When your doctor prescribes Prometrium, it’s usually because your body isn’t making enough progesterone - whether you’re trying to get pregnant, managing menopause symptoms, or balancing hormones after a miscarriage. But Prometrium isn’t the only option. Many people wonder: is there something cheaper, more natural, or easier to take? The truth is, there are several progesterone alternatives, each with different pros, cons, and side effects. This isn’t about which one is "best" - it’s about which one fits your body, your lifestyle, and your goals.

What is Prometrium, really?

Prometrium is a brand-name medication containing micronized progesterone a bioidentical form of the hormone naturally produced by the ovaries. It’s taken orally, usually as a softgel capsule, and absorbed through the gut. Unlike synthetic progestins (like those in birth control pills), Prometrium matches the exact molecular structure of the progesterone your body makes. That’s why it’s often preferred for fertility support and menopause care - it’s less likely to cause mood swings or blood clots compared to older synthetic versions.

But here’s the catch: Prometrium isn’t cheap. In the UK, a 30-day supply can cost over £60 without insurance. And because it’s taken by mouth, some people report dizziness, sleepiness, or bloating - especially if they take it right before bed. That’s why many patients and doctors look at other ways to get progesterone into the body.

Progesterone creams: natural, but not always reliable

You’ve probably seen ads for "natural progesterone creams" sold online or in health stores. These often claim to balance hormones without a prescription. They usually contain progesterone extracted from soy or wild yam. But here’s the problem: wild yam extract does not convert to progesterone in the human body. The progesterone in these creams is lab-made and added in - so they’re not "natural" in the way people think.

More importantly, studies show these creams don’t reliably raise progesterone levels in the blood. A 2021 review in the Journal of Clinical Endocrinology & Metabolism found that topical progesterone creams delivered less than 10% of the dose needed to support pregnancy or stop abnormal uterine bleeding. They might help with mild hot flashes for some, but if you’re trying to conceive or need precise hormone control, they’re not a substitute for prescribed progesterone.

Progesterone injections: fast, effective, but not convenient

If you need a strong, fast-acting dose of progesterone - say, after IVF or to prevent preterm birth - your doctor might suggest intramuscular progesterone injections oil-based injections given in the buttock or thigh. These are used in fertility clinics across the UK and are known to deliver higher, more consistent blood levels than oral pills.

They work. Studies show pregnancy rates with injections are slightly higher than with oral Prometrium in IVF cycles. But they come with trade-offs. You need to inject yourself (or have someone do it) every day. The oil can cause pain, swelling, or hard lumps at the injection site. And because it’s not absorbed through the gut, it avoids the drowsiness that comes with oral progesterone - which some people love, but others find inconvenient.

Vaginal progesterone: the hidden favorite

Many OB-GYNs and fertility specialists in the UK now recommend vaginal progesterone gels, suppositories, or inserts that deliver hormone directly to the uterus over oral Prometrium. Why? Because when progesterone is absorbed through the vaginal wall, it goes straight to the uterus - bypassing the liver entirely. This means you get more of the hormone where it’s needed, with less of it circulating in your bloodstream.

That’s a big deal. A 2023 NHS clinical guideline update found vaginal progesterone was just as effective as Prometrium for luteal phase support in IVF, but with fewer side effects like drowsiness and nausea. Brands like Crinone (gel) and Utrogestan (capsules) are widely available on prescription. Utrogestan, in fact, is often the first choice in UK clinics because it’s micronized like Prometrium, but delivered vaginally - so you get the same hormone, without the afternoon nap.

Oral generics: the budget-friendly option

Here’s something most people don’t know: Prometrium is just one brand of micronized progesterone. The active ingredient - micronized progesterone the same molecule used in Prometrium - is also sold as a generic. In the UK, you can get it under names like Progeffik or simply as "micronized progesterone capsules" from pharmacies like Boots or Lloyds.

These generics cost about £15-£25 for a 30-day supply - less than half the price of Prometrium. They’re made by the same manufacturers, follow the same standards, and contain the same active ingredient. The only differences? The capsule shell, the filler ingredients, and the brand name. If your doctor is okay with it, switching to a generic can save you hundreds a year.

What about bioidentical hormone therapy?

Some clinics - especially private ones - offer "bioidentical hormone therapy" (BHT) for menopause. These are custom-compounded progesterone and estrogen blends, made in special pharmacies. They sound appealing because they’re marketed as "tailored" to your needs. But here’s the reality: the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) doesn’t regulate compounded hormones the same way it does FDA- or EMA-approved drugs. There’s no standard testing for potency or purity.

While some women report feeling better on compounded progesterone, there’s no large-scale evidence showing they’re safer or more effective than FDA-approved options like Prometrium or Utrogestan. Plus, they’re not covered by the NHS. If you’re considering this route, ask your doctor for a written prescription for an approved product instead. You’ll get consistent dosing, fewer risks, and better insurance coverage.

Choosing the right option for your situation

There’s no one-size-fits-all answer. Your best progesterone option depends on why you need it:

• If you’re trying to conceive or support early pregnancy: vaginal progesterone (Utrogestan or Crinone) is the top choice in UK clinics.
• If you’re managing menopause symptoms and want to avoid drowsiness: vaginal or injections work better than oral pills.
• If cost is a major concern: generic micronized progesterone capsules are just as effective as Prometrium.
• If you need high, steady levels: injections are the most reliable, but require daily self-administration.
• If you’re tempted by creams or supplements: avoid them unless you’re just looking for mild symptom relief - they won’t help with fertility or endometrial protection.

One thing all these options have in common: they need a prescription. Don’t buy progesterone online without medical supervision. Too much or too little can disrupt your cycle, affect your mood, or even increase cancer risk if used incorrectly.

What to ask your doctor

Before you decide, have this conversation:

• "Why am I being prescribed progesterone?" (To support pregnancy? To stop bleeding? To treat menopause?)
• "Is there a generic version available?"
• "Would vaginal progesterone work better for me?"
• "What are the side effects I should watch for?"
• "Can we try a different form if this one doesn’t suit me?"

Most doctors are happy to switch you if something isn’t working. Prometrium isn’t the gold standard because it’s the best - it’s just one option that’s been around a long time. Today, vaginal progesterone and generics are often better choices.

Final thoughts: it’s not about the brand - it’s about delivery

Progesterone is progesterone, no matter the brand. What changes everything is how it gets into your body. Oral pills make you sleepy. Vaginal forms target your uterus directly. Injections give you high levels fast. Generics save you money. Creams don’t work for serious needs.

If you’re on Prometrium and it’s not working - whether because of side effects, cost, or inconvenience - talk to your doctor. There are better, more targeted, and often cheaper ways to get the progesterone your body needs.