Prometrium vs. Provera

See how Prometrium and Provera compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both Prometrium and Provera are progestins used to protect the uterus during estrogen therapy, but Prometrium is bioidentical progesterone while Provera is a synthetic compound.

  • Prometrium capsules contain peanut oil and are unsafe for people with peanut allergies, while Provera tablets contain no peanut oil.

  • Provera has been on the market since 1959 and typically costs far less per month than Prometrium, which was approved in 1998.

Prometrium vs. Provera Drug Summary

Prometrium

Prometrium is a progestin that contains micronized progesterone identical to the hormone the body makes naturally. It is FDA-approved to prevent endometrial hyperplasia in postmenopausal women taking estrogen and to treat secondary amenorrhea. It comes as an oral capsule, usually taken once daily at bedtime.

Provera

Provera is a synthetic progestin called medroxyprogesterone acetate. It is FDA-approved to treat secondary amenorrhea, abnormal uterine bleeding from hormonal imbalance, and to prevent endometrial hyperplasia in postmenopausal women on estrogen. It comes as an oral tablet taken once daily for a set number of days each cycle.

Prometrium vs. Provera Side Effects

Prometrium

Most common
Dizziness (up to 16%)
Breast pain (up to 11%)
Headache (up to 10%)
Abdominal pain (up to 10%)

Provera

Most common
Breast tenderness (not specified)
Headache (not specified)
Abnormal bleeding (not specified)
Nausea (not specified)

Prometrium vs. Provera Dosage

Prometrium

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 200 mg once daily At the start
Maximum dose 400 mg once daily If needed
Dose changes 1 increase As tolerated

Provera

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg or 10 mg daily At the start
Maximum dose 10 mg daily If needed
Dose changes 1 increase As tolerated

Prometrium vs. Provera Indications

Prometrium

Prometrium is FDA-approved to prevent endometrial hyperplasia in postmenopausal women taking estrogen and to treat secondary amenorrhea. It is also widely prescribed off-label for fertility treatment and hormone support, uses not covered by its FDA label.

  • Endometrial hyperplasia prevention with estrogen therapy (FDA-approved)

  • Secondary amenorrhea treatment (FDA-approved)

  • Luteal phase support in IVF (off-label)

  • Preterm birth prevention in high-risk pregnancies (off-label)

Provera

Provera is FDA-approved to treat secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance. It is also approved to prevent endometrial hyperplasia in postmenopausal women taking estrogen, but it is not approved for contraception or for preventing heart disease or dementia.

  • Secondary amenorrhea treatment (FDA-approved)

  • Abnormal uterine bleeding from hormone imbalance (FDA-approved)

  • Endometrial hyperplasia prevention with estrogen therapy (FDA-approved)

  • Distinct from injectable Depo-Provera formulations

Prometrium vs. Provera Pros and Cons

Prometrium

Prometrium's bioidentical structure appeals to patients who prefer a hormone chemically identical to what the body produces. It carries the same class-wide boxed warnings as other progestins used with estrogen, plus a peanut allergy risk from its capsule formulation.

Pros

  • Chemically identical to the progesterone the body makes

  • Approved for secondary amenorrhea and endometrial protection

  • Widely used off-label for IVF luteal support and pregnancy loss prevention

Cons

  • Unsafe for people with peanut allergy due to peanut oil in capsules

  • Costs roughly $497 to $936 per month without insurance

  • Fewer decades of real-world outcome data than Provera

Provera

Provera's synthetic formulation has been used clinically since 1959, giving it a long track record for treating bleeding disorders and amenorrhea. Its label lists side effects without specific rates, and it is not approved for fertility-related or hormone replacement uses.

Pros

  • Contains no peanut oil, safe for people with peanut allergy

  • Decades of established clinical use since 1959

  • Costs roughly $15 to $75 per month, far less than Prometrium

Cons

  • Synthetic progestin, not chemically identical to natural progesterone

  • Not approved for fertility treatment or pregnancy support

  • Side effect rates are not quantified in the FDA label

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