Best HRT for Progesterone Intolerance: How to Feel Better When the Progesterone Is the Problem

The HRT Index Editorial TeamIndependent women's health research

Published: May 15, 2026Last reviewed: June 16, 2026

Editorial research — not medically reviewed by a clinician. Why this label

Independent · Editorial research · Last verified: June 16, 2026· By the editorial team at The HRT Index

The HRT Index is an independent comparison resource for HRT telehealth providers. The provider links on this page are direct, non-affiliate editorial links — we don’t currently have affiliate partnerships with the companies we compare, and we’re never paid for rankings. This page is editorial research, not medical advice, and it is not medically reviewed. For decisions about starting, stopping, or changing hormone therapy, talk to a licensed clinician who knows your history.

If the progesterone in your HRT is making you feel worse — anxious, flat, bloated, weepy, or just not like yourself — here’s the bottom line. The best HRT for progesterone intolerance is almost never “estrogen on its own.”It’s the same estrogen, paired with a progesterone your body can actually handle. If you have a uterus, you can’t simply drop the progesterone, and we’ll explain why in plain English in a moment. But you canchange the type, the dose, the timing, or the route — and for most people, one of those changes makes the difference.

Quick definitions. Progesterone is a hormone your ovaries used to make. Progestogen is the umbrella word for progesterone plus its lab-made cousins. Progestinmeans the synthetic (man-made) versions. When people say they “can’t tolerate progesterone,” the exact one matters — synthetic progestins are the problem for many people, and switching to body-identical progesterone helps a lot of them, though some still react to that too.

Fast answer: which path fits you?

This table is your shortcut. Find your situation, see the first move, then read on for the why.

Your situation	Best starting move	Why
You have a uterus, on an estrogen pill/patch, and the progesterone tanks your mood or energy	Ask a clinician to switch you to body-identical progesterone and adjust the dose (Midi if you want insurance; Winona if you want fast cash-pay)	The fix is usually a switch, not quitting — so you want someone who’ll keep tuning it
You have a uterus and want the least hormone reaching the rest of your body	Ask about a 52 mg levonorgestrel IUD (placed in person)	It releases hormone right where it’s needed, with very low blood levels
You have a uterus and want estrogen with no progestogen at all	Ask a clinician about Duavee (an FDA-approved estrogen + SERM pill)	It protects the uterine lining without a progestin
You’ve had a hysterectomy (no uterus)	Estrogen-only is usually fine — confirm with a clinician	Without a uterus, most people don’t need a progestogen
You want it covered by insurance	Midi Health	Built around PPO insurance and ongoing visits
You want shipped, cash-pay medication and easy dose changes	Winona	Ships an FDA-approved progesterone capsule with free dose tweaks
You want a fast cash-pay visit and your own pharmacy	A telehealth visit (e.g., Sesame)	You get a script and fill generic progesterone locally
Bleeding, a severe mood crash, or several failed regimens	In-person OB-GYN or menopause specialist	Some things telehealth simply can’t do

Not sure where you land?That’s normal — the right answer depends on your body and your history. Take our free 60-second matching quiz and get a plan you can bring to your clinician.

Take the quiz →

What’s the best HRT for progesterone intolerance? The short version

For many people with a uterus who react to a synthetic progestin, the best first change to ask about is FDA-approved micronized (body-identical) progesterone, usually taken at bedtime. If you already reacted to micronized progesterone, the next moves are a lower dose, a different schedule, a change of route (vaginal or a 52 mg levonorgestrel IUD), an estrogen-plus-SERM option like Duavee, or in-person specialist care. People without a uterus can often use estrogen alone.

Here’s the part nobody wants to say out loud: if you still have a uterus and you’re taking estrogen that travels through your whole body, the honest answer usually isn’t “quit the progesterone.” It’s “find a version you can live with.” That can feel like a letdown when you came here hoping to drop it for good.

But stay with us, because this is good news in disguise. Progesterone intolerance is common — specialist menopause clinics estimate it affects around 10–20% of women who take progestogens. It’s a well-recognized problem, and there are several levers clinicians use to make it better. The reason to pick a provider who can troubleshoot— change the type, the dose, the timing, the route — instead of one that just mails you a fixed kit is exactly this: you may need to run through more than one option before you find the one that works.

Can you take estrogen without progesterone if you have a uterus?

If you have a uterus and take estrogen that reaches your bloodstream, you need a progestogen — or another approved method — to protect the lining of your uterus. Estrogen on its own thickens that lining (the endometrium), which raises the risk of overgrowth (hyperplasia) and uterine cancer. Adding a progestogen keeps the lining in check. People who’ve had a hysterectomy don’t have this concern and can usually use estrogen alone.

Think of estrogen and progesterone as a pair that balances each other. Estrogen builds up the uterine lining. Progesterone tells it to settle down. Take estrogen by itself, month after month, and the lining can keep growing unchecked.

This isn’t a gray area. FDA-approved estrogen labels spell it out: in a person with a uterus, estrogen taken without a progestogen raises the risk of endometrial cancer, and adding a progestogen lowers the risk of that overgrowth. In February 2026, the FDA removed several old boxed warnings from the first six HRT products, but it kept the endometrial cancer warning for systemic estrogen-only products. See our full 2026 FDA HRT label change explainer and our guide to whether you need progesterone if you have a uterus.

So the goal of this page isn’t to help you ditch progesterone. It’s to help you find the gentlest way to keep your uterus protected while you feel like yourself again.

Two groups get a pass on the progestogen. People without a uterus, and people using only low-dose vaginal estrogen— the small, local kind for dryness and irritation, which is a different category because very little reaches the rest of the body. Don’t apply the “no progestogen” rule to systemic estrogen pills, patches, gels, or higher-dose products. For more, see our page on vaginal estrogen.

Is it really progesterone intolerance? How to tell

Progesterone intolerance tends to look like bad PMS that shows up on the days you take the progestogen: low mood, anxiety, irritability, bloating, fluid retention, sore breasts, headaches, acne, or broken sleep. A big clue is timing — feeling worse in the second half of a cyclical regimen, or “permanently premenstrual” on a daily one. If the symptoms reliably appear when you take it and ease when you don’t, that points to the progestogen.

You know your body. Most people who land here say some version of “estrogen helped me, then the progesterone wrecked me.” That pattern is the tell. Watch the calendar, because the timing is the biggest clue your clinician needs:

On a cyclical (sequential) regimen — where you take the progestogen only part of the month — symptoms often hit during those progestogen days and lift when you stop.
On a continuous regimen — progestogen every day — some people describe feeling premenstrual all the time, with no break.

Common ways people describe it: feeling “drugged” or exhausted, “zero motivation,” brain fog, rage or weepiness out of nowhere, bloating and breast tenderness, headaches.

A real safety note

A small number of people get a severe mood crash on certain progestogens — deep depression, even thoughts of self-harm. If that’s you, please treat it as urgent. Don’t wait it out. Contact your clinician right away, or in the US call or text 988(the Suicide & Crisis Lifeline), or your local emergency number. This is a recognized reaction to a medication, not a flaw in you — and it’s a strong reason to change course quickly.

One more thing: not every bad week is the progesterone. Perimenopausal hormone swings, thyroid problems, or simply too high an estrogen dose can feel similar. That’s exactly why the move is a clinician who can sort it out — not a guess. Our perimenopause symptoms checklist is a good thing to fill in first.

The 5 ways clinicians make progesterone easier to tolerate

In real practice, clinicians work through five levers: (1) switch from a synthetic progestin to body-identical micronized progesterone; (2) move the dose to bedtime; (3) lower the dose to the smallest amount that still protects your lining; (4) change the route — vaginal, or a 52 mg levonorgestrel IUD — to cut how much reaches the rest of your body; (5) adjust the schedule (cyclical vs. continuous). Most people don’t need all five.

“Endometrial protection” = protecting your uterine lining if you have a uterus and take estrogen. FDA status applies to the medication, not the telehealth company.

The switch	What it is	FDA status for endometrial protection (US)	How much reaches your whole body	Telehealth available?	Key thing to know
Body-identical (micronized) progesterone — oral	Same molecule your body made, in a capsule (Prometrium / generic), taken at night	FDA-approved †	Moderate	✅ Yes (Midi, Winona, Hers)	Better tolerated than synthetics for many — not all. Contains peanut oil (see below). Can make you sleepy, so take it at bedtime.
Vaginal micronized progesterone	The same kind of progesterone, used vaginally	Off-label for this use	Lower	⚠️ Sometimes (clinician’s call)	Cuts systemic side effects, but evidence that it fully protects the lining is limited — needs close clinician oversight, usually at oral-equivalent doses.
52 mg levonorgestrel IUD (Mirena, Liletta)	A small device placed in the uterus that releases a little progestin locally	Off-label in the US (approved only for birth control and heavy bleeding)	Very low (works locally)	❌ No — needs in-person insertion	Often the route clinicians reach for if you react to any systemic progestogen. Lower-dose IUDs aren’t backed for this.
A different progestin / schedule change	Trying another progestogen, or moving between cyclical and daily dosing	Some progestins are FDA-approved for this	Moderate–high	✅ Yes (clinician’s call)	Body-identical isn’t always the winner — occasionally a different synthetic suits a particular person better.
Duavee (estrogen + a SERM)	An FDA-approved pill that uses bazedoxifene (a SERM) to protect the lining instead of a progestogen	FDA-approved	Systemic estrogen, no progestogen	⚠️ Limited availability — ask a clinician	The one mainstream option that skips progestogen entirely. More below.

† Prometrium’s specific FDA-labeled job is preventing endometrial overgrowth in postmenopausal women with a uterus who take conjugated estrogens tablets (FDA label). Clinicians also commonly pair micronized progesterone with other estrogens.

A SERM(selective estrogen receptor modulator) is a drug that acts like estrogen in some parts of the body and blocks it in others. In Duavee, the SERM keeps the uterine lining calm — doing the protective job a progestogen normally would. Clinicians usually start with the first one or two levers and only move on if needed. If you’re not sure which lever fits your reaction, take the 60-second quiz and bring the result to your appointment — it’ll save you a visit.

Body-identical vs synthetic progesterone: what actually changes how you feel

Body-identical (micronized) progesterone — sold in the US as Prometrium or generic micronized progesterone — has the exact molecular structure of the progesterone your body used to make. Many people who feel awful on synthetic progestins do better on it. It’s not a guarantee: some still get symptoms, and a few do better on a particular synthetic. But switching off a synthetic is the highest-payoff first move.

“Body-identical” just means same shape as your own hormone. “Bioidentical” is the same idea — but heads up: the FDA doesn’t treat the word “bioidentical” as a quality stamp on its own. What matters is whether the product is FDA-approved (tested, standardized, consistent dose) or compounded (custom-mixed by a pharmacy, not FDA-approved). More on that distinction soon.

In the US, your body-identical options include:

Prometrium (and generic micronized progesterone) — an oral capsule, FDA-approved to help protect the uterine lining alongside estrogen (FDA label). It’s also where most people start when a synthetic progestin isn’t working.
Bijuva — an FDA-approved single pill that combines estradiol with body-identical micronized progesterone. Handy if you do fine on body-identical progesterone and want one pill instead of two.

The peanut-oil detail most pages skip

Prometrium is made with peanut oil, and its FDA label says it’s off-limits if you’re allergic to peanuts. And it’s not just Prometrium — Winona, for example, lists peanut oil in its progesterone capsules too. So if you have a peanut allergy, don’t assume a generic capsule is safe. Ask your prescriber or pharmacist to check the inactive ingredients before you choose a product — a different formulation or a non-oral route may be the safer answer.

A name you’ll see in UK and European articles is Utrogestan (their brand of micronized progesterone) and dydrogesterone / Duphaston(a progestogen many people tolerate well over there). Useful to know — but dydrogesterone isn’t currently marketed in the US, so it’s not a practical option here. Your real US path is body-identical micronized progesterone, a route change, or the IUD.

Bottom line: if you’re on a synthetic progestin and feeling rough, asking to switch to FDA-approved body-identical progesterone — taken at night — is the move most likely to help.

Want to make that switch with someone who’ll adjust the dose until it’s right?

Insurance and an ongoing clinician relationship: See how Midi handles HRT and check your coverage →
Fast, cash-pay, with free dose changes: See Winona’s FDA-approved progesterone capsule →

For the full lineup, see our comparison of online HRT providers.

Does the route matter? Oral vs vaginal vs the IUD

Yes — how you take progesterone changes how much lands in the rest of your body, and that’s often what drives side effects. A capsule you swallow is fully systemic. The same progesterone used vaginally puts more where it’s needed and less in your blood. A 52 mg levonorgestrel IUD works locally in the uterus and keeps blood levels very low, which is why clinicians often reach for it when systemic progestogens are poorly tolerated.

Picture a ladder of “how much reaches everywhere else,” from most to least:

1Oral capsule (swallowed) — fully systemic. Simple and FDA-approved, but it’s the most likely to cause whole-body effects like sleepiness or mood changes. Taking it at bedtime helps with the drowsiness.
2Vaginal progesterone — lower blood levels, so often fewer systemic side effects. The catch: using it this way for uterine protection is off-label, and the proof that it fully protects the lining is limited. If a clinician uses it because oral side effects are a problem, it’s generally given at doses and durations similar to oral progesterone, with monitoring. Don’t switch your capsules to vaginal use on your own — that’s a clinician decision.
352 mg levonorgestrel IUD (Mirena, Liletta) — the device sits in the uterus and releases a tiny daily dose of progestin right where protection is needed — about 21 micrograms a day at the start, easing to roughly 11 micrograms a day by year five (FDA label). Blood levels stay very low. Note: lower-dose hormonal IUDs don’t have the same evidence for HRT protection, so confirm the 52 mg device with your clinician.

One honest limit on the IUD: in the US it’s FDA-approved only for birth control (up to 8 years) and heavy periods (up to 5 years). Using it for HRT uterine protection is off-label — supported by real-world use and a 2025 review in the journal Menopause— but off-label all the same. And it has to be placed in person. No telehealth service can insert one.

If a pill or dose change is what you need, the providers below can handle it online. If your best route is an IUD,that’s an in-person procedure. Take the quiz to map it out and find local care.

Best online HRT providers for progesterone intolerance, compared

For progesterone intolerance, the best provider is the one that can change your plan — not the one with the simplest box. Midi Health is our top pick if you want insurance plus a clinician who keeps adjusting your regimen. Winona is our top pick for fast, cash-pay access to FDA-approved body-identical progesterone with free dose changes. A cash-pay visit (like Sesame) suits people who want to use their own pharmacy. For an IUD or a complicated history, see someone in person.

We checked each provider’s own pages on June 16, 2026. Checkout prices and state availability change, so confirm them at signup. FDA approval applies to the medication, not the telehealth company or a particular regimen.

What matters for intolerance	Midi Health	Winona	Hers
Can prescribe an FDA-approved progesterone capsule	✅ separate prescription	✅ FDA-approved capsule	✅ (confirm form at checkout)
Easy / free dose adjustment	✅ ongoing visits	✅ free, unlimited by message	✅ provider messaging
Can change your route (oral → vaginal)	✅ clinician’s call	⚠️ clinician’s call	⚠️ clinician’s call
Places an IUD	❌ in-person only	❌	❌
Takes insurance	✅ most PPOs (not Medicaid/Medi-Cal/Medicare)	❌ cash-pay (HSA/FSA ok)	❌ cash-pay
Care style	Video + ongoing relationship	Questionnaire + messaging	Online intake + messaging
Indicative cost (verify at signup)	~$250 first visit, ~$150 follow-ups self-pay; often just a copay with PPO	Progesterone capsule from ~$39/mo, no membership	Menopause care from ~$79/mo; not in all states
Best for the reader who…	wants insurance + a clinician who tunes the plan	wants fast cash-pay body-identical progesterone + free dose changes	wants a simple shipped option

Midi Health — best overall first stop

Midi is the best fit when progesterone intolerance means you need a clinician to adjust HRT thoughtfully, not mail you a fixed kit.It prescribes FDA-approved hormones — including body-identical micronized progesterone — as separate prescriptions, so your estrogen and progesterone can be tuned on their own. It accepts most PPO insurance plans, which can knock visits down to a copay. And it’s built around follow-up care, so when the first plan isn’t right, your clinician keeps adjusting.

The honest limit: Midi can’t place an IUD, and it can’t bill Medicaid, Medi-Cal, or Medicare (it can see Medicare patients self-pay, but you can’t file claims). If you need an IUD or Medicaid coverage, an in-person clinic is your route — start with the quiz to find one.

See current Midi pricing and check your insurance →

Winona — best fast, cash-pay route to body-identical progesterone

Winona is the best fit if you want body-identical progesterone fast, without dealing with insurance — and you want to change the dose easily. It ships an FDA-approved progesterone capsule from $39 a month with no membership fee, and its board-certified doctors include free, unlimited dose adjustments by message. You can cancel anytime, and it’s rated 4.6 out of 5 on Trustpilot (a service-experience signal — it tells you people find the care easy to use, not that any treatment is guaranteed to work).

The honest limit: Winona doesn’t take insurance, and its combination creamsare compounded — not FDA-approved. If you want insurance, or you want to avoid compounded products entirely, start with Midi instead. But for this specific job, you’d use its FDA-approved progesterone capsule, not the cream.

See Winona’s FDA-approved progesterone capsule and price →

Hers — simple, shipped, straightforward cases

Hers is a good fit for more straightforward menopause care, when you want a clean online intake, provider messaging, and common options shipped to you. It offers oral and through-the-skin estradiol plus progesterone, with menopause care starting around $79 a month, no insurance required. Confirm the exact progesterone you’re prescribed, and your plan length, at checkout.

The honest limit: Hers isn’t available in every state, and it’s less suited to a severe progesterone reaction or an IUD/Duavee workup. If your case is complex, Midi or an in-person specialist is the safer call. See also our Hers menopause review.

See Hers’ menopause options and check your state →

Is compounded progesterone cream a safe alternative?

The safety point that matters most:

Compounded progesterone — especially creams — is custom-mixed by a pharmacy and is not an FDA-approved finished product. Compounded progesterone’s ability to protect your uterine lining is not established.So if you have a uterus and take estrogen, a compounded cream is not a reliable substitute for proven protection. It may ease side effects, but it shouldn’t be your protection plan without specialist oversight.

“Compounded bioidentical” can soundsafer or more natural than a pharmacy drug. It isn’t automatically either. FDA-approved products go through testing for safety, effectiveness, consistent dosing, and manufacturing. Compounded products are mixed for one patient and skip that process. The Menopause Society and ACOG both say compounded hormone therapy shouldn’t be used routinely when FDA-approved options exist, citing concerns like limited regulation, doses that can run too high or too low, possible impurities, and thin safety data.

For uterine protection specifically, menopause guidance is cautious: low-dose and through-the-skin progesterone preparations are unlikely to deliver enough protectionfor the lining. A nice-feeling cream that doesn’t protect your endometrium is not a trade worth making. And when a provider’s marketing conflicts with independent guidance, we follow the more conservative independent guidance unless your own clinician has a specific reason for your case.

When is compounding legitimately useful? Real cases exist — for example, a documented allergy to a dye or ingredient in the standard product. If a clinician recommends compounding for a reason like that, ask:

Is it from a 503A (patient-specific) or 503B (larger-scale) pharmacy?
Which pharmacy makes it, and is it licensed in my state?
Is there a certificate of analysis?
How will we confirm my uterine lining is actually protected?

Questions to ask before you start (and the red flags to watch for)

A good HRT provider should explain your uterus-status risk, tell you exactly how they’d handle progesterone side effects, name which medication forms they prescribe, say how they watch for bleeding, and have a plan for when the first regimen fails. If a provider can’t explain the difference between FDA-approved and compounded, that’s a red flag.

Copy these into your phone before any consult — they cut through the marketing fast.

1Based on my uterus status, do I need a progestogen or another way to protect my lining?
2If progesterone makes me depressed, anxious, sedated, or premenstrual, what will you change?
3Can you prescribe estrogen and progesterone separately so you can adjust each one?
4Can you move me between cyclical and continuous dosing?
5Do you prescribe FDA-approved estradiol and progesterone (patches, pills, capsules)?
6Do you use compounded products? If so, why — and how will you confirm my lining is protected?
7How do you handle bleeding if it happens?
8Can you discuss or refer me for a 52 mg levonorgestrel IUD?
9Is Duavee or another no-progestin option appropriate for me?
10What labs or follow-ups are included?
11Is the medication cost included, or separate?
12What happens if I can’t tolerate the first prescription?

Green flags

Names your uterus status before recommending anything
Separates FDA-approved from compounded clearly
Explains the bleeding rules
Has a real follow-up and adjustment path
Never promises "no side effects"

Red flags

Says "you don't need progesterone" without asking your uterus status
Treats a compounded cream as the same as an FDA-approved drug
Can't tell you what to do if you bleed
Uses "buy now" urgency for a medical decision

Want this made personal?Take the 60-second quiz and we’ll map your likely options and the exact questions to bring to your appointment.

Take the 60-second quiz →

What we actually checked for this page

We don’t ask you to take our word for it. Here’s what we looked at, and when.

FDA labels for oral micronized progesterone (Prometrium) — including its approval to help protect the uterine lining and the peanut-oil contraindication — and for the levonorgestrel IUD (its US approvals are birth control and heavy bleeding only, so HRT protection is off-label).
Peer-reviewed reviews and society guidance (including ACOG and The Menopause Society) on body-identical vs synthetic progesterone, vaginal vs oral routes, the IUD for uterine protection, and compounded hormones.
Each provider’s own pages — medication types, dose-adjustment policy, insurance stance, and pricing — checked on June 16, 2026. Checkout prices and state availability must be confirmed at signup.
The FDA’s February 2026 boxed-warning changes, and the retained endometrial-cancer warning for estrogen-alone products.

Our “best for” picks are our editorial conclusions based on those facts. They’re not medical advice, and they don’t replace your prescriber. Prices and policies change — we re-check the commercial details monthly and the medical guidance quarterly. See our HRT benefits and risks guide and our full HRT cost guide for 2026.

Frequently asked questions

Can I take estrogen without progesterone if I have a uterus?

Generally no — not with systemic estrogen, unless your clinician sets up another way to protect your lining. The exceptions are people without a uterus and people using only low-dose vaginal estrogen. If you can’t tolerate progestogens, ask about Duavee (an FDA-approved estrogen-plus-SERM pill) or a 52 mg levonorgestrel IUD.

What is the best-tolerated progesterone?

For many people who react badly to synthetics, FDA-approved body-identical (micronized) progesterone taken at bedtime is the best-tolerated oral option. For people sensitive to any systemic progestogen, a 52 mg levonorgestrel IUD keeps blood levels very low because it works locally in the uterus.

Why does progesterone make me feel so bad?

Progestogens can affect mood, fluid balance, and sleep, and synthetic progestins seem to trigger more of these effects in sensitive people than body-identical progesterone does. The pattern usually tracks with the days you take it. If symptoms are severe, that is a reason to switch with a clinician — not to push through.

How long do progesterone side effects last?

It depends on the symptom. Breakthrough bleeding after a regimen change can sometimes settle over the first few months. But a mood crash, severe sedation, or any thoughts of self-harm should not be waited out — contact your clinician promptly, and treat severe mood symptoms as urgent.

Can the Mirena coil replace the progesterone in my HRT?

Yes — a 52 mg levonorgestrel IUD can provide the progestogen part of HRT with very low blood levels, which is why it helps people who react to systemic progesterone. In the US this use is off-label, and the device must be placed in person.

Can I take progesterone vaginally instead of swallowing it?

Some clinicians use vaginal progesterone to reduce systemic side effects, but using it for uterine protection is off-label and the evidence is more limited, so it needs clinician oversight at proper doses. Don’t switch your capsules to vaginal use on your own.

Is compounded progesterone cream enough to protect my uterus?

Don’t assume so. Compounded progesterone isn’t FDA-approved, and low-dose or through-the-skin progesterone is unlikely to fully protect the uterine lining. If you have a uterus on estrogen, it shouldn’t be your protection plan without specialist oversight.

What if I had a hysterectomy?

Without a uterus, most people don’t need a progestogen and can usually use estrogen alone — but surgical details matter, so confirm with a clinician.

What if I had an endometrial ablation?

Don’t assume ablation removes the need for protection. Some lining can remain, and menopause guidance generally recommends a combined (estrogen-plus-progestogen) regimen after ablation. This is a clinician decision.

Is Duavee an option if I can’t tolerate progesterone?

It may be. Duavee pairs conjugated estrogens with bazedoxifene, a SERM that acts against estrogen’s stimulation of the uterine lining — so there’s no progestogen to react to. It’s for people with a uterus, it isn’t estrogen on its own, availability has varied, and it isn’t right for everyone, so ask a clinician.

Which online provider is best if I need insurance?

Midi Health, because it’s built around PPO insurance and ongoing clinician care that can adjust your plan over time. It doesn’t bill Medicaid, Medi-Cal, or Medicare.

Which is best if I want fast care without insurance?

For shipped FDA-approved body-identical progesterone with free dose changes, Winona. For a quick visit where you fill the script at your own pharmacy, a cash-pay marketplace like Sesame.

Should I stop my HRT if the progesterone ruins my mood?

Don’t stop or change prescribed HRT on your own, especially if you have a uterus and take systemic estrogen. Contact your clinician — and if your mood crashes hard or you have thoughts of self-harm, treat it as urgent (in the US, call or text 988).

Still not sure which HRT program is right for you?

You came here feeling like the choice was “suffer or quit.” It isn’t. Progesterone intolerance is common, it’s well understood, and for most people it comes down to finding the right switch — the type, the dose, the timing, the route, or a no-progestogen option like Duavee. Now you know the levers, who can pull them, and what it costs.

Start the quiz →

Sources

1.FDA/DailyMed. Prometrium (progesterone capsule) label: endometrial-hyperplasia-prevention indication; peanut-oil contraindication; bedtime dosing. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1cf237ff-c4f8-4faa-a7aa-77599c856889
2.FDA/DailyMed. Mirena (52 mg levonorgestrel IUD) label: US indications (contraception ≤8 yr; heavy bleeding ≤5 yr); local LNG release ~21→11 µg/day. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?audience=consumer&setid=dcbd6aa2-b3fa-479a-a676-56ea742962fc
3.FDA/DailyMed. Estradiol label: unopposed-estrogen endometrial-cancer risk; progestogen reduces hyperplasia. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?audience=consumer&setid=67e8665c-5331-423c-99fd-546ab6cccb07
4.FDA. Duavee (conjugated estrogens/bazedoxifene) label: FDA-approved estrogen + SERM; bazedoxifene counters estrogen stimulation of the endometrium. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/022247lbl.pdf
5.FDA statement, Feb 2026. Boxed-warning labeling changes; endometrial-cancer warning retained for systemic estrogen-alone products. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations
6.ACOG + The Menopause Society (PubMed 37856860). FDA-approved options first-line; concerns about compounded hormone therapy. https://pubmed.ncbi.nlm.nih.gov/37856860/
7.The Menopause Society 2025 review. 52 mg levonorgestrel IUD for uterine protection in MHT (off-label); British Menopause Society guidance on progestogen route/dose. https://menopause.org/patient-education/menopause-topics/hormone-therapy
8.Healthinmenopause.co.uk. Specialist-clinic estimate that ~10–20% of women experience progesterone-intolerance symptoms. https://healthinmenopause.co.uk/progesterone-intolerance/
9.Midi Health. Pricing & Insurance: PPO acceptance, Medicaid/Medicare exclusions. https://www.joinmidi.com/pricing-insurance
10.Winona. FDA-approved progesterone capsule: pricing from $39/mo; free unlimited dose adjustment; peanut oil noted. https://bywinona.com/product/progesterone-capsule
11.Hers. Menopause care: estradiol/progesterone options from ~$79/mo; not all states. https://www.forhers.com/menopause
12.Sesame. Online menopause treatment. https://sesamecare.com/service/menopause-treatment
13.The Menopause Society. Find a menopause practitioner directory. https://www.menopause.org/for-women/find-a-menopause-practitioner

The HRT Index is an independent comparison resource for HRT telehealth providers. Editorial research, not medical advice; not medically reviewed. Last verified: June 16, 2026.