Progesterone Pills vs. Creams: What’s the Difference?

If you’re entering perimenopause or menopause, you’ve probably heard about hormone replacement therapy (HRT) — and you might be wondering about your options. 

Progesterone plays a crucial role in balancing estrogen and protecting your uterine lining during this stage of life. When you supplement estrogen through HRT, adding progesterone helps prevent endometrial overgrowth (called hyperplasia), which in turn lowers your risk of uterine cancer.

So, what’s the difference between a progesterone cream vs pill for menopausal symptoms?

Below, we break down the benefits and drawbacks of each option, plus explain why doctors often consider oral progesterone the gold standard for endometrial protection.

Before menopause, your body makes progesterone after ovulation each month to help prepare the uterus for pregnancy. As you approach menopause and ovulation stops, progesterone levels drop. That’s why some hormone therapy plans include progesterone.

If you still have a uterus, progesterone is an important companion to estrogen therapy. Taking estrogen alone can cause the lining of your uterus (the endometrium) to thicken, raising the risk of endometrial cancer. Progesterone helps prevent this by telling your uterine lining to shed, protecting you from overgrowth and lowering cancer risk.

Progesterone also has other benefits:

• Better sleep. Oral progesterone can have a mildly sedating effect, helping you fall and stay asleep — much needed when hormones are in flux. 

• Improved mood. It can help stabilize your mood, making irritability and mood swings less of a problem. 

• Cycle regularity. During perimenopause, progesterone can make periods more predictable and reduce heavy bleeding. 

• Fewer hot flashes and night sweats. When combined with estrogen, it can help ease these common menopause symptoms. 

Overall, progesterone is an essential part of a safe and effective HRT plan for many women. But what’s the difference between a progesterone cream vs. pill? Let’s break down the options.

Progesterone pills, or oral progesterone, work by being absorbed through your gastrointestinal (GI) tract. After you swallow them, your liver processes the hormone and sends it into your bloodstream. From there, progesterone travels throughout your body and attaches to specific receptors in places like your uterus, brain, and breasts — helping relieve symptoms and offering protective benefits.

Because oral progesterone goes through your liver first (a process called first-pass metabolism), doctors can measure and predict its effects more precisely. This makes it a reliable option for hormone therapy.

Oral progesterone is the most widely studied and FDA-approved way to protect the uterine lining when used with estrogen. It helps lower the risk of endometrial thickening and cancer.  

Many women also find that progesterone capsules have a calming effect and may improve sleep, though mild stomach upset is possible. 

Because of its consistent dosing, protective benefits, and proven effectiveness, oral progesterone is often the go-to for people with uteruses who are undergoing HRT.

Now, how do progesterone creams compare?

Unlike oral progesterone, which you swallow, you apply progesterone creams directly to your skin — usually your arms, thighs, or abdomen. The hormone is absorbed transdermally, which means it passes through your skin and straight into your bloodstream, bypassing your liver.

Many people prefer topical progesterone because it’s easy to use and may cause fewer whole-body side effects than pills. But, just like with pills, side effects are possible, including breast tenderness, especially if your hormone levels fluctuate.

How much progesterone your body absorbs from the cream can also vary a lot. Factors like skin thickness, body temperature, and where you apply the cream can impact its effects.  Because of this, it’s hard to know if you’re getting the right dose for protection. 

That’s why doctors usually don’t recommend progesterone cream as your only source of progesterone in HRT.

If you’re on the fence about whether progesterone cream or pills are best for you, here’s a quick comparison.

Worried about weight gain on hormone therapy? You’re not alone. While progesterone isn’t a major cause of weight changes, some women may notice fluid retention or a boost in appetite — especially when starting treatment. 

If you need tips for maintaining a healthy weight, check out our guide on how to lose weight during menopause. 

When it comes to picking the right form of progesterone therapy, it really depends on your personal needs, symptoms, and whether your HRT also needs to protect your uterine lining.

Here’s the bottom line: If you’re taking estrogen and still have your uterus, oral progesterone is the best option. It’s backed by decades of research, offers steady dosing, and delivers reliable endometrial protection. Plus, many women find that progesterone pills help them sleep better, thanks to their naturally calming effect.  

Prefer a topical option? Progesterone creams are an alternative, especially if you don’t need endometrial protection. Just keep in mind, creams can be less dependable because your body absorbs them differently each time.

If you’re approaching menopause, your doctor might recommend HRT with estrogen and progesterone. Progesterone can help protect your uterine lining and lower your risk of endometrial cancer. Let’s recap what we know about pills vs. creams:

• Pills are usually the go-to for reliable uterine protection. Your doctor might prescribe progesterone pills alongside estrogen if you’ve never had a hysterectomy. 

• Creams don’t go through your liver, so they might be a better option for some people. Everyone’s different. Talk to a qualified healthcare professional to find an HRT plan that works for you.

Hers offers prescription progesterone pills, giving you access to a reliable, evidence-based option to protect your wellness through perimenopause and beyond. 

To learn more about your HRT options, take our free online quiz to connect with a licensed healthcare provider.