It’s completely normal to feel cautious or even fearful when you hear the word progesterone, especially if you’ve come across confusing or alarming information online. Sadly, headlines designed to sell often scare women with half-truths. You deserve clarity when it comes to your women’s health needs so you can make informed, confident choices about your hormone therapy.

One of the biggest sources of confusion in menopause care is the belief that all progesterone medications are the same. They’re not. Let’s break it down.

What Are Progestogens?

Progestogens are a family of hormones that play a key role in supporting pregnancy and regulating the menstrual cycle. They are used in many medical therapies like birth control, menopause hormone therapy, and treatment of gynecologic conditions to protect the uterine lining and influence hormone stability.

There are two main types of progestogens:

Natural progesterone, made by your body
Synthetic progestogens (called progestins), which are man-made versions created to mimic progesterone's effects

Both types are considered progestogens because they can act on the body’s progesterone receptors but they don’t all act the same way. That’s where things get important.

Why Do You Need a Progestogen in Menopause?

If you’re taking estrogen therapy and still have your uterus but are not using an IUD like Mirena or Liletta, you’ll also need a progestogen to protect your uterine lining. Estrogen alone can cause the lining to thicken, increasing your risk for uterine (endometrial) cancer. A progestogen balances this effect and reduces that risk.

But the type of progestogen used MATTERS, a lot!.

Micronized Progesterone: Nature-Identical and Gentle on the Body

Micronized progesterone is a form of progesterone that is bioidentical, meaning it’s chemically identical to the progesterone your body makes naturally. This version is usually derived from plant sources like yams and is processed so your body can absorb it effectively when taken as a capsule.

This type of progesterone has been shown to have a lower risk of side effects and health complications than synthetic progestins. Research has found that micronized progesterone:

Is not linked to the same increased risk of breast cancer that’s seen with some synthetic progestins
Has minimal impact on blood clot risk (venous thromboembolism or VTE)
Doesn’t negatively affect cholesterol or blood sugar the way some synthetic versions can

The most common side effect? Drowsiness which is why we usually recommend taking it at bedtime.

Micronized progesterone is the preferred choice for many women, especially those with higher risks of cardiovascular disease, breast cancer, or clotting disorders.

Synthetic Progestins: Are Not the Same As Micronized Progesterone

Synthetic progestins such as medroxyprogesterone acetate (MPA) or norethindrone acetate are not the same as natural progesterone. These are man-made hormones that were developed decades ago and work a bit differently in the body.

While they also protect the uterus when combined with estrogen, synthetic progestins:

Have been associated with a higher risk of breast cancer and blood clots compared to natural progesterone
May affect mood and increase fluid retention (think bloating or puffiness)
Can negatively impact cholesterol and blood sugar levels

These risks occur because many synthetic progestins interact with other hormone receptors in the body, not just the progesterone receptor. That means they can behave more like androgens (male hormones), corticosteroids, or aldosterone (which affects salt/water balance), and that’s why they can have more unwanted side effects.

Why the Choice of Progestogen Matters

Although all progestogens share the ability to protect the uterus, they do not have the same safety or side effect profiles. There is no class effect when it comes to safety, meaning you can’t assume all progestogens work the same just because they have a similar name. This is where the media makes headlines that scare women.

More than 200 synthetic progestins have been developed, but only a few are used in clinical practice today. Their individual differences, especially how they interact with other hormone receptors can significantly impact a woman’s experience on hormone therapy. If you have ever used birth control pills and experienced side effects on one brand that resolved on another, you have lived the difference.

That’s why choosing the right one should be personalized to your medical history, risk factors, and treatment goals.

Bottom Line

Your hormone therapy should support your health, not add to your worries.

Feeling overwhelmed by hormone therapy options is completely normal. But rest assured: there is a world of difference between micronized progesterone, which is bioidentical and well tolerated, and synthetic progestins, which may carry higher risks.You deserve care that’s convenient, rooted in science, delivered with compassion, and tailored to you, like the care offered at MyMenopauseRx.