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Progesterone pessary

Updated 2 Feb 2023 | Progestogens


Pessaries containing progesterone

Drugs List

  • CYCLOGEST 200mg pessary
  • CYCLOGEST 400mg pessary
  • progesterone 200mg pessary
  • progesterone 400mg pessary
  • Therapeutic Indications


    Depression - puerperal
    Luteal support after oocyte retrieval during assisted reproduction
    Premenstrual syndrome

    Treatment of premenstrual syndrome, including premenstrual tension and depression
    Treatment of puerperal depression
    Luteal phase support as part of assisted reproductive technology (ART) treatment for women.



    Premenstrual syndrome
    200 mg daily to 400 mg twice a day, by vaginal or rectal insertion.

    For premenstrual syndrome commence treatment on day 14 of menstrual cycle and continue treatment until onset of menstruation. If symptoms are present at ovulation commence treatment on day 12.

    Puerperal depression
    200 mg daily to 400 mg twice a day, by vaginal or rectal insertion.

    Luteal phase support as part of assisted reproductive technology (ART)
    400 mg administered vaginally twice a day starting at oocyte retrieval.
    Treatment should be continued for 38 days, if pregnancy is confirmed.


    For rectal or vaginal insertion.

    Rectal administration is advisable if barrier methods of contraception are used, in patients who have recently given birth, or if the patient suffers from vaginal infection or recurrent vaginal cystitis.

    Use vaginally if patient has colitis or faecal incontinence.


    Predisposition to thromboembolic disease
    Suspected hormone dependent neoplasm
    Undiagnosed irregular menstrual bleeding
    Ectopic pregnancy
    History during pregnancy of pemphigoid gestationis
    History of cholestatic jaundice during pregnancy
    History of hepatic neoplasm
    History of pruritus during pregnancy
    History of thromboembolic disorder
    History of thrombophlebitis
    Hormone dependent neoplasm
    Missed abortion
    Severe arterial disorder
    Severe hepatic impairment
    Thromboembolic disorder

    Precautions and Warnings

    Cardiac impairment
    Diabetes mellitus
    Epileptic disorder
    History of depression
    Mild hepatic impairment
    Renal impairment

    Use rectally in patients with recurring cystitis
    Use vaginally in patients with faecal incontinence
    Not all available strengths are licensed for all indications
    Use rectally during the puerperium
    Use rectally in patients with vaginal infection
    Use vaginally in patients with colitis
    Female: Use rectally if barrier methods of contraception are used
    Monitor blood glucose closely in patients with diabetes mellitus
    Consider discontinuing if depression develops
    Discontinue at first signs of thrombophlebitis or thromboembolism
    Discontinue if cerebrovascular disorders occur
    Discontinue if myocardial infarction occurs
    Discontinue if retinal thrombosis occurs
    Discontinue if thromboembolism occurs
    Advise patient not to take St John's wort concurrently

    Pregnancy and Lactation


    Use progesterone pessaries with caution in pregnancy.

    Progesterone pessaries should only be used in the first trimester as indicated as part of assisted reproduction.

    Progesterone is a naturally occurring hormone and is produced by the placenta during pregnancy. However, there is limited evidence on the affects of supplemental progesterone exposure during pregnancy.

    Schaefer (2007) states that accidental high dose progesterone preparations used during pregnancy is not a valid reason for termination of the pregnancy. A detailed ultrasound examination could verify a normal development of the foetus.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Progesterone pessaries are contraindicated in breastfeeding.

    Progesterone is a natural hormone and is present in breast milk in low levels. Therefore, progestogen is not expected to have adverse effects in a breastfed infant. However, the manufacturer advises against use in breastfeeding.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Anaphylactoid reaction
    Breast tenderness
    Changes in libido
    Fluid retention
    Gastro-intestinal symptoms
    Irregular menstruation
    Leakage of pessary base
    Premenstrual symptoms
    Soreness, diarrhoea and flatulence may occur with rectal administration
    Weight changes


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: December 2015

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press. Accessed on 22 December 2015].

    Summary of Product Characteristics: Cyclogest 200mg. Actavis UK Ltd. Revised April 2015.
    Summary of Product Characteristics: Cyclogest 400mg. Actavis UK Ltd. Revised November 2015.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    progesterone Last revised: 05 May 2015
    Last accessed: 22 December 2015

    The Norwegian Porphyria Centre (NAPOS).
    Available at:
    Last revised: 14 April 2010
    Last accessed: 22 December 2015

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