What Happens If You Miss a Dose of Progesterone

If you miss one dose of progesterone, FDA-approved labeling for commercial progesterone products states that a single missed dose may be associated with return of menopausal symptoms, may be associated with breakthrough bleeding, or may be associated with reduced uterine-lining protection. FDA-approved labeling for commercial oral progesterone products (such as Prometrium) states that, if a dose is missed, the dose may be taken as soon as it is remembered that day, then the usual schedule resumed; patients should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product. Double doses should not be taken unless directed by the prescriber. The prescriber should be contacted if doses are missed repeatedly or if symptoms change.

In more detail: commercial progesterone preparations include oral capsules, vaginal suppositories, vaginal gels, and injections. Per FDA-approved labeling for commercial oral progesterone products, a single missed oral dose may be associated with light breakthrough bleeding or may be associated with return of menopause symptoms such as hot flashes or sleep changes; patients should follow their prescriber's instructions for their specific preparation. Per FDA-approved labeling for commercial oral progesterone products (such as Prometrium), if vomiting occurs within approximately 2 hours after an oral dose, the dose may be repeated per the labeled guidance; patients should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product. Per FDA-approved labeling for commercial vaginal progesterone products (such as Crinone or Endometrin), a missed vaginal dose may be associated with breakthrough bleeding or symptom changes; patients should follow prescriber and dispensing pharmacy guidance for their specific preparation. Per FDA-approved labeling for commercial injectable progesterone products, a delayed injection may be associated with earlier return of symptoms; patients should contact their clinic to reschedule rather than self-injecting additional doses, and should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product.

This information reflects FDA-approved labeling for commercial progesterone products and does not establish the safety, effectiveness, or labeling status of any compounded preparation; compounded preparations differ in formulation and regulatory status and should be used only as directed by the prescriber and the dispensing pharmacy.

What to do now

• Single missed oral dose: per FDA-approved labeling for commercial oral progesterone products, the missed-dose instruction is to take the dose as soon as it is remembered that day, then resume the usual schedule, unless otherwise directed by the prescriber; patients should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product.
• Vomited after oral dose: per FDA-approved labeling for commercial oral progesterone products, if vomiting occurred within approximately 2 hours, the dose may be repeated per the labeled guidance; patients should follow their prescriber's instructions.
• Single missed vaginal dose: per FDA-approved labeling for commercial vaginal progesterone products, patients should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product regarding a missed vaginal dose.
• Missed more than one dose or several consecutive days: per FDA-approved labeling for commercial progesterone products, breakthrough bleeding or irregular bleeding may be associated with missed doses; the prescriber should be contacted promptly—if estrogen therapy is also prescribed, prolonged missed progesterone doses may be associated with uterine-lining changes that require timely clinical discussion.
• Injectable progesterone: per FDA-approved labeling for commercial injectable progesterone products, patients should contact their clinic to schedule the next injection; additional doses should not be self-administered unless directed by the prescriber.
• When to seek help: heavy bleeding, severe pain, or repeated missed doses—the prescriber should be contacted so the treatment plan may be adjusted appropriately; patients should follow their prescriber's directions and the dispensing pharmacy's instructions for their specific product.