Is this page for you?
✅ Yes, if:
- You have a uterus and use systemic estrogen (patch, pill, gel, spray), or you're considering it
- Your sleep changed during the menopause transition
- You want the form of progesterone that was actually studied — not the one with the best marketing
- You've had a hysterectomy and want a straight answer about whether this still applies (it might — see below)
⚠️ Slow down, if:
- You have a peanut allergy. Prometrium contains peanut oil. There's a real workaround and we cover it.
- You have a history of breast cancer, blood clots, stroke, heart attack, or liver disease. Don't start with a routine intake form. This needs individualized evaluation first.
- You snore, gasp, or stop breathing at night. That's a different problem wearing a menopause costume.
- You have bleeding nobody has explained. Get evaluated before anyone prescribes you hormones.
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.
Affiliate disclosure: We earn a commission if you start care with some of the providers on this page. It doesn't change what we found. On this page we recommend against the higher-priced product sold by one of our affiliate partners, because the evidence doesn't support it for sleep. Full disclosure →
The 20-second version
The right provider depends on your situation. Here's a quick map — details follow.
| Your situation | Where to start |
|---|---|
| You have PPO insurance | Midi Health — in-network with most PPO plans, all 50 states, video visit |
| You're paying cash and want it shipped | Winona — from $39/month, no separate consult fee — but only 37 states |
| You have a peanut allergy | Midi Custom Rx — compounded, peanut-free, from $35 (not FDA-approved — read why that matters) |
| You want a video visit and your local pharmacy | Sesame Care — from $59/month, medication separate |
| You want the lowest possible price | Any licensed visit + generic at your pharmacy — roughly $14–20/month |
| You're not sure hormones are the answer | Find My HRT Path → — about 90 seconds, no email |
Does progesterone actually help you sleep?
We're going to show you all of it. Every trial. Including the ones that found nothing.
That's deliberate. You've been sold to before. So instead of "studies show progesterone improves sleep!" and hoping you don't check — here's the research.
One caveat we're not going to bury: that review's search stopped in March 2020. It's the best synthesis that exists, and it is not a live feed. We haven't found a later systematic review that supersedes it, but this is a snapshot, not a permanent scoreboard.
Every trial in the review
| Study | Who was in it | Dose | Compared to | Measured by | What happened |
|---|---|---|---|---|---|
| Caufriez 2011 | 8 postmenopausal women, avg 57 | 300 mg oral | Placebo | Sleep lab | Total sleep +20%, efficiency +15%, time awake −53%, deep sleep +50% — but only on the night they drew blood. Nothing on the undisturbed night. |
| Schüssler 2008 | 10 postmenopausal women, avg 60 | 300 mg oral | Placebo | Sleep lab | Slept longer, fell asleep faster, less time awake. Asked how they slept? No difference. |
| Hitchcock & Prior 2012 | 133 postmenopausal women, avg 55 | 300 mg oral | Placebo | Self-rated | Sleep improved (p=0.019). Largest placebo-controlled trial in postmenopausal women. |
| Prior 2023 (perimenopause) | 189 perimenopausal women, avg 50 | 300 mg oral | Placebo | Self-rated | Perceived sleep improved vs placebo. The trial's primary hot-flash endpoint did not reach significance — sleep was a secondary outcome. |
| Montplaisir 2001 | 21 postmenopausal women, avg 55 | 200 mg oral + estrogen | Estrogen + Provera | Sleep lab | Sleep efficiency 80.9% → 89.4%. Time awake 86 min → 47 min. Beat the Provera regimen. |
| Gambacciani 2005 | 60 postmenopausal women, avg 53 | 100 mg oral + estrogen | Estrogen + Provera; calcium | Sleep rating | Beat both. And: hot-flash improvement didn't track with sleep improvement. |
| Schüssler 2018 | 12 postmenopausal women, avg 60 | 9 mg intranasal | Ambien; placebo | Sleep lab | Improved on multiple measures. (Not available in the US.) |
| Leeangkoonsathian 2017 | 100 postmenopausal women, avg 52 | 100 mg oral + estrogen | Estrogen + dydrogesterone | Questionnaire | Both improved. No difference between them. |
| Heinrich 2005 | 35 postmenopausal women, avg 64 | 100 mg oral + estrogen | Estrogen alone; placebo | Sleep item | Everyone improved, including placebo. No difference. |
| Friess 1997 | 9 men, avg 25 | 300 mg oral | Placebo | Sleep lab | Deep sleep came on faster. Total sleep, efficiency, latency: nothing. |
The pooled results — what nobody publishes
| Outcome | Effect | 95% CI | Statistically significant? |
|---|---|---|---|
| Sleep-onset latency (all routes, 4 studies) | 7.10 minutes | 1.30 to 12.91 | ✅ Yes |
| Sleep-onset latency (oral only) | 6.89 minutes | 0.69 to 13.08 | ✅ Yes |
| Total sleep time (oral) | 14.65 min | −14.10 to 43.39 | ❌ No |
| Sleep efficiency (oral) | 0.47 | −3.34 to 4.29 | ❌ No |
Look at the bottom two. The interval crosses zero. The effect on total sleep time and sleep efficiency wasn't strong enough to rule out chance.
What that means for you
- ▶️ Falls asleep faster: supported, by roughly seven minutes on average, in a small pooled analysis.
- ❌ Sleeps more hours: not established.
- ⚠️ Less time awake at 3 a.m.: individual trials found it. Pooled, it didn't clear the bar.
And here's the uncomfortable part for anyone reading this at 3 a.m.: the outcome with the strongest evidence is the one you probably don't have a problem with. That's not a reason to stop reading. It's a reason to know what you're asking for. Several individual trials — Montplaisir's especially, cutting time-awake from 86 minutes to 47 — did find maintenance benefits. They just weren't consistent enough across small studies to pool cleanly.
The review's authors were honest about why. One trial had eight people. Some women were also on estrogen, so you can't separate the drugs. Their actual conclusion: micronized progesterone could be consideredfor sleep in postmenopausal women already on hormone therapy, at 300 mg at night. Could be considered. Not "cures insomnia."
And notice who was studied. Eight of ten trials enrolled postmenopausal women. One enrolled perimenopausal women. One enrolled nine young men. If you're 47 and still cycling, you're leaning on one trial. If you're 56 and two years past your last period, you're leaning on eight.
Are you the woman these trials enrolled?
Seven questions. About 30 seconds. No email. Find out whether your situation matches the research — and whether online care is even the right starting point for you.
Run the Progesterone Sleep Fit Check →Is progesterone FDA-approved for sleep?
This is where most affiliate sites go quiet. We're not going to.
Progesterone is not approved for sleep. If a provider tells you it is, they're wrong. If a website implies it, they're hoping you don't check.
If you need a medication formally approved for insomnia, this isn't it, and a sleep specialist is a better door than any online menopause clinic. If that's your answer, our menopause sleep guide will serve you better than this page.
What's actually in the February 2026 label
On February 12, 2026, the FDA approved the first six revised menopausal hormone therapy products — removing boxed-warning language about cardiovascular disease, breast cancer, and probable dementia. Prometrium was the only progestogen-alone product in that first group.
| What you want to know | What the February 2026 Prometrium label says |
|---|---|
| Approved for insomnia? | No. Approved uses: preventing endometrial hyperplasia in nonhysterectomized postmenopausal women on conjugated estrogens, and secondary amenorrhea. Sleep is not listed. |
| So the sleepiness is internet talk? | No. It's in the label. Under Precautions, "Dizziness and Drowsiness": the capsules "may cause transient dizziness and drowsiness" and "should be taken as a single daily dose at bedtime." |
| Does the FDA say to take it at night? | Yes. Endometrial protection: 200 mg at bedtime, 12 days of each 28-day cycle. Secondary amenorrhea: 400 mg at bedtime for 10 days. |
| Why bedtime? | The patient leaflet is blunt: take it at bedtime "as some women become very drowsy and/or dizzy after taking PROMETRIUM Capsules." |
| Boxed warning? | None in this version. The cardiovascular, breast cancer, and dementia risk statements were removed. WHI data remains in Warnings. |
| Peanut oil? | Yes, in both 100 mg and 200 mg. Contraindicated in peanut allergy. |
| Who distributes it? | Acertis Pharmaceuticals, Raleigh, NC. (The national shortage bulletin still listed Virtus as of late 2025. The distributor changed.) |
The sentence that should make your shoulders drop
The FDA does not approve progesterone for sleep. It approves it to protect your uterine lining — and then tells you to take it at bedtime because it makes you drowsy.
The drowsiness isn't a rumor you found on Instagram. It's printed on the FDA-approved label. It's filed under "side effect" instead of "indication." A labeled side effect is not proof of efficacy — but if you have a uterus and use systemic estrogen, you may already need this medication for uterine protection. You're not walking in asking for a sleep drug under a fake name. You're asking your clinician to think about timing on something your regimen may already require.
"Off-label" isn't a dirty word
Off-label means a clinician prescribes an approved drug for a use, population, route, or dose that isn't in its approved labeling. It's legal. It's routine. Older US outpatient research put off-label prescribing at roughly one in five prescriptions. It doesn't mean sketchy. It means the FDA hasn't reviewed progesterone specifically as a sleep treatment — so the decision rests on your clinician and your situation.
Does that sound like your last appointment?
We wrote a two-page script — the exact words, with the label citation, so this becomes a conversation instead of an argument. Free. No email.
Get the consult script →Is your sleep problem the kind progesterone helps?
| Your pattern | How well the trials fit | The honest next question |
|---|---|---|
| Can't fall asleep | Best fit. This is the outcome that survived pooling — about 7 minutes | Worth raising with a clinician |
| Night sweats wake you | Indirect fit — treating the hot flashes may be the lever | Ask about vasomotor treatment first |
| Wake at 2–4 a.m. | Weaker fit. Individual trials found benefit; pooled analysis didn't reach significance | Reasonable to raise, with realistic expectations |
| Snoring, gasping, morning headaches | No fit. Screen first. | Ask about a sleep evaluation before hormones |
| Restless legs | No fit — the reviewed evidence doesn't address it | Different workup |
| Anxiety, racing thoughts since your 30s | Poor fit | Ask about insomnia-specific treatment |
You wake up drenched
If night sweats wake you, the fix may not be progesterone's calming effect at all — it may be treating the hot flashes. Hormone therapy is the most effective treatment for vasomotor symptoms, per The Menopause Society. Though notice from the table above: in Gambacciani's trial, hot-flash improvement and sleep improvement didn't move together. So it's not only about night sweats. But if you're soaking a shirt nightly, that's the thread to pull first.
You fall asleep fine, then wake at 2–4 a.m.
This is the most common pattern in this search. It has a name: sleep maintenance insomnia — trouble staying asleep rather than falling asleep.
The honest part: this is the pattern with the weaker pooled evidence.It's also extremely common in people nowhere near perimenopause. Waking at 3 a.m. does not prove your progesterone is low. Anyone who tells you it does is selling something.
🚩 You snore, gasp, or wake with headaches — stop here.
Loud snoring, gasping, someone telling you that you stop breathing, morning headaches, or dangerous daytime sleepiness — that's a screen for sleep-disordered breathing. It's common in midlife women and gets missed constantly because everyone assumes it's menopause.
Get it evaluated. Then come back. Our menopause sleep guide covers the full picture.
What dose of progesterone is used for sleep?
The table below reports what studies used. It is not a dosing recommendation.
| Dose | What was studied | Result |
|---|---|---|
| 100 mg | Usually combined with estrogen | Improved sleep quality in some trials; no better than the comparator in two |
| 200 mg | The label's endometrial-protection regimen | Beat a Provera regimen on sleep efficiency and time-awake in one 21-person sleep-lab study |
| 300 mg | The dose in every major placebo-controlled sleep trial | The dose the review's authors named in their conclusion |
Why it flattened your friend and did nothing for you
Here's something in the FDA label that almost nobody reads. Table 1 — how much progesterone actually reaches the blood:
| Daily dose | Peak level (mean ± SD) | Time to peak | Total exposure |
|---|---|---|---|
| 100 mg | 17.3 ± 21.91 ng/mL | 1.5 hrs | 43.3 ± 30.8 |
| 200 mg | 38.1 ± 37.8 ng/mL | 2.3 hrs | 101.2 ± 66.0 |
| 300 mg | 60.6 ± 72.5 ng/mL | 1.7 hrs | 175.7 ± 170.3 |
Look at the 100 mg row. Average peak: 17.3. Standard deviation: 21.91. The spread is bigger than the average. The variability in measured exposure is documented and expected.When she says 100 mg knocked her flat and you took 200 mg and felt nothing, neither of you is doing it wrong. Your first response isn't the final conclusion — it's information to bring back to whoever prescribed it.
Food increases absorption
The FDA label reports that taking 200 mg with food increased bioavailability compared to fasting. Midi's own patient guidance adds: pick one way and be consistent, so you absorb the same amount each night. Follow whatever instruction came with your prescription — but if you weren't given one, that's a good question to ask.
Get out of bed slowly
MedlinePlus (National Library of Medicine) warns that progesterone can cause dizziness, lightheadedness, and fainting when you stand up too fast, and that it's most common when you first start. Their advice: get out of bed slowly, resting your feet on the floor for a few minutes before standing. Think about what that means at 2 a.m., in the dark, having taken a medication that makes you drowsy.
Capsule, cream, or vaginal: which progesterone has the sleep evidence?
| Form | FDA status | Sleep trial evidence | Endometrial protection | Peanut oil | Cost |
|---|---|---|---|---|---|
| Oral capsule (Prometrium + generics) | ✅ FDA-approved | ✅ The studied form — 9 of 10 trials, 100–300 mg | ✅ Established for the labeled regimen | ⚠️ Prometrium: yes — verify your generic | ~$14–20 generic from $39 shipped |
| Compounded cream (transdermal) | ❌ Not FDA-approved finished product | ❌ No comparable trials — none in the review used a cream | ❌ Not established. See below. | ✅ No | from $89 |
| Vaginal progesterone | Mixed by product | ❌ No sleep trials at menopause doses | ⚠️ Product-, dose-, and regimen-dependent | ✅ No | Varies widely |
| Synthetic progestins (Provera) | ✅ FDA-approved | ⚠️ In one 21-person study, micronized progesterone beat the Provera regimen on sleep efficiency and time-awake | ✅ Established | ✅ No | Generic |
The thing every cream ad gets backwards
You've seen the pitch: creams are better because they "bypass the liver." It sounds sophisticated. For sleep specifically, that's backwards.
You swallow progesterone. Your liver metabolizes it into neuroactive compounds — including allopregnanolone, which acts on GABA-A receptors, the same receptor system that Ambien and Valium work on. That's the leading explanation for why oral progesterone makes you drowsy. The liver step that cream marketing tells you to avoid is the step that plausibly produces the sedating compound.
Be precise: this is a well-supported mechanism, not proof. What we can say is narrower and still decisive: we found no randomized menopause sleep trial of a transdermal progesterone cream. You're being asked to pay double for the version without data.
One more thing, and it's almost funny. Winona's own hormone therapy page sells transdermal by saying it "bypasses metabolization by the liver, which may result in fewer side effects." For a woman shopping for sleep, "fewer side effects" means less of the drowsiness you came for. Their marketing makes our point.
The part we have to say plainly
If you have a uterus and use systemic estrogen, this isn't about sleep anymore. It's about safety.
A 2016 systematic review in Climacteric concluded that transdermal micronized progesterone does not provide endometrial protection.
The British Menopause Society (guidance updated May 2026) states that compounded products haven't been evaluated in controlled randomized trials and are not recommended, and that transdermal creams and gels have variable absorption that may not provide sufficient endometrial protection.
One of our own affiliate partners sells a compounded progesterone cream and states in its help center that it protects the uterus as effectively as its oral capsule. We found no published randomized evidence supporting that, and it runs against the position of two major menopause bodies. We're telling you that about a company that pays us.
So: the cream costs roughly twice the FDA-approved capsule, has no comparable sleep evidence, and if you're on systemic estrogen with a uterus, its ability to protect your lining is not established. If a provider offers you a cream for sleep, one question ends it: "Which trial supports that?"
If you want the form the trials actually used:
Winona's progesterone capsule is oral micronized progesterone — progesterone USP in a peanut-oil base — from $39/month, no insurance needed, shipped in about five business days. Read the fine print on its regulatory status in the provider section below, then decide.
See Winona's current capsule price and state availability →Do you need progesterone with vaginal estrogen?
If you're using a low-dose vaginal estrogen cream, tablet, or ring for dryness or painful sex, you generally are not in the "you need progesterone anyway" group. So the argument that you may already need this medication for uterine protection doesn't apply to you. Progesterone for sleep would be a standalone off-label ask.
If you're on a patch, pill, gel, or spray, that's systemic. That's the group where endometrial protection is part of the regimen.
Any unexpected bleeding on vaginal estrogen still needs evaluation. Always.
Do you need progesterone after a hysterectomy?
If you've had your uterus removed, the entire "you may need this anyway" argument evaporates. Progesterone for sleep becomes a purely off-label ask with no secondary justification. That doesn't make it unreasonable — Hitchcock's 133-woman trial gave progesterone alone against placebo and found sleep improved. But it does change the conversation and the risk-benefit math.
Three things to bring:
- Total or supracervical? They're not the same.
- Were your ovaries removed? That changes your whole hormone picture. See also: HRT after oophorectomy.
- Any history of endometriosis? Residual tissue can change the answer.
For a full guide, see HRT after hysterectomy.
If you've had a hysterectomy and you're here for sleep, don't start with a checkout page.
Take Find My HRT Path →Accounts for surgical history and flags when this belongs with an in-person clinician.
Who should not take progesterone for sleep?
Per the Prometrium label, do not take it if you have:
- 1.A peanut allergy — Prometrium is formulated with peanut oil.
- 2.Vaginal bleeding nobody has explained — Get evaluated before anyone prescribes you hormones.
- 3.Breast cancer, a history of it, or a suspected case — Requires individualized evaluation — not a routine intake form.
- 4.A blood clot now, or a history of DVT or pulmonary embolism
- 5.A stroke or heart attack now, or a history of either
- 6.Known liver dysfunction or disease
When a routine online intake is the wrong front door
Unexplained bleeding. Bleeding that hasn't been worked up needs prompt clinical evaluation before anyone prescribes you hormones.
Breast cancer, clot, or stroke history. You may still have options. They need individualized evaluation and often a specialist — not a form you fill out in eleven minutes.
We noticed something worth crediting: Midi's own patient guidance tells you to flag unexplained bleeding — "this must be evaluated first" — plus severe liver disease and cancer history, before being prescribed progesterone. That lines up with the label. A platform that publishes its own stop signs is a platform paying attention.
Not sure if any of that is you? Seven questions. About 30 seconds. You'll get the formulation the evidence supports for your situation, a straight answer on whether online care fits, and a consult script with your specifics in it. No email.
Run the Progesterone Sleep Fit Check →Where can you get progesterone for sleep in menopause online?
Everything below we checked on the providers' own pages on — not review sites.
| Claim | Status | What we found |
|---|---|---|
| Winona's capsule is FDA-approved | ⚠️ Conflicting | Winona's product page says FDA-approved. Other Winona material describes most treatments as compounded. No manufacturer or NDC is published, so we could not match it to an approval record. Ask before you pay: "Which manufacturer, and is the finished product FDA-approved?" |
| Winona capsule price | ✅ Verified | From $39/month. No membership fee. Free intake and standard shipping. |
| Winona availability | ✅ Verified | Its state page lists 37 states plus Puerto Rico. We counted. 13 states are not on it. |
| Winona cream protects the uterus like the capsule | ⚠️ Conflicting | Stated in its help center. Contradicted by BMS (May 2026) and Stute 2016. No published randomized evidence found. |
| Winona insurance | ✅ Verified | Does not bill insurance. HSA/FSA accepted; receipts for self-submission. |
| Winona cancellation | 📋 Provider-stated | Subscription-based with a limited window to cancel or refund once an order is processed. Read its cancellation policy before your first charge. |
| Midi self-pay | ✅ Verified | $250 first visit / $150 follow-up. Excludes labs and medication. |
| Midi + insurance | ✅ Verified | In-network with most PPO plans. Your cost depends on your plan's copay, coinsurance, and deductible. |
| Midi + Medicare/Medicaid | ✅ Verified | 🔴 Not enrolled with Medicare — self-pay only, no claims. Cannot treat Medicaid or Medi-Cal patients at all, even self-pay. |
| Midi Custom Rx capsule | ✅ Verified | Compounded oral micronized progesterone, peanut-free and vegan, from $35 per 30-day supply plus applicable care costs. Not FDA-approved. Requires a Midi visit. Available in all states except Arizona. |
| Sesame menopause care | ✅ Verified | From $59/month. Video visit, you choose the clinician, prescription to your local pharmacy. Medication is separate. |
| Hers menopause care | ⚠️ Conflicting / opaque | Oral medication plans from $79/month on a 12-month plan. The exact product, manufacturer, and standalone price aren't published before intake. Not available in all states. |
🔴 The 13 states nobody mentions
Winona's marketing says "nationwide." Its own state page says otherwise. We counted every entry: 37 states plus Puerto Rico.
Not on the list, as of :
Alabama · Alaska · Arkansas · Kansas · Louisiana · Mississippi · New Mexico · North Dakota · Rhode Island · South Dakota · Utah · Vermont · West Virginia
If you live in one of those, the $39 capsule isn't your path today. Midi's standard care covers all 50 states.
If you have PPO insurance → Midi Health
Verdict: if you're insured, this may well be your lowest total cost, even though the sticker price looks worst. Video visit with a clinician who does menopause all day. In-network with most PPO plans. All 50 states. Labs through Labcorp when indicated.
Straight talk: $250 for a first visit excludes labs and medication. "In-network" with an unmet deductible can still mean paying the full visit. Check your deductible before you pay cash anywhere else.
One patient, published on Midi's own site: "I signed up and had a visit the next day."
Check Midi coverage and visit pricing →See also: Midi Health review · Midi vs Winona comparison
If you're paying cash → Winona's progesterone capsule
Verdict: the cleanest cash path to an oral micronized progesterone capsule — if you're in one of the 37 states, you don't have a peanut allergy, and you're satisfied with the answer to the manufacturer question.
From $39/month. No membership fee. No separate consult fee. Free intake, free shipping, unlimited physician messaging. Plan within 24 hours, delivery within a week.
The damaging admission: Winona does not do a live video visit. You complete a detailed questionnaire and a board-certified physician reviews it and decides. Asynchronous care — a real clinical review, just not a real-time one. If seeing a clinician matters to you, Midi is the better door and we'd rather you go there.
One patient, published on Winona's own site: "I would recommend Winona because they listened where others didn't." — Julie
See Winona's current capsule price and state availability →If you want a video visit and your own pharmacy → Sesame Care
Verdict: the best fit if you want to see a clinician's face, choose who you see, and fill at your local pharmacy — possibly using your pharmacy benefit even though the visit isn't billed to insurance.
From $59/month. Video visit, provider choice, prescription to the pharmacy you already use. Medication is separate — which means you can use a discount card or your plan's formulary.
View Sesame clinicians and pricing →If you have a peanut allergy → Midi Custom Rx, with eyes open
Prometrium is contraindicated for you. Not a preference — a contraindication.
Midi makes a compounded oral progesterone for exactly this: peanut-free, vegan, from $35 per 30-day supply. Requires a Midi visit. Available in all states except Arizona.
The tradeoff you must understand: Compounded is not FDA-approved. The FDA does not review compounded drugs for safety, effectiveness, or quality before marketing. None of the sleep trials studied a compounded capsule. Midi also states this product is out-of-pocket, not billed to insurance.
Take Find My HRT Path →Accounts for allergy, state, and history — and flags when this belongs in person.
If you want the lowest price → any licensed visit + a generic
Get a prescription from anyone licensed. Fill it at your pharmacy with a discount card. Roughly $14–20 a month for a 30-day supply of the generic — treat that as a starting point to check, not a quote. The catch: you're the project manager. No follow-up. Nobody helping you adjust. And during a shortage, you're the one calling pharmacies.
What we're not recommending, and why
Hers — we couldn't confirm which progesterone product it prescribes, from which manufacturer, or at what standalone price before intake. That's not an accusation. It means we can't tell you what you'd be getting, so we won't tell you to get it. See our Hers review.
Oestra (Inner Balance) — a compounded estradiol-and-progesterone vaginal cream at $199/month for the first six months, then $99.50. Different route, different product, different regulatory status, and the sleep evidence on this page is for oral micronized progesterone.
What does progesterone for sleep cost?
Assumptions: one initial visit plus one follow-up; twelve uninterrupted months of medication; no labs; no plan or price changes. Your real number will differ.
| Path | Visit | Medication | 12-month illustration | Best for |
|---|---|---|---|---|
| Midi + PPO | Plan-dependent | Formulary-dependent | Depends on your plan | Insured women |
| Midi self-pay | $250 + $150 | ~$14–20/mo | ~$570–640 | Uninsured wanting video + labs |
| Winona capsule | $0 | From $39/mo | ~$468 at starting price | Cash-pay, 37 states, no peanut allergy |
| Sesame + generic | From $59/mo | ~$14–20/mo | ~$890+ | Video visit + local pharmacy |
| Any visit + generic | One-time | ~$14–20/mo | ~$210–330 | Cheapest, self-managed |
See what happens? Winona's $39 looks unbeatable next to Midi's $250 — until you have insurance. Then it might not be.
Brand vs generic: generic micronized progesterone is FDA-rated AB — therapeutically equivalent and substitutable at the counter. Ask your pharmacist about brand Prometrium pricing.
Insurance and HSA/FSA: formulary tier varies by plan. Winona takes HSA/FSA and provides receipts to self-submit; it does not bill insurance. Midi states its Custom Rx compounded product is out-of-pocket. See also: Prometrium cost without insurance.
What are the real downsides?
| Reported effect | Progesterone + estrogen | Placebo |
|---|---|---|
| Headache | 31% | 27% |
| Breast tenderness | 27% | 6% |
| Joint pain | 20% | 29% |
| Depression | 19% | 12% |
| Dizziness | 15% | 9% |
| Bloating | 12% | 5% |
| Hot flashes | 11% | 35% |
| Night sweats | 7% | 17% |
Breast tenderness is the standout — 27% versus 6%. Nobody warns you. Hot flashes and night sweats are lower on treatment because the placebo group wasn't being treated for anything. That's not progesterone magic. That's untreated menopause in the comparison group.
Morning fog
The same drowsiness you wanted at 10 p.m., overstaying. If it's happening, that's a message to your prescriber — they may adjust timing or dose. The review found nighttime dosing didn't impair morning cognition on average. But "on average" and "for you" can be different animals. See also: progesterone side effects in menopause.
The first-dose reaction the label describes
From the label's postmarketing section: during initial therapy, a few women have experienced extreme dizziness and/or drowsiness, blurred vision, slurred speech, difficulty walking, loss of consciousness, vertigo, confusion, disorientation, and — the FDA's own phrase — "feeling drunk."
The label doesn't put a frequency on it. Now you know it exists.
Interactions
Tell your clinician about anti-seizure medications, certain antibiotics, and St. John's wort. The FDA label notes that ketoconazole (a CYP3A4 inhibitor) may increase progesterone bioavailability, while stating the clinical relevance is unknown. Ask your pharmacist about anything else you take, including grapefruit.
Alcohol + progesterone: Midi's clinicians warn that combining them can cause extreme drowsiness or coordination problems. Use caution.
If any of that is a dealbreaker — or you're now unsure progesterone is the right lever at all — that's a completely reasonable place to land.
Take Find My HRT Path →Build a plan around your symptoms, history, and state. About 90 seconds.
Can you actually get progesterone right now?
Nobody else on page one is telling you this. You'd find out at the counter.
What's actually happening
This is two separate events. The first shortage record ran from to , when it was marked resolved. A new record opened — that's the current one. Availability differs by strength and by manufacturer.
There's also a wrinkle: the ASHP database and the FDA's own shortage tracker don't always list the same products. Different criteria, different answers. If a pharmacist tells you there's no shortage and your neighbor says there is, you may both be looking at real data.
Check the current status before you plan around it. We re-verify this monthly.
If your pharmacy is out
- Ask about a different manufacturer. One may have stock when another doesn't.
- Call an independent pharmacy. Different wholesalers than the chains.
- Ask the pharmacist and prescriber which strength, manufacturer, and quantity are currently available.
- Home-delivery programs use a different fulfillment path — which can help, though no program is immune.
- Note the distributor change. The February 2026 label lists Acertis Pharmaceuticals as Prometrium's distributor; the shortage bulletin listed Virtus. If you're chasing supply, that matters.
What to check before you pay
Before you pay:
- ▢Is the finished product FDA-approved, or compounded? Ask exactly that. "Made with FDA-approved ingredients" is not the same answer — once ingredients are compounded, the finished product isn't FDA-approved.
- ▢Which manufacturer? You need this to verify anything.
- ▢Does it contain peanut oil? Gelatin?
- ▢Visit fee, medication fee, lab fee, follow-up fee, shipping — all of them
- ▢Minimum plan length
- ▢How do I cancel, and by when?
- ▢Is the clinician licensed in my state?
When it arrives:
- ▢Does the medication name match what you discussed?
- ▢Do the inactive ingredients match what you were told?
- ▢Does the dose match the prescription?
- ▢To check approval status: take the manufacturer and product name and search Drugs@FDA or the Orange Book on fda.gov.
⚠️ Correction we want to make loudly
An NDC number on the bottle does not mean a product is FDA-approved. The FDA's own guidance on its National Drug Code Directory is explicit — assignment of an NDC "does not in any way denote FDA approval," the directory includes both approved and unapproved drugs, and some compounded products appear in it. FDA goes further: implying approval because a product has an NDC "is misleading and violates federal law."
If anyone tells you the NDC proves it's approved, they're wrong. Use Drugs@FDA.
What if it doesn't work — or makes things worse?
Don't chase the dose on your own.
You've seen how variable measured exposure is between people. That cuts both ways: it means a change might help, and it means guessing is a bad idea. Message your prescriber. Not a decision for 2 a.m. See also: symptoms your HRT dose is too low and what to do if you miss a dose.
Don't just stop it if you're on systemic estrogen.
If you have a uterus and use systemic estrogen, the progestogen is protecting your uterine lining. Quitting because it didn't fix your sleep leaves the estrogen unopposed. Talk to your prescriber before stopping any prescribed endometrial-protection component. Always.
Track the pattern, not the vibe.
For two weeks, log: bedtime, roughly when you fell asleep, how many times you woke and when, night sweats, morning fog 1–5, alcohol and caffeine timing, any bleeding, and the date you contacted your prescriber. That's a document a clinician can use. "I still sleep badly" isn't.
Then reopen the question.
Go back to the sleep-pattern table. Sometimes the honest answer is that progesterone was reasonable to try and it wasn't the thing. That's not failure. That's information — and it's a much better place to stand than where you started.
How The HRT Index verified this page
✅ What we did
- Read the FDA Prometrium label, revision 02/2026 (Reference ID 5744934) in full
- Confirmed sleep is not listed as an indication in that revision
- Pulled all 10 trials and pooled effect sizes from Nolan, Liang & Cheung (2021), JCEM
- Counted Winona's published state list — 37 states plus Puerto Rico
- Verified Midi pricing, Medicare/Medicaid exclusions, and Custom Rx details on Midi's own pages
- Verified Sesame starting price
- Cross-checked compounded transdermal claims against BMS (May 2026) and Stute et al., Climacteric (2016)
- Verified NDC guidance against FDA's NDC Directory page directly
⚠️ What we could not resolve
- Winona's capsule approval status — labeled conflicting, not confirmed
- Whether every FDA-approved generic contains peanut oil — verify your specific product
- Brand Prometrium's cash price — sources ranged too widely to publish
- Hers' specific progesterone product and standalone price
❌ What we did not do
- We have not tested these products
- We have not audited any pharmacy
- This page is not reviewed by a clinician. It is editorial research. We are not clinicians and this is not medical advice.
Our method
We apply 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. We evaluate providers on five things, in order: clinical legitimacy, care quality, medication fit, price transparency, and access. We don't assign scores. Scores hide reasoning. See our full methodology.
About the two quotes on this page
Both are published by the providers themselves on their own sites. They describe individual experiences with access and communication. They are not independent reviews, they don't establish typical results, and neither is evidence that progesterone will improve your sleep. We used them because they're real and attributable.
Last verified: . Prices, availability, and shortage status change. If something here is wrong, tell us — we'll fix it and date the fix.
Frequently asked questions
Does progesterone help you sleep?
It helps some women fall asleep faster — pooled trial data showed roughly a 7-minute improvement in sleep-onset latency. Total sleep time and sleep efficiency did not reach statistical significance.
Is progesterone FDA-approved for insomnia?
No. The current Prometrium label lists endometrial hyperplasia prevention and secondary amenorrhea. Sleep is not listed.
How much progesterone is used for sleep?
There's no approved sleep dose. Trials that found sleep-lab improvement used 200–300 mg at night. That's a conversation with a clinician.
Why does progesterone make me groggy in the morning?
Measured blood levels vary widely between people at the same dose — that's in the FDA's own data. Tell your prescriber; timing or dose may be adjustable.
Does progesterone cream help you sleep?
No randomized menopause sleep trial of a transdermal cream exists that we could find. Oral progesterone's sedating effect is attributed to liver metabolism into allopregnanolone, which creams bypass.
Can I take progesterone without estrogen just for sleep?
Some trials did exactly that — Hitchcock's 133-woman trial used progesterone alone versus placebo. It's off-label and requires clinical judgment. Not automatically appropriate.
Do I need progesterone with vaginal estrogen?
Generally no. Low-dose vaginal estrogen has minimal systemic absorption, and current guidance doesn't recommend adding a progestogen for it. Systemic estrogen is different.
Do I need progesterone after a hysterectomy?
Usually not for endometrial protection. Which means taking it for sleep becomes purely off-label. Bring your surgical details — total and supracervical aren't the same.
Can I get progesterone online without insurance?
Yes. Winona ships its capsule from $39/month with no insurance. Generics run roughly $14–20 with a discount card.
How long until progesterone works for sleep?
No reliable universal timeline exists for a sleep benefit. The label's pharmacokinetics don't predict your clinical response. Ask your prescriber what to expect and when to check in.
Is progesterone in shortage?
There's an active ASHP shortage record opened May 14, 2026. A previous record from December 2023 was resolved in October 2025. Status varies by strength and manufacturer.
Can I take progesterone with food?
The label reports higher absorption with food. Follow your prescription's instructions; if you weren't given any, ask.
Can I drink alcohol with progesterone?
Use caution. Midi's clinicians warn that combining them can cause extreme drowsiness or coordination problems. Ask your prescriber.
What if I'm allergic to peanuts and need progesterone?
Prometrium contains peanut oil and is contraindicated. Verify any generic's ingredients. Compounded peanut-free capsules exist — Midi offers one from $35 — but compounded products aren't FDA-approved and aren't billed to insurance.
Will insurance cover progesterone for sleep?
Depends on your plan's formulary and the exact product. Compounded products generally aren't covered. Winona doesn't bill insurance at all.
Is online care okay if I have unexplained bleeding?
Don't use a routine online prescribing pathway without first disclosing it and getting it evaluated. That comes first.
Sources
Medical and regulatory
- Nolan BJ, Liang B, Cheung AS. Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data. J Clin Endocrinol Metab. 2021;106(4):e942–e951. doi:10.1210/clinem/dgaa873 (Literature search through March 31, 2020)
- Prior JC, et al. Oral micronized progesterone for perimenopausal vasomotor symptoms and sleep: randomized controlled trial. 2023. PMID 37277418
- Hitchcock CL, Prior JC. Oral micronized progesterone for vasomotor symptoms. Menopause. 2012;19(8):886–893
- PROMETRIUM (progesterone, USP) Capsules — FDA Prescribing Information, Rev. 02/2026. Reference ID 5744934. accessdata.fda.gov
- FDA. Approves Labeling Changes to Menopausal Hormone Therapy Products. February 12, 2026
- FDA. National Drug Code Directory. Content current as of March 4, 2026
- FDA. Compounding and the FDA: Questions and Answers
- Stute P, et al. The impact of micronized progesterone on the endometrium: a systematic review. Climacteric. 2016
- British Menopause Society. Tool for Clinicians: Progestogens and endometrial protection. Updated May 2026
- The Menopause Society. Hormone Therapy Position Statement
- MedlinePlus. Progesterone Drug Information. National Library of Medicine
- ASHP Drug Shortage Detail: Progesterone Capsules. University of Utah Drug Information Service
Provider sources — verified
- Winona — Progesterone Capsule product page
- Winona — Online Menopause Specialists (state list)
- Winona — Hormone Replacement Therapy page
- Winona — Cancellation and Refund Policy
- Midi Health — Pricing & Insurance
- Midi Health — HRT page
- Midi Health — Custom Rx: Progesterone
- Sesame Care — Menopause Treatment
- Hers — Menopause
- GoodRx — Progesterone pricing
One last thing
You came here because you're tired.
You're not imagining it: the FDA prints the drowsiness on the label. You're not naive for asking: off-label prescribing is ordinary medicine. And you're not broken if it worked for your friend and not for you — the variability in the FDA's own data is enormous.
You also know something now that most people selling this don't want you to: the evidence is real, and it's smaller than the ads suggest, and the cheaper product is the one with the data behind it.
Still not sure which HRT program is right for you?
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