.

How you take it

Inserted at a doctor’s appointment; procedure can be painful but rarely causes risks.

(3) Medroxyprogesterone Acetate (MPA) (Not Recommended Per Expert Guidelines)


2.5 mg daily.

How you take it


(4) Other progestins, including Norethindrone acetate, Norgestimate, and Drospirenone



How you take it

Orally or via combined estrogen-progestin patch.

Note. If you have a uterus (no hysterectomy), you will need to take a progestogen in addition to estrogen to prevent uterine cancer.

Visit for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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