Progesterone Therapy Consent

PURPOSE OF TREATMENT

Progesterone therapy is prescribed to help restore hormonal balance in women experiencing symptoms related to estrogen dominance, perimenopause, or menopause. It is also used in combination with estrogen therapy to protect the uterine lining in women who still have a uterus.

 

Expected Benefits:

Progesterone therapy can help with improvement in sleep quality, mood stability, and emotional well-being. Progesterone can also reduce premenstrual symptoms, cyclical migraines, anxiety, breast tenderness, and heavy or irregular menstrual bleeding. When used alongside estrogen, it helps reduce the risk of endometrial hyperplasia or cancer. It may also support cognition, bone health, and cardiovascular protection.

Treatment may include oral capsules, compounded formulations such as lozenges, troches, or topical/transdermal creams.

 

Risks and Side Effects:

As with any hormone therapy, there are potential risks and side effects, which may include but are not limited to: bloating, drowsiness, dizziness, breast tenderness, mood swings, changes in menstrual bleeding, weight gain, or nausea.

Rare but serious risks may include allergic reactions, increased risk of clotting (especially in combination with estrogen), and mood alteration. If you experience any new or concerning symptoms, notify your provider. Regular monitoring will be required.

 

Alternatives to Progesterone Replacement Therapy:

You may choose not to undergo progesterone therapy. Other options include:

No Treatment: Choosing not to treat hormone deficiency may result in continued symptoms and potential endometrial risk when taking estrogen alone (if uterus is present)

Lifestyle Modification: Incorporating lifestyle changes, dietary adjustments, and improvemnts in sleep hygienediet to alleviate symptoms.

Other Hormonal Options: Some Progesterone therapies may be formulated synthetically (e.g., Provera) or prescribed by other providers using different protocols. You may choose to consult with another provider for alternative views or approaches.

 

Off-Label Use and Informed Consent:

The use of bioidentical progesterone, particularly in compounded formulations or in patients without classical menopausal symptoms, may be considered Off-Label by the U.S. Food and Drug Administration (FDA).

“Off-Label” refers to the use of a prescription medication for purposes not specifically approved by the FDA, but which are supported by clinical literature, extensive provider experience, and expert consensus. In the case of progesterone, this includes treatment for symptoms such as insomnia, anxiety, mood changes, menstrual irregularities, and hormonal imbalances even in women who do not meet strict diagnostic criteria for menopause.

This treatment plan is based on:

• Individualized clinical judgment
• Medical literature
• Observed symptomatology and therapeutic response

You are encouraged to ask any questions about the nature of this treatment and its intended goals. 

 

Treatment Monitoring and Follow-Up:

Dosing will be based on symptom response and periodic lab review (if appropriate). Our goal in post-menopausal woman is to maintain serum progesterone in the functional range of 10–20 ng/mL for optimal effect.

You agree to routine follow-ups and communication of any adverse symptoms.

Please initial below to acknowledge the following:

I confirm that I have reviewed and understand the potential risks, benefits, alternatives, and the off-label nature of progesterone therapy.

AUTHORIZATION

I voluntarily request and give my informed consent for Alexander Medical, LLC and its healthcare providers to initiate progesterone hormone therapy as recommended.

I authorize the providers to perform any additional tests, evaluations, or procedures reasonably necessary to support my care. I understand that this treatment is elective and that I may stop at any time by informing my provider.

 

ACKNOWLEDGMENT

I have read (or had read to me) this entire consent form. I have had the opportunity to ask questions and all questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives, and I consent to the use of progesterone hormone therapy.