Questions about Cyclic Progesterone for Bone Density

Posted by emmyg1979 @emmyg1979, May 8 3:27pm

Hi all,

I am a 43 year old woman on HRT for Premature Ovarian Insufficiency (POI, formerly POF). I have done copious amounts of research and the take away is the that cyclic micronized oral progesterone (MOP) with a transdermal (TD) estradiol patch is the most effective strategy for preserving bone mineral density (TD or vaginal progesterone have shown no/inconclusive benefits like wise with TD estrogen creams/gels).

Estradiol inhibits osteoblast activity (bone breakdown) and Progesterone activates osteoclasts (bone building). The latest research that I have seen demonstrates greater osteoclast activation when administered cyclically versus continuous so that is what I am doing (12 of 28 days on progesterone). We are trying to achieve levels that would be within the physiologically normal-low range for my age.

My question is should I think about cycling a low dose and higher dose progesterone to maintain base levels of progesterone and balance the estradiol? It is my understanding that the MOP does not stay in the system for very long (gone within 24 hours after last dose). In other words, what are the negative side effects of having no progesterone, but normal estrogen for 2 weeks every month?

From what I have gleaned even normal estrogen can be a bit miserable without the proper amount of progesterone to balance it out. Any solid advice would be greatly appreciated.


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I don't know what it would be like to have estrogen not balanced with progesterone. I believe I did read somewhere that there was a trial of post-menopausal HRT that was stopped early because progesterone plus estrogen was associated with a very slight increase in risk of developing cognitive impairment, more so than with estrogen alone.
You could try the plan you've sketched out with your health care team, and see how it goes before deciding whether you want to change course.


I am an 80 years old intersex woman, which means, I never had working ovaries. The endocrinologists of the Gender Department of the Mayo Clinic in Rochester are treating me for many years now. They have me on estrogen, 100mg of progesterone, and low dose testosterone for many years now. I get an annual bone density test, and my bones are found to have very high density. I feel very comfortable with the hormone levels I have, and being 80, I can say that they have not had any negative changes for me.


At age 50 I started taking hormone replacement therapy due to low bone density. I used the estradiol patch and 200 mg of progesterone. The progesterone made me very tired and they switched it out 2 1/2 years ago to 12 days per month. It has been fine for me.


The ovarian insufficiency sounds to me like it may have a little bit in common with premature menopause. Since both my mom and an aunt had their menopause at a young age, I've looked into what I may be able to do to help delay mine, even a little. Obviously, at this point you really need the real hormone replacement, but in addition it may not hurt to research this route, too, to support your other treatments. One study in China found that women who ate more vegetables, especially green and yellow vegetables, had a somewhat later menopause. I'm trying to follow this kind of advice for my overall health and also to keep at least some hormones for as long as I can.

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