Norethindrone vs Micronized Progesterone for HRT: What the Evidence Actually Says

Neither one wins. For norethindrone vs micronized progesterone for HRT, the exact product matters more than the drug name. Micronized progesterone has FDA-labeled endometrial evidence and a more reassuring—but observational—breast signal; NETA has strong product-specific endometrial data inside fixed combinations. Estrogen route, dose, bleeding, sleep, peanut allergy, contraception, and risk history change the answer.

The answer changes if: the label says norethindrone rather than norethindrone acetate; the NETA is inside Activella, CombiPatch, or Jinteli rather than a standalone 5 mg tablet; your estrogen dose is high; sleep or daytime grogginess is driving the decision; you need contraception; or your exact progesterone product contains peanut oil.

One thing before you go further. If you have a uterus and take systemic estrogen, do not stop or skip the prescribed progestogen because of anything on this page. The progestogen is part of the plan that protects the uterine lining from estrogen-driven hyperplasia and cancer risk. Every road out of this page runs through the clinician managing your estrogen.^[10]

Now the part almost nobody tells you.

The bottle you are holding matters more than the drug name on it. The standalone 5 mg norethindrone acetate tablet carries a US label stating that it is not intended, recommended, or approved with postmenopausal estrogen for endometrial protection.^[5] The same molecule appears at much lower amounts inside FDA-approved menopause products such as Activella, CombiPatch, and Jinteli—but approval belongs to those exact fixed products and regimens, not to the ingredient in the abstract.^[7][8][26]

That is not proof that a clinician-directed off-label regimen is wrong. It is proof that “norethindrone” is not enough information.

For this page, we reviewed the current US labels for standalone oral micronized progesterone, standalone norethindrone acetate 5 mg, norethindrone 0.35 mg, Activella, CombiPatch, Bijuva, and Jinteli; the current British Menopause Society dose tools; and the original studies behind the breast, endometrial, sleep, and clot claims.

A 2026 FDA label update does not create a safety winner

In February 2026, the FDA asked sponsors of estrogen- and progestogen-containing hormone-therapy products to remove cardiovascular disease, breast-cancer, and probable-dementia language from boxed warnings, while keeping those risks in the Warnings and Precautions sections. The FDA did not ask sponsors to remove the endometrial-cancer boxed warning from systemic estrogen-alone products.^[10]

That changes how some current labels present risk information; it does not establish that norethindrone acetate is safer than micronized progesterone, or vice versa. Read the current label for the exact product, and do not treat a boxed-warning edit as a new head-to-head clinical-outcomes study.

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Is this page for you?

Answer: This page is for a woman with a uterus who uses or is considering systemic estrogen and needs to compare exact progestogen products before a consult. It is not a dose-conversion guide, a bleeding-triage tool, a contraception guide, or a substitute for assessment when symptoms are urgent or unexplained.

This page fits if…	Start somewhere else if…
You have a uterus and take, or are considering, systemic estrogen	You have new, heavy, prolonged, or otherwise unexplained bleeding that has not been assessed
Your clinician suggested changing the progestogen component	You are looking for a patient-facing dose conversion between the two—there is not a safe one
Bleeding, sleep, mood, grogginess, allergy, route, or cost is driving the question	You use only low-dose local vaginal estrogen and have not confirmed that systemic uterine protection applies
You want to identify the exact product before a consult	You need contraception and assume ordinary menopause HRT provides it—it does not
You want sharper questions for the clinician managing your estrogen	You may be pregnant, have emergency symptoms, or cannot function safely because of a severe mood change

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How do norethindrone and micronized progesterone compare in 30 seconds?

Answer: Micronized progesterone offers separate-component flexibility, FDA-labeled endometrial evidence in exact regimens, and some sleep evidence. NETA has strong FDA-reviewed endometrial data inside exact fixed products. Neither has a safe patient-facing dose conversion, and completed direct evidence does not establish a universal safety winner.

Decision factor	Micronized progesterone	Norethindrone acetate in menopause HRT
What it is	Progesterone; the current Prometrium label describes it as chemically identical to progesterone of ovarian origin[1]	A synthetic progestin
Common US forms relevant here	Standalone Prometrium/generic; fixed estradiol/progesterone Bijuva	Fixed estradiol/NETA tablets such as Activella; fixed estradiol/NETA patch CombiPatch; ethinyl estradiol/NETA tablet Jinteli; separately prescribed standalone 5 mg NETA is a different, off-label context
FDA-labeled endometrial evidence	Yes, but it belongs to exact products and regimens: Prometrium with conjugated estrogen on its labeled cyclic schedule; Bijuva as a fixed product[1][9]	Yes inside exact fixed NETA-containing products such as Activella, CombiPatch, and Jinteli; no approved postmenopausal endometrial-protection indication for the standalone 5 mg tablet[5][7][8][26]
Breast evidence	More reassuring observational signal than pooled synthetic progestins	No completed NETA-specific randomized cancer-outcomes comparison
Sleep evidence	Randomized-trial evidence supports improvement in some sleep outcomes; sedation can become the downside[18]	No comparable randomized sleep-benefit evidence was identified in the sources reviewed for this page
Peanut oil	Prometrium and the current standalone generic labels reviewed contain peanut oil; Bijuva does not	Not a peanut-oil product in the labels reviewed; inactive ingredients still vary by manufacturer
Component flexibility	A standalone capsule can be prescribed separately from estrogen	Fixed products tie the estrogen and NETA together; standalone NETA creates a separate off-label decision
Dose conversion	None	None
Universal winner	No	No

Do not read that table as a scoreboard. Product-label percentages come from different trials with different estrogens, routes, populations, schedules, durations, and endpoints. We show the numbers below because hiding them would be worse. We also show why they cannot be ranked.

The HRT Index is the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.

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What is the real bottom line on norethindrone vs micronized progesterone for HRT?

Answer: Neither drug is better across the board. Micronized progesterone has a more reassuring observational breast signal and direct sleep evidence; NETA has strong endometrial and bleeding data inside specific fixed estradiol products. No completed randomized trial has established an overall safety winner between the two.

That is the honest headline, and it is uncomfortable—because you came here for a winner.

The cleanest-sounding version of this argument is: progesterone for the breast, norethindrone for the uterus, choose which organ matters more. It is powerful. It is also cleaner than the data. The breast and endometrial findings came from separate observational E3N analyses, the progestin comparison was not NETA-specific, and neither analysis can prove that one molecule caused the result.^[15][16]

The damaging admission stays:

The direct randomized comparison the internet keeps pretending already exists has not reported peer-reviewed results.

The useful question is not “Which molecule wins?” It is:

1. 1. Which exact product am I holding?
2. 2. What estrogen am I pairing it with—route, dose, and schedule?
3. 3. What problem am I actually trying to solve: uterine protection, bleeding, sleep, tolerability, convenience, allergy, contraception, or cost?

Answer those three and the discussion becomes much less vague.

Who may reasonably discuss micronized progesterone

• You want estrogen and progestogen prescribed separately so one component can change without automatically changing the other.
• Sleep is part of the problem and bedtime drowsiness would be useful rather than disabling.
• The observational breast signal matters to you, and you understand that it is not a NETA-specific randomized safety verdict.
• You can use the exact dispensed product safely; Prometrium and the standalone generic labels reviewed contain peanut oil.
• Your clinician can explain which evidence supports the dose and schedule with your estrogen route.

Who may reasonably discuss a NETA-containing regimen

• You want one fixed FDA-approved combination pill or patch rather than separate estrogen and progesterone prescriptions.
• Micronized progesterone caused unacceptable dizziness, sedation, or another tolerability problem.
• Product-specific bleeding expectations and one-product adherence matter to you.
• Your clinician can explain whether the recommendation is an FDA-approved fixed product or a separately prescribed off-label regimen.
• Peanut oil rules out the standalone progesterone capsules available to you, while the other variables still fit.

Who may need neither comparison

• You have had the uterus removed and have no other clinical reason for a progestogen.
• You use only a standard low-dose local vaginal estrogen product.
• Your main need is contraception rather than menopause HRT.
• The actual product is norethindrone 0.35 mg contraception, not NETA used in a menopause regimen.
• You have unexpected bleeding that needs assessment before a comparison can settle anything.

The right online HRT provider isn't the same for every woman — it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Some situations belong with an in-person clinician first. Because a general answer can't resolve those for you, use The HRT Index's Find My HRT Path tool to match your situation to the right provider — and to flag when online care isn't the right starting point — before your first consult.

Map my situation before my consult: Use Find My HRT Path →

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Are norethindrone and micronized progesterone the same thing?

Answer: No. Micronized progesterone contains progesterone. Norethindrone and norethindrone acetate are synthetic progestins. They can perform overlapping jobs in hormone therapy, but they are different drugs with different formulations, labels, evidence, and practical side effects.

Three words get mixed up constantly, so let us fix them now.

• Progesterone — the naturally occurring hormone and the generic drug name.
• Progestin — the usual US term for a synthetic drug with progesterone-like activity. Norethindrone and NETA are progestins.
• Progestogen — the umbrella term that covers progesterone and synthetic progestins.

Micronized means the progesterone particles were processed to improve oral absorption. It is a formulation description. It is not a safety claim.

The day-to-day difference readers notice most clearly is already visible in the labels. Prometrium carries a specific dizziness and drowsiness warning and directs bedtime dosing. The standalone NETA label instead lists issues such as mood changes, fluid retention, acne or other androgenic effects, and adverse lipid changes.^[1][5]

That does not mean every symptom can be predicted from the molecule. It means the labels give you different questions to ask.

One more myth worth killing. “Bioidentical” does not mean compounded, and it does not mean safer. Prometrium and Bijuva are FDA-approved manufactured products containing progesterone. Compounded hormone products are not FDA-approved finished drugs; FDA does not review them for safety, effectiveness, or quality before marketing.^[13]

This page never treats a compounded progesterone cream or capsule as equivalent to Prometrium, Bijuva, or another FDA-approved product.

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Which norethindrone product do you actually have?

Answer: At least three product categories can place a version of “norethindrone” in front of a patient, and they are not interchangeable: norethindrone 0.35 mg contraception, standalone norethindrone acetate 5 mg for labeled gynecologic indications, and low-dose NETA inside fixed menopause combinations.

This is where most confusion starts, and honestly, it is not your fault. The naming is genuinely bad.

The product-identity ledger

What the label says	Exact drug and amount	Its labeled job	What it does not prove
Norethindrone 0.35 mg	Norethindrone, not NETA	Progestin-only oral contraception[6]	That it is an HRT endometrial-protection dose or interchangeable with a menopause product
Norethindrone acetate 5 mg	Standalone NETA	Secondary amenorrhea, endometriosis, and certain abnormal uterine bleeding after organic pathology is excluded[5]	That it is FDA-approved with postmenopausal estrogen for endometrial protection
Activella 0.5/0.1 or 1/0.5	Fixed oral estradiol plus NETA	Menopause hormone therapy with product-specific endometrial evidence[7]	That a standalone NETA tablet at another amount is equivalent
CombiPatch 0.05/0.14 or 0.05/0.25 mg per day	Fixed transdermal estradiol plus NETA	Menopause hormone therapy with product-specific endometrial evidence[8]	That an oral NETA dose can be converted from the patch amount
Jinteli 1/5	Fixed oral NETA 1 mg plus ethinyl estradiol 5 micrograms	Menopause hormone therapy for vasomotor symptoms and osteoporosis prevention in a woman with a uterus[26]	That every NETA/ethinyl-estradiol product is menopause HRT rather than contraception

Opill does not belong in this table. Opill contains norgestrel 0.075 mg, not norethindrone.^[14]

The standalone NETA label says NETA is about twice as potent by weight as norethindrone for inducing secretory changes in an estrogen-primed endometrium.^[5] That is a narrow pharmacologic statement about one tissue effect. It is not a universal swap rate, a systemic-exposure conversion, or permission to turn 0.35 mg norethindrone into a guessed NETA dose.

Do not use any product table on this page as a dose-conversion chart. It exists to prevent a name error, not to help anyone self-adjust.

Outside the United States, norethindrone acetate is usually called norethisterone acetate. That is why the British Menopause Society documents use “norethisterone.”

Not sure which product you have? Identify which norethindrone product you were prescribed →

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Is norethindrone acetate FDA-approved for HRT?

Answer: The standalone 5 mg NETA tablet is not FDA-approved with postmenopausal estrogen for endometrial protection. NETA is FDA-approved inside exact fixed menopause products such as Activella, CombiPatch, and Jinteli, each with its own estrogen, route, strength, schedule, and evidence package.

The FDA-label gap ledger

Product	What it contains	Current US label context	The practical meaning
Prometrium / standalone oral micronized progesterone	Progesterone 100 or 200 mg	Prometrium is indicated to help prevent endometrial hyperplasia in a nonhysterectomized postmenopausal woman receiving conjugated estrogen tablets; its labeled prevention schedule is 200 mg at bedtime for 12 days per 28-day cycle[1]	Direct label support exists, but it belongs to that estrogen and schedule—not every patch-plus-progesterone regimen
Standalone NETA 5 mg	Norethindrone acetate	Its label excludes concomitant postmenopausal estrogen use for endometrial protection[5]	A clinician may still prescribe an off-label regimen, but the evidence cannot be described as an approved standalone HRT indication
Norethindrone 0.35 mg	Norethindrone	Progestin-only contraception[6]	It is not ordinary menopause HRT and should not be inserted into an HRT dose table
Activella and generics	Fixed oral estradiol plus 0.1 or 0.5 mg NETA	FDA-approved menopause product with a randomized endometrial study[7]	The evidence belongs to the fixed combination
CombiPatch	Fixed transdermal estradiol plus 0.14 or 0.25 mg/day NETA	FDA-approved menopause patch with continuous and sequential product data[8]	The evidence belongs to the fixed patch and cannot be converted to an oral dose
Jinteli	Fixed oral NETA 1 mg plus ethinyl estradiol 5 micrograms	FDA-approved for moderate-to-severe vasomotor symptoms and prevention of postmenopausal osteoporosis in a woman with a uterus[26]	It is a distinct ethinyl-estradiol menopause product; the same ingredient names can also appear in contraceptives at different strengths
Bijuva	Fixed oral estradiol plus 100 mg progesterone	FDA-approved for moderate-to-severe vasomotor symptoms in a woman with a uterus, with product-specific 52-week endometrial data[9]	It is a peanut-oil-free fixed progesterone route, but its two components cannot be independently adjusted

Before you panic, read this part

This does not mean an off-label prescription is automatically a mistake, and it does not mean that the drug is automatically unsafe.

Three things are true at the same time:

One — approval belongs to the exact product and use. Activella and CombiPatch have FDA-reviewed evidence for their exact estradiol/NETA combinations. That evidence does not automatically transfer to a standalone 5 mg tablet paired with a different estrogen.

Two — off-label prescribing is legal and can be evidence-based. A clinician can use a marketed drug outside its approved label when the clinician judges that the evidence and the patient's circumstances support it. The prescriber should be able to explain that reasoning.

Three — many common estradiol-patch plus oral-progesterone regimens also sit outside the standalone Prometrium label. The Prometrium indication specifies conjugated estrogen tablets and its prevention schedule is cyclic 200 mg. If you use a patch with 100 mg nightly, that does not make your regimen wrong. It means the support must come from professional guidance and other evidence—not from pretending the standalone label studied that exact combination.^[1][20]

So the real question is not “Is this ingredient approved somewhere?” It is:

What evidence supports my exact product, at my exact dose and schedule, with my exact estrogen?

That is a fair question. And it is answerable.

Get the product, route, uterus status, symptoms, and safety flags into one page before the appointment: Build my Find My HRT Path result →

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Do you need either one at all?

Answer: A woman with a uterus using systemic estrogen generally needs an intentional progestogen plan because estrogen stimulates the uterine lining. Hysterectomy, low-dose local vaginal estrogen, endometrial ablation, contraception needs, and unexplained bleeding can change the decision.^[11][10]

Four situations change everything. Find yours.

You have a uterus and use systemic estrogen—patch, gel, spray, a systemic vaginal ring such as Femring, or pill. This comparison may apply. The plan must match the total systemic estrogen exposure, not merely exist on the medication list.

You have had the uterus removed. Estrogen alone is commonly used after hysterectomy because there is no endometrium to protect. Confirm what surgery you actually had and whether another diagnosis changes the plan.^[11]

You have had an endometrial ablation. Ablation does not remove the uterus. Do not treat “I had an ablation” as the same fact as “I do not have a uterus.” The protection and bleeding plan needs individual review.

You use only low-dose local vaginal estrogen. That is a different exposure category. Major menopause guidance generally does not require a routine progestogen solely for standard low-dose local vaginal estrogen, while systemic products and high-dose or unclear cream regimens need a different answer.^[12] See do you need progesterone with vaginal estrogen.

You are bleeding and do not know why. A drug comparison cannot diagnose that. Unexpected bleeding belongs in a clinical assessment, not in a self-directed dose change.

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What do the product trials show—and what can they not show?

Answer: The labels show that the studied progesterone and NETA regimens sharply reduced estrogen-associated endometrial hyperplasia within their own trials. They do not show that one row can be ranked against another or that a separately assembled regimen is equivalent to a fixed FDA-approved product.

The HRT Index US Progestogen Evidence Map

Last verified August 31, 2026

Exact product or regimen	Estrogen and progestogen model	Same-product endometrial result	Same-product bleeding result	What the row cannot prove
Prometrium 200 mg cyclic with conjugated estrogen tablets	Separate oral progesterone plus conjugated estrogen	Hyperplasia was reported in 6% with the combination versus 64% with conjugated estrogen alone through up to 36 months; placebo was 3%[1]	The label does not provide a comparable 12-month amenorrhea figure	That 100 mg nightly with an estradiol patch is the same studied regimen
Bijuva 0.5/100 and 1/100	Fixed oral estradiol plus progesterone	Hyperplasia was reported in 1 of 303 women on 0.5/100 and 1 of 281 on 1/100 at 52 weeks[9]	Cumulative amenorrhea at week 52 was 67.6% and 56.1%, respectively[9]	That Bijuva is superior to a separate patch-plus-progesterone regimen
Activella 0.5/0.1 and 1/0.5	Fixed oral estradiol plus NETA	In the 12-month study, hyperplasia was 14.6% with estradiol alone, 0.8% with 0.1 mg NETA, and 0.4% in the 0.25 and 0.5 mg NETA groups[7]	About 86% of women on 1/0.5 were amenorrheic after 12 months; the lower-dose product's label reports 88% after six months[7]	That the percentages can be compared directly with Bijuva or CombiPatch
CombiPatch 0.05/0.14 and 0.05/0.25 mg/day	Fixed transdermal estradiol plus NETA	Continuous use: 1 of 123 and 1 of 98 women developed hyperplasia, versus 39 of 103 on estradiol patch alone; sequential-regimen rates were below 1% in both arms versus 20% with estradiol alone[8]	Amenorrhea during cycles 10–12 was 53% and 39% for the two continuous strengths[8]	That a lower or higher NETA number alone predicts better bleeding control
Jinteli 1/5	Fixed oral ethinyl estradiol plus NETA	In the label study, hyperplasia was reported in 0 of 110 women biopsied at month 12 and 0 of 102 biopsied at month 24 in the marketed 1/5 group[26]	Bleeding and amenorrhea were evaluated, but no single percentage is used here because the label presents that result graphically	That an ethinyl-estradiol product can be ranked against estradiol tablets or patches from these figures
Standalone NETA 5 mg	Separate oral NETA; estrogen chosen separately	No FDA-approved postmenopausal endometrial-protection regimen in this label[5]	Not a menopause-HRT amenorrhea trial	That the fixed-product evidence transfers to this bottle
Norethindrone 0.35 mg	Progestin-only contraceptive	No HRT endometrial-protection conclusion should be drawn	Irregular bleeding belongs to its contraceptive context	That the minipill is a lower-dose version of a menopause regimen

Do not rank the percentages across rows. The trials used different estrogens, doses, routes, schedules, populations, durations, biopsy rules, endpoints, and analysis sets. The map tells you what happened in each product's own evidence package. It does not create a winner.

That warning is not a footnote. It is the most important sentence beneath the numbers.

The apples-to-oranges check

What differs	Why it breaks a direct comparison
Estrogen molecule	Conjugated estrogens and estradiol are not the same exposure
Oral versus transdermal estrogen	Route changes pharmacokinetics and first-pass effects
Estrogen dose	The amount of endometrial stimulation changes
Cyclic versus continuous progestogen	Protection and bleeding expectations change
Trial duration	Twelve months and 36 months are not the same test
Endpoint and pathology review	Hyperplasia definitions and adjudication can differ
Analysis population	Enrolled participants and women with evaluable biopsies are not always the same denominator
Menopause stage and eligibility	The enrolled women may not resemble a woman still cycling in perimenopause

A 6% figure in a longer conjugated-estrogen trial and a 0.4% figure in a 12-month estradiol trial do not mean one drug is fifteen times better. They mean two different questions received two different answers.

What the product evidence does show is simpler and more useful: in the trials that included an estrogen-only comparator, adding the studied progestogen regimen dramatically reduced hyperplasia compared with unopposed estrogen.^[1][7][8]

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Which one protects the uterine lining better?

Answer: Both can protect the endometrium when the entire estrogen–progestogen regimen is adequately supported. The evidence does not justify a molecule-only winner. Dose, schedule, estrogen route and amount, adherence, duration, and the exact product determine how persuasive the protection evidence is.

Now the part we would rather not write. We are writing it anyway.

The half of the evidence almost nobody puts next to the breast claim

The E3N cohort is often quoted because its breast analysis found a more reassuring association for estrogen plus micronized progesterone than for estrogen plus synthetic progestins as a pooled group. In that analysis, the relative risks were 0.9 (95% CI 0.7–1.2) and 1.4 (1.2–1.7), respectively.^[15]

A separate E3N endometrial analysis followed 65,630 postmenopausal women for a mean 10.8 years and recorded 301 endometrial cancers. Estrogen plus micronized progesterone was associated with an HR of 1.80 (1.38–2.34) versus never use; after more than five years, the HR was 2.66 (1.87–3.77). Preparations containing a norsteroid derivative had an HR of 1.30 (0.85–1.99), which was not statistically significant.^[16]

If you came here believing micronized progesterone was simply the safer choice, that is a hard read. It should be.

But do not turn it into the opposite slogan.

• The analyses were observational, not randomized.
• The breast comparison pooled multiple synthetic progestins.
• The endometrial “norsteroid derivative” category was not a clean NETA-only comparison.
• The breast and endometrial analyses did not ask the same question with an identical analytic sample and follow-up.
• The endometrial authors qualified the conclusion with the phrase “at the doses used in France.”^[16]

Dose and schedule are plausible explanations for at least part of the endometrial signal. They are not proven to explain all of it. That is exactly why this page cannot convert E3N into “progesterone protects the breast; norethindrone protects the uterus.”

What is known, what is suggested, and what is still unknown

Question	Known	Suggested, not proven as a head-to-head fact	Still unknown
Can the products protect the lining?	Exact FDA-studied progesterone and NETA products reduced hyperplasia in their own trials	Other clinician-directed regimens may be reasonable when supported by guidance and individual factors	Whether every separately assembled dose/route combination provides equivalent protection
Does micronized progesterone have a better breast profile?	Observational studies and a meta-analysis are more reassuring versus pooled synthetic progestins[17]	A true formulation difference may exist	Whether it produces fewer breast cancers than NETA in a randomized long-term outcomes trial
Does NETA have stronger endometrial evidence?	Fixed Activella and CombiPatch products have strong product-specific trial data	Some clinicians may prefer a progestin when bleeding or protection is the dominant concern	Whether NETA as a molecule is universally more protective than adequately dosed micronized progesterone
Does bleeding prove protection?	No	A change in bleeding can reveal an adherence or regimen issue	A home bleeding pattern cannot rule hyperplasia in or out

The scary cohort number converts into a checkable question:

Does the progestogen plan match my estrogen route, dose, and schedule—and what evidence supports that match?

That is not a reason to stop the progestogen. The risk being discussed is inadequate opposition of estrogen. Stopping the protective part of the regimen is not the solution.

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What progestogen doses do current guidance tables use?

Answer: The 2026 British Menopause Society tables list micronized progesterone 100 mg daily or 200 mg sequentially for low-to-medium estrogen doses, increasing to 200 mg daily or 300 mg sequentially with high-dose estrogen. Its norethisterone table uses the lowest standalone UK tablet and explicitly separates that availability problem from the dose that provides protection.^[20]

These are UK specialist guidance references, not US FDA labeling and not instructions to change your prescription.

British Menopause Society 2026 reference table

Estrogen category in the BMS table	Micronized progesterone—continuous	Micronized progesterone—sequential	Norethisterone note
Low or medium dose	100 mg daily	200 mg for 12–14 days per month	The BMS table lists 5 mg because that is the lowest standalone UK tablet, while its footnote states that 1 mg provides protection for low/medium estrogen doses
High dose	200 mg daily	300 mg for 12 days per month	The document calls for proportionate progestogen and acknowledges limited dose-specific evidence at high estrogen doses

The guidance also states that fewer than 10 days of progestogen in a sequential month is associated with higher endometrial risk and that compounded transdermal progesterone can have variable absorption and may not provide adequate protection.^[21]

Why the standalone 5 mg NETA tablet creates confusion

The BMS table does not say that 5 mg is a universal menopause target. It uses 5 mg because a 1 mg standalone norethisterone tablet is not marketed in the UK, then explains the lower amount that provides protection for low and medium estrogen doses.^[20]

Do not turn that footnote into “your tablet is five times bigger than it needs to be” or a plan assembled from multiple contraceptive minipills. That is not a safe consumer conclusion. Product availability, route, formulation, adherence, bleeding control, individual risk, and clinician judgment still matter. There is no patient-facing US substitution chart.

The sentence worth taking to the appointment

A 100 microgram estradiol patch falls into the BMS high-dose category. Its table lists 200 mg continuous micronized progesterone for that category. That makes 100 mg nightly with a 100 microgram patch a clinician-review question, not proof that an individual regimen is inadequate.^[20]

Ask:

“Is my progestogen plan proportionate to my estrogen dose, and which evidence supports this exact combination?”

Do not split tablets, combine minipills, double a capsule, or change the number of treatment days from this table.

Organize the exact product, dose, route, uterus status, and questions before you call: Use Find My HRT Path →

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Which one causes less bleeding?

Answer: Neither has a proven molecule-level advantage across all regimens. Bleeding depends heavily on whether treatment is cyclic or continuous, how long you have used it, whether you are still in perimenopause, the estrogen route and dose, adherence, and the exact fixed or separate product.

Most people assume NETA is the bleeding-control drug and progesterone is the messy one. The product labels are not clean enough to support that slogan.

• Bijuva's 52-week cumulative amenorrhea figures were 67.6% and 56.1% for its two strengths.^[9]
• Activella 1/0.5 reported about 86% amenorrhea after 12 months.^[7]
• CombiPatch reported 53% and 39% amenorrhea during cycles 10–12 for its two continuous strengths.^[8]

You will want to rank those numbers. Do not. The oral and transdermal products used different estrogen doses, populations, trial methods, and definitions.

Two variables actually explain more of the day-to-day pattern:

Cyclic versus continuous. A cyclic regimen is designed to expose the lining to progestogen for part of the month and may produce a scheduled withdrawal bleed. A continuous-combined regimen aims for amenorrhea, but unscheduled spotting is common during the settling-in phase.

Perimenopause versus postmenopause. If your ovaries are still cycling unpredictably, your own hormonal activity can make bleeding harder to interpret.

And this matters: bleeding is not a home test of endometrial protection. You can bleed on an adequately supported regimen. You can have no bleeding and still need the regimen reviewed. The bleeding pattern tells you what happened; it does not provide a biopsy result.

When unexpected bleeding needs clinical review

Current BMS guidance says clinicians can often adjust treatment for low-risk women when unscheduled bleeding begins within six months of starting HRT or persists within three months of a dose or product change. It recommends urgent transvaginal ultrasound when bleeding first appears more than six months after starting, more than three months after a change, or at any time when bleeding is heavy/prolonged or material risk factors are present.^[22]

For a US reader, the practical action is simpler:

• Contact the clinician if bleeding is unexpected.
• Seek prompt review for heavy or prolonged bleeding, bleeding after sex, or new bleeding after a stable pattern.
• Do not stop the progestogen or increase it on your own while waiting.

The HRT Index bleeding note

Before the appointment, record:

Record	Why it matters
Date and amount: spotting, light, moderate, heavy	Gives the clinician a pattern rather than a memory
Continuous or cyclic regimen	Changes what bleeding is expected
Exact estrogen and progestogen taken that day	Reveals missed doses or a product change
Time since starting or changing HRT	Connects the pattern to current bleeding guidance
Natural periods still possible?	Separates perimenopausal cycling from postmenopausal bleeding
Pain, bleeding after sex, dizziness, or other symptoms	Identifies reasons not to manage this as routine adjustment

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Is micronized progesterone better for sleep?

Answer: Micronized progesterone has randomized-trial evidence supporting improvement in some sleep outcomes. That is a real advantage for some women, not a universal one. The same neuroactive effects that may help at night can produce dizziness, next-day drowsiness, or—in a small number of women—much more intense impairment.

This is the clearest evidence-based difference on progesterone's side, and it is worth being precise about it.

A systematic review identified nine randomized trials with 388 participants; eight studies involved postmenopausal women. Several sleep outcomes improved, and a meta-analysis of four trials favored micronized progesterone for sleep-onset latency, with an effect estimate of 7.10 (95% CI 1.30–12.91). Total sleep time and sleep efficiency did not improve consistently across studies.^[18]

The Menopause Society's 2022 position statement also described oral micronized progesterone 300 mg nightly as reducing vasomotor symptoms and improving sleep compared with placebo, while noting the limits of the evidence. That monotherapy finding is not an endometrial-protection dosing instruction.^[19]

The catch is written in the label. Prometrium directs bedtime dosing because it can cause transient dizziness and drowsiness. In one label table, dizziness was reported in 15% with 200 mg progesterone plus conjugated estrogen versus 9% with placebo; at 400 mg in another study, it was 24% versus 4%.^[1]

The label's postmarketing section also describes a small number of women with severe initial reactions including extreme dizziness, confusion, trouble walking, and feeling “drunk.”^[1]

If that describes you, you are not imagining it. The label recognizes it. Because the label says a few women, this page will not tell you it is common.

Who should take the sedation problem seriously: anyone who drives early, operates machinery, has a fall risk, takes other sedating drugs, has disabling morning fog, or cannot function safely.

One more thing: if sleep improved after starting HRT, do not automatically credit the progesterone. Better control of hot flashes and night sweats can improve sleep on its own. If estrogen changed at the same time, you changed two variables.

---

Which is better for mood and brain fog?

Answer: Neither drug reliably predicts an individual's mood or cognitive response. Prometrium's label includes depression in a placebo-controlled adverse-event table, and the standalone NETA label lists depression and mood changes. The useful evidence is the timing and severity of your own symptoms—not an internet promise that one molecule is always calmer.^[1][5]

You can find one woman who felt flat and exhausted on progesterone and much better on NETA, and another who had the opposite experience. Both can be telling the truth.

That contradiction is the finding. It shows variability. It does not show a winner.

In one three-year Prometrium label table, depression was reported in 19% of women taking progesterone plus conjugated estrogen versus 12% taking placebo; worry was 8% versus 4%. The NETA label lists clinical depression, mood swings, and insomnia, and says women with a history of clinical depression should be observed carefully.^[1][5]

Those label facts do not let you compare 19% with an unlabeled NETA percentage. The trials did not use the same population, estrogen, reporting system, or duration.

The one question that fixes most of these conversations

“What else changed at the same time?”

Estrogen dose. Estrogen route. Sleep. Hot-flash control. Another new medication. Where you are in your cycle. Pain. Life stress. Any of these can create the same feeling.

For two weeks before a planned appointment, record:

• Mood, anxiety, irritability, and ability to function.
• Sleep duration and morning alertness.
• Bleeding and hot flashes.
• Exact medication timing.
• Missed doses.
• Any other medication or supplement change.

That is not a self-diagnosis. It is better evidence for the appointment than a symptom list reconstructed from memory.

One hard line: severe depression, thoughts of self-harm, mania, psychosis, or an inability to function safely is not a medication-comparison problem. Contact emergency services or urgent professional support now.

---

Which has the lower breast cancer risk?

Answer: Observational evidence is more reassuring for estrogen combined with micronized progesterone than for estrogen combined with synthetic progestins as a pooled group. That is not proof that progesterone is causally safer than NETA, and it is not a completed NETA-specific randomized cancer-outcomes comparison.

Here is what is actually known.

In the E3N breast analysis, estrogen plus synthetic progestins as a group was associated with a relative risk of 1.4 (95% CI 1.2–1.7), while estrogen plus micronized progesterone had a relative risk of 0.9 (0.7–1.2). The difference between those groups was statistically significant.^[15]

A later systematic review and meta-analysis of two cohort studies and one case-control study found progesterone was associated with lower breast-cancer risk than synthetic progestins when each was combined with estrogen, RR 0.67 (0.55–0.81). The authors rated the underlying evidence as observational and at moderate risk of bias.^[17]

Four limits belong next to those numbers:

1. 1. Women were not randomized. Treatment groups can differ in ways statistical adjustment does not fully remove.
2. 2. Synthetic progestins were pooled. A pooled group result does not become a NETA-specific effect.
3. 3. Estrogen route, dose, timing, and duration also matter. The progestogen is not the whole regimen.
4. 4. A non-significant relative risk is not proof of zero risk. “More reassuring” is the accurate phrase; “breast-safe” is not.

The Women's Health Initiative cannot settle this exact comparison either. Its estrogen-plus-progestin trial used conjugated estrogens plus medroxyprogesterone acetate—not NETA and not micronized progesterone.

How this page will write the conclusion:

Micronized progesterone has a more reassuring observational breast signal than pooled synthetic progestins, but the evidence does not establish a universal or NETA-specific safety advantage.

How this page will not write it:

• “Micronized progesterone does not increase breast-cancer risk.”
• “Norethindrone causes breast cancer.”
• “The breast-safe choice.”

If a page gives you one of those three, close it.

---

Which is safer for blood clots?

Answer: The clearest signal is the estrogen route, not a clean NETA-versus-progesterone verdict. Observational data are more reassuring for transdermal estrogen and for micronized progesterone, but the clinical-outcomes studies reviewed here did not directly isolate these two progestogens within the same estrogen regimen.

This is the comparison women make most often, and it has a weaker foundation than the confident internet summaries suggest.

A large 2019 UK nested case-control analysis found oral estradiol plus norethisterone was associated with increased VTE risk versus no HRT; the combined adjusted odds ratio was about 1.68. Across transdermal HRT preparations, the adjusted odds ratio was 0.93 (0.87–1.01), not a statistically significant increase.^[24]

The French ESTHER study found oral estrogen was associated with VTE, OR 4.2 (1.5–11.6), while transdermal estrogen was not, OR 0.9 (0.4–2.1). Micronized progesterone was not significantly associated with VTE, OR 0.7 (0.3–1.9).^[25]

Now the part most summaries skip:

• ESTHER did not provide a clean NETA estimate in the comparison that produced the micronized-progesterone number.
• The UK study had little micronized-progesterone exposure.
• The two numbers come from different countries, periods, populations, and comparison groups.

So the claim “progesterone is proven safer than norethindrone for clots” is assembled across studies. It may reflect a real difference. It has not been demonstrated in one direct clinical-outcomes comparison.

The NETA-to-ethinyl-estradiol finding—and its limit

A small amount of NETA is metabolically converted to ethinyl estradiol. A current Jinteli label states that exposure after 1 mg NETA is equivalent to oral exposure from 2.8 micrograms of ethinyl estradiol.^[26]

That is a pharmacokinetic fact. It is not proof that a 5 mg standalone tablet is clinically equivalent to a birth-control pill, and it is not proof that NETA cancels the clot-risk advantage associated with transdermal estrogen. Do not multiply the label figure into a birth-control-pill equivalent or treat it as a clinical-outcomes result; that goes beyond the evidence.

The useful question survives:

“Does the dose and route of my entire regimen still fit the reason we chose transdermal estrogen?”

That is a question, not an alarm. Do not stop anything over it.

---

Which side effects differ day to day?

Answer: Micronized progesterone's most distinctive labeled issue is dizziness and sedation. Standalone NETA's label lists mood effects, fluid retention, acne or other androgenic effects, and adverse lipid changes. Neither label can predict which regimen a particular woman will tolerate better.

Issue	Micronized progesterone	Standalone NETA	What not to conclude
Drowsiness and dizziness	Explicit label warning; bedtime dosing; 15% versus 9% placebo for dizziness at 200 mg in one table[1]	Not the defining label feature	That progesterone is automatically a sleep medicine for everyone
Breast tenderness	27% versus 6% placebo in one Prometrium trial table[1]	Listed among possible adverse reactions	That tenderness predicts breast-cancer risk
Depression or mood change	Depression 19% versus 12% placebo in one label table[1]	Depression and mood swings listed; prior depression needs observation[5]	That the percentages can be compared across labels
Bloating or fluid retention	Bloating 12% versus 5% placebo in one table[1]	Edema and fluid retention listed[5]	That scale weight proves fat gain
Headache	31% versus 27% placebo in one table[1]	Headache and migraine listed[5]	That every headache is caused by the progestogen
Acne or hair/skin changes	Not a defining label difference	Acne and other androgenic effects are listed[5]	That every NETA user will experience them
Lipids	No simple “neutral” conclusion from the label	Decreased HDL and increased LDL/HDL ratio listed[5]	That one lab change proves a clinical event
Allergy/excipients	Prometrium and multiple current standalone generic labels contain peanut oil[2][3][4]	Excipients vary by manufacturer; reviewed NETA labels did not contain peanut oil	That an ingredient table replaces checking the exact dispensed label

Always look for the comparator. Headache at 31% sounds alarming until the placebo rate of 27% is visible. Joint pain in the same table was lower with treatment than placebo, 20% versus 29%.^[1]

And one caution: you cannot compare adverse-event percentages across the two labels. Different trials, different estrogens, different durations, different reporting methods.

---

What if you are allergic to peanuts?

Answer: Prometrium and multiple current standalone generic oral progesterone labels contain peanut oil, and Prometrium is contraindicated in peanut allergy. Bijuva contains micronized progesterone in a fixed estradiol/progesterone capsule without peanut oil. NETA products provide another route, but the entire regimen still has to fit.^{[1][2][3][4][9]}

The clean distinction is not “micronized progesterone always contains peanut oil.” Bijuva is a micronized-progesterone capsule and does not contain peanut oil. The standalone oral capsules checked for this page did contain it, but the exact current manufacturer label still controls.

The verified allergen fork

Product	What the current label reviewed shows	Decision consequence
Prometrium	Peanut oil; contraindicated in peanut allergy[1]	Do not use this branded product with peanut allergy
Standalone oral progesterone generics reviewed	Peanut oil in multiple current labels[2][3][4]	Check the exact manufacturer and current package insert; do not assume a generic is peanut-free
Bijuva	Medium-chain glycerides/triglycerides rather than peanut oil[9]	Peanut-oil-free progesterone route, but fixed to oral estradiol and not pairable with an existing patch
Standalone NETA	No peanut oil in the reviewed labels	May avoid that excipient, but FDA status, dose context, and other risks still need review

For a woman with a peanut allergy, NETA is not a downgrade. It may be one of the workable choices. Bijuva may also be an option if a fixed oral estradiol/progesterone product fits.

That is the section where the page runs the other way.

A “peanut-free” ingredient list is not a guarantee about manufacturing cross-contact. With a severe allergy, ask the pharmacist about the exact manufacturer and facility information.

If allergy is driving the decision, map it before the consult: Get my Find My HRT Path result →

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What does each one cost?

Answer: Generic standalone progesterone and generic NETA are both relatively low-cost prescriptions on discount pages, but there is no stable price winner. On August 31, 2026, GoodRx's default dosage tables displayed $19.55 for 30 progesterone 100 mg capsules and $22.72 for 30 NETA 5 mg tablets.^[29][30]

Cash-price snapshot—verified August 31, 2026

Exact prescription	Displayed GoodRx coupon figure	What can change the final price
Progesterone 100 mg, 30 capsules	$19.55 displayed GoodRx price	Manufacturer/NDC, pharmacy, ZIP code, coupon, quantity, insurance, and date
Norethindrone acetate 5 mg, 30 tablets	$22.72 displayed GoodRx price	Manufacturer/NDC, pharmacy, ZIP code, coupon, quantity, insurance, and date

Those are coupon-page snapshots, not pharmacy quotes and not guaranteed checkout prices. The exact strength matters. A fixed brand product such as Bijuva, Activella, or CombiPatch has a different coverage and pricing question from either generic standalone prescription.

The useful conclusion is not “they cost the same.” It is:

There is no dependable cost reason to assume the cheaper-looking prescription is inferior. Verify the exact NDC and pharmacy price before treating a few dollars on a coupon page as a clinical signal.

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Does menopause HRT prevent pregnancy?

Answer: No. Menopause hormone therapy is not contraception. Norethindrone 0.35 mg is a contraceptive product; standalone NETA 5 mg and the NETA amounts inside ordinary menopause combinations are not approved as contraceptive regimens.^[6]

This trips up more women than it should, and the naming makes it worse.

Norethindrone 0.35 mg is a contraceptive. Its label is explicit.^[6]

Standalone NETA 5 mg is not a contraceptive product. Different drug form, different labeled indications, different job.^[5]

The NETA inside Activella, CombiPatch, or Jinteli is not contraception either. It is part of a menopause hormone product.

If you are in perimenopause, pregnancy remains possible even when periods are irregular. Four different jobs get collapsed under one hormone name:

1. 1. Treating hot flashes and night sweats.
2. 2. Protecting the endometrium during systemic estrogen.
3. 3. Managing a bleeding disorder that has been assessed.
4. 4. Preventing pregnancy.

No single product automatically does all four. Ask which jobs yours is actually doing.

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Can you switch from one to the other?

Answer: A clinician can switch progestogens when tolerability, bleeding, route, allergy, cost, coverage, or another treatment goal justifies it. There is no safe patient-facing milligram conversion, washout, or universal taper rule. If you have a uterus and remain on systemic estrogen, the replacement plan must preserve deliberate endometrial protection.

Do not switch on your own. Not because we are being cautious for the sake of it—because there is no conversion rate to switch by, and a gap in the plan is where the risk lives.

Step one — write down exactly what you have

• Product name and manufacturer.
• Active ingredient or ingredients.
• Strength.
• Form: capsule, tablet, or patch.
• Schedule.
• Estrogen product, dose, and route.
• Start date and any recent change.
• Missed doses.

Step two — name the actual problem

“I want to switch” is not the useful reason. These are:

• Daytime grogginess.
• Mood change.
• Bleeding pattern.
• Route preference.
• Patch adhesion.
• Peanut or another excipient allergy.
• Cost or coverage.
• Supply shortage.
• Wanting to adjust estrogen and progestogen separately.
• Needing contraception.

The answer changes with the problem.

Step three — bring these six questions

1. 1. What exact product and dose am I using, and is it a fixed combination or two separate prescriptions?
2. 2. What evidence supports endometrial protection with this progestogen, at this dose and schedule, with my estrogen route and dose?
3. 3. Is the progestogen plan proportionate to my estrogen dose?
4. 4. What bleeding pattern should I expect, and what would trigger assessment?
5. 5. If we switch, what protects the endometrium during the change?
6. 6. When will we review whether the new plan is working?

Two scripts for two different conversations:

• If someone says the products are interchangeable: “Which exact product, dose, schedule, and estrogen route is that based on?”
• If someone rules one option out entirely: “Is that because of my risk history, or is it a general policy?”

One additional option to ask about

A 52 mg levonorgestrel intrauterine device can provide local progestogen exposure and is used in UK guidance as an endometrial-protection option with estrogen. In the United States, its current label covers contraception and heavy menstrual bleeding—not endometrial protection during menopause HRT—so that specific use is off-label. It can be a useful prescriber discussion when systemic progestogen effects are the problem, but it is not an internet workaround.^[21][23]

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Who should not use this page to decide?

Answer: This page cannot resolve unexplained bleeding, possible pregnancy, severe mood deterioration, emergency symptoms, or a complex history of hormone-sensitive cancer, blood clots, stroke, heart disease, liver disease, or unclear pelvic surgery. Those situations need individual clinical assessment, not a medication-comparison verdict.

Some readers should stop here and make an appointment instead. If that is you, we would rather lose the click.

Contact a clinician promptly if:

• Bleeding is heavy, prolonged, occurs after sex, or begins after a stable HRT pattern.
• Unexpected bleeding first appears well after starting or changing HRT.
• You are unsure whether the uterus or cervix remains after surgery.
• A new pelvic symptom or mass has appeared.
• Mood symptoms are rapidly worsening.

Get emergency help now for:

• Chest pain or sudden shortness of breath.
• Sudden one-sided weakness, trouble speaking, or sudden vision loss.
• Severe leg pain and swelling with clot concern.
• Thoughts of self-harm or an inability to function safely.

The exact contraindication list belongs to the current label for the exact product. Prometrium, NETA, Activella, CombiPatch, and Bijuva do not all have an identical list. Do not merge them into one internet checklist and use it to clear yourself.

---

What does nobody know yet?

Answer: No peer-reviewed results were located as of August 31, 2026 from the randomized PROBES comparison of micronized progesterone and NETA. The published protocol is designed to compare breast-density, endometrial, bleeding, mood, coagulation, metabolic, and quality-of-life outcomes—but a planned or estimated completion date is not a publication date.^[27]

Every page arguing this question is arguing ahead of the direct randomized evidence. Including, in fairness, the parts of this one that offer judgment.

What PROBES is designed to test

The 2024 protocol describes:

• A double-blind randomized first phase at three Swedish university hospitals.
• 260 postmenopausal women assigned to 100 mg micronized progesterone or 0.5 mg NETA, each with 1 mg oral estradiol, continuously for 12 months.
• Mammographic breast-density change as the primary randomized endpoint.
• Secondary measures including breast proliferation, endometrial histology and proliferation, bleeding, mood, quality of life, coagulation, metabolic markers, and microbiome outcomes.
• A second, open single-arm micronized-progesterone phase, producing a total planned enrollment of 520 and an endometrial-safety population of 390.^[27]

The protocol exists because comparative randomized data were lacking.

What it will not settle by design

• Decades-long breast- or endometrial-cancer incidence.
• Mortality superiority.
• Every estrogen route or dose.
• Perimenopausal outcomes.
• Individual tolerability.
• Equivalence between fixed US products and separately prescribed regimens.
• Safety or effectiveness of compounded products.

The registry may carry an estimated completion date. ClinicalTrials.gov defines an estimated study-completion date as the researchers' expected date, not the date results will appear.^[28]

The accurate current statement is:

No peer-reviewed PROBES results were located as of August 31, 2026. This section should be reviewed immediately when results, a preprint, or a peer-reviewed paper appears.

---

How did The HRT Index verify this comparison?

Answer: Every material claim on this page traces to a named source. We began with the exact US product labels, separated fixed FDA-approved combinations from standalone off-label contexts, then added professional guidance and original studies while keeping label facts, observational associations, and editorial conclusions visibly separate.

This is The HRT Index Verification Standard: read every published price, separate FDA-approved from compounded, verify state availability and insurance, and re-check on a fixed schedule—top providers monthly, full roster quarterly.

When The HRT Index evaluates providers, it uses exactly five pillars, in this order: clinical legitimacy, care quality, medication fit, price transparency, access. This medication page does not turn those pillars into a numeric score and does not invent a per-product score.

What we actually verified

• Current DailyMed labeling for Prometrium, three standalone generic progesterone labels, standalone NETA 5 mg, norethindrone 0.35 mg, Activella, CombiPatch, Bijuva, and Jinteli.
• Prometrium's cyclic label regimen, peanut-oil contraindication, endometrial trial, and dizziness/drowsiness data.
• The standalone NETA label's exclusion of concomitant postmenopausal estrogen use for endometrial protection.
• Activella, CombiPatch, and Bijuva product-specific endometrial and bleeding tables.
• Both the breast and endometrial E3N analyses from the original publications.
• The randomized-trial systematic review of micronized progesterone and sleep.
• The 2026 British Menopause Society practical prescribing and endometrial-protection tools.
• The BMS unscheduled-bleeding guideline.
• Vinogradova and ESTHER for the clot section.
• The current Jinteli label for the existence of NETA-to-ethinyl-estradiol conversion.
• The PROBES protocol and the absence of a peer-reviewed result located by August 31, 2026.
• GoodRx coupon snapshots for the two generic standalone prescriptions.
• Current provider pricing and public-plan policies in the late care-access section below.

What we did not verify

• Your prescription or your clinician's reasoning.
• Any patient-facing dose conversion.
• Whether your exact generic NDC contains a particular inactive ingredient without seeing its current label.
• Your insurer's formulary or your pharmacy's final price.
• A universal breast, endometrial, or clot-risk winner.
• A current completed PROBES result, because none was located.
• Firsthand use of either medication or any provider service.

Who wrote this and why: The HRT Index Editorial Team. We built this page because comparison articles kept arguing a side without first telling a woman which bottle she was holding. This is documentation-based editorial research. It has not been reviewed by a clinician, and we will not claim otherwise.

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Where can you find a prescriber who will actually have this conversation?

Answer: Both generic standalone drugs are inexpensive enough that the care model—not the pill price—is often the bigger decision. Your existing gynecologist or menopause prescriber is the first choice when that person knows your history and will review the exact estrogen, progestogen, bleeding pattern, and reason for changing.

Let us be straight with you: this page may have just saved you a purchase.

If you already have a clinician who knows you and will answer the six switching questions, book that appointment. Nothing below is required.

The problem is when you do not have that person—or when the person you have will not engage. Then the useful comparison is not “which subscription ships hormones fastest?” It is “which care model gives a licensed clinician enough context to review this exact regimen?”

Affiliate disclosure: The HRT Index may earn a commission if you start care through a marked provider link, at no extra cost to you. That relationship did not change the medication evidence or which providers were excluded from this section. Read the full affiliate disclosure.

Midi Health — if you want insurance-billed menopause care

Midi states that it is in-network with most commercial PPO plans. Its current self-pay prices are $250 for the initial visit and $150 for continued-care visits, with no membership fee. Coverage, copays, deductibles, and coinsurance still depend on the plan.^[31]

Why it fits this question: this is not a “send me the cheapest capsule” decision. The useful visit is the one where someone reviews the exact estrogen dose and route, explains the progestogen evidence, and gives you a monitoring plan.

Here is the part we have to tell you.

Midi is not enrolled with Medicare. Medicare beneficiaries may use Midi as self-pay patients but cannot submit Midi-related claims. Midi also states that it cannot treat Medicaid or Medi-Cal patients, even as self-pay patients.^[31]

Midi asks patients to cancel or reschedule at least 24 hours before a visit to avoid a cancellation fee.^[32]

Two provider-published access comments capture the friction this route is meant to solve:

“Midi was incredibly easy. I signed up and had a visit the next day.” — Katherine G., published by Midi^[33]

“My Midi clinician understood the nuances of perimenopause & provided options.” — Pamela S., published by Midi^[34]

These comments describe access and communication. They are not evidence that either medication works, is safe, or will produce a typical result. Midi separately says some featured patients became Midi Ambassadors and may receive free products or swag; the two pages carrying these excerpts do not state whether that applies to Katherine or Pamela.^[31]

If that excludes you, do not force the fit. Use your own gynecologist, a local in-network clinician, or a cash-pay route that serves your situation.

The strength of Midi's model for a commercially insured reader is also its limitation: it prices clinician care rather than bundling a generic medication into a membership. The prescription can be sent to a pharmacy, and the pharmacy cost remains a separate insurance or cash-price question.

Does this sound like your situation? Check Midi's current coverage and book a menopause visit →

Affiliate link. We may earn a commission at no extra cost to you. A Midi clinician decides whether treatment is appropriate.

Sesame — if you want a cash-pay ongoing menopause program

Sesame's current menopause program is advertised from $59 per month. The program page describes ongoing provider care, treatment adjustments, basic lab work when necessary, and prescriptions sent to a preferred local pharmacy; medication costs are separate.^[35]

Here is the part we have to tell you. Cancel at least three hours before the initial visit for a full refund. Once the initial visit has occurred, the first month is not refundable. You can self-cancel before the next billing cycle to avoid future charges, but prior months are not refundable.^[35]

Sesame also offers a separate one-off refill visit from $34. It is designed around one or two existing prescriptions, a prescription is not guaranteed, and the visit is not refundable if the provider decides medication is not necessary.^[36] That is not the same product as an ongoing menopause-care relationship.

For this question, use the menopause-care program or book a sufficiently comprehensive clinician visit. Do not choose a short refill slot and expect a full risk, bleeding, and regimen review.

If cash-pay ongoing care fits better, see Sesame's current menopause-care pricing and availability →

Provider link. Prescriptions remain at the clinician's discretion, and the pharmacy price is separate.

Who is not a primary recommendation on this page—and why

Winona advertises both FDA-approved and compounded options, and its official page says its estrogen and progesterone body creams are compounded. Inner Balance states that Oestra is a compounded estradiol/progesterone vaginal cream.^[37][38]

Those may be separate decisions for a woman who specifically needs a compounded formulation. They are not the primary route for a page comparing the evidence behind FDA-approved oral micronized progesterone and NETA products. A compounded finished preparation is not FDA-approved, and this page will not present it as equivalent to Prometrium, Bijuva, Activella, CombiPatch, or another approved product.^[13]

No medication-result testimonial appears on this page. A quote saying one drug “worked” would not establish efficacy, safety, or typical response.

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Frequently asked questions about norethindrone vs micronized progesterone for HRT

Answer: The recurring questions are about equivalence, uterine protection, sleep, mood, breast and clot evidence, allergy, pregnancy prevention, and switching. The answer keeps returning to the exact product and the complete estrogen–progestogen regimen—not the drug name or milligram number alone.

Is norethindrone a progesterone?

No. Norethindrone and NETA are synthetic progestins. Micronized progesterone contains progesterone. They can serve overlapping roles in HRT but are not the same drug.

Is norethindrone acetate the same as the norethindrone in the minipill?

No. The traditional progestin-only minipill contains norethindrone 0.35 mg. The standalone tablet discussed here contains NETA 5 mg. Do not convert between them from the numbers on the label.

Is Opill norethindrone?

No. Opill contains norgestrel 0.075 mg.^[14]

Is norethisterone acetate the same as norethindrone acetate?

Yes. “Norethisterone acetate” is the name commonly used outside the United States for NETA.

Is micronized progesterone the same as Prometrium?

Prometrium is a brand of oral micronized progesterone. Generic products contain progesterone but can differ in inactive ingredients and manufacturer labeling.

Does bioidentical mean safer?

No. It describes molecular structure, not an automatic safety advantage. FDA-approved manufactured progesterone and compounded progesterone are also different regulatory categories.

Is 100 mg progesterone equivalent to 0.5 mg NETA?

No. There is no patient-facing milligram conversion between them.

Is standalone NETA 5 mg FDA-approved with estrogen after menopause?

No. Its current label excludes concomitant postmenopausal estrogen use for endometrial protection.^[5]

Is 5 mg of NETA too much?

An internet page cannot answer that for an individual. UK guidance explains that its table uses 5 mg because a lower standalone tablet is not marketed there, but that does not create a US self-adjustment rule.^[20]

Is 100 mg progesterone nightly enough with an estradiol patch?

It depends on the estrogen dose and the evidence supporting the regimen. The 2026 BMS table lists 100 mg continuous progesterone for low-to-medium estrogen and 200 mg continuous for high-dose estrogen. Use that as a clinician question, not a self-dosing instruction.^[20]

Which is better for sleep?

Micronized progesterone has randomized-trial evidence supporting some sleep improvements. The tradeoff is dizziness or next-day sedation for some women.^[18][1]

Which is better for mood?

Neither reliably predicts an individual's response. Record timing, severity, sleep, bleeding, estrogen changes, and other medication changes before the appointment.

Which causes less bleeding?

There is no clean molecule-only answer. Continuous versus cyclic treatment, menopause stage, estrogen route and dose, adherence, and the exact product matter more than one label name.

Which has the lower breast-cancer risk?

Observational evidence is more reassuring for micronized progesterone than for synthetic progestins as a group. It is not proof of a specific causal advantage over NETA.^[15][17]

Which has the lower clot risk?

The estrogen route is the strongest consistent signal in the evidence reviewed. Transdermal estrogen was not associated with increased VTE in the cited observational studies, while a direct NETA-versus-micronized-progesterone clinical-outcomes comparison is missing.^[24][25]

Which one causes weight gain?

Neither can be predicted from the drug name. Fluid retention and weight changes can occur, but a scale change does not tell you which tissue changed or prove a causal drug effect.

Do I need a progestogen after hysterectomy?

Usually not for endometrial protection because the uterus is absent. Confirm which organs were removed and whether another diagnosis changes the plan.^[11]

Do I need a progestogen with low-dose vaginal estrogen?

Usually not solely for a standard low-dose local product. Systemic vaginal products, high-dose or prolonged cream regimens, other systemic estrogen, and unexplained bleeding change the answer. See do you need progesterone with vaginal estrogen.

What if I have had an endometrial ablation?

Ablation does not remove the uterus. Treat it as a specific clinician question rather than assuming no endometrium remains.

Can I take progesterone with a peanut allergy?

Prometrium is contraindicated in peanut allergy, and multiple current standalone generic labels contain peanut oil. Bijuva does not contain peanut oil, and NETA products provide another route. Check the exact current label.^{[1][2][3][4][9]}

Does HRT prevent pregnancy?

No. Menopause HRT is not contraception.

Can I take progesterone in the morning instead?

Prometrium's label directs bedtime dosing because of dizziness and drowsiness. Ask the prescriber before changing timing.^[1]

Can I switch without tapering?

There is no safe universal internet rule. The clinician should define timing so the endometrial-protection plan remains intentional while systemic estrogen continues.

Is compounded progesterone equivalent?

No. A compounded finished product is not FDA-approved, and FDA does not review it for safety, effectiveness, or quality before marketing. Compounded transdermal progesterone may also provide unreliable endometrial protection.^[13][21]

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What should you do before you go?

Answer: Identify the exact product, write down the estrogen route and dose, name the problem you are trying to solve, and bring the six questions from the switching section. Do not change the progestogen while continuing systemic estrogen without a deliberate clinician-directed replacement plan.

You came here for a winner.

What you are leaving with is better: you know which bottle you are holding, what its own label does and does not support, why the trial percentages cannot be ranked, what your progestogen dose must be measured against, and the exact questions that can make your next appointment worth the copay.

That is a better outcome than a verdict, because the verdict does not exist yet.

Still not sure which HRT program is right for you? Take our free matching quiz.

Find My HRT Path →

Find My HRT Path takes about 90 seconds, requires no email, and gives you a private pre-consult care-path result. It also flags when online care is not the right starting point.

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The HRT Index publishes independent educational research about online menopause and hormone replacement therapy care for women. This page is not medical advice, diagnosis, or treatment and has not been medically reviewed by a clinician. Talk with a qualified healthcare professional before starting, stopping, switching, or changing any medication.

Sources

¹ DailyMed — Prometrium (progesterone) capsules, current US prescribing information, revised February 2026; DailyMed updated July 23, 2026; accessed August 31, 2026.

² DailyMed — Progesterone capsules, current generic label, accessed August 31, 2026.

³ DailyMed — Progesterone capsules, Aurobindo/Eugia label, accessed August 31, 2026.

⁴ DailyMed — Progesterone capsules, Dr. Reddy's label, accessed August 31, 2026.

⁵ DailyMed — Norethindrone acetate tablets 5 mg, US prescribing information, accessed August 31, 2026.

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