Susten (Progesterone (micronised))
Also sold as: Susten, Naturogest, Gestofit, Utrogestan, Prometrium
Pregnancy
Cat B
Lactation
Caution
Schedule
H
Forms
Capsule (oral/vaginal) 100mg, 200mg, 400mg +2
Indications
- Luteal phase support in ART (IVF/ICSI) — vaginal or oral route
- Threatened/habitual miscarriage (early pregnancy support)
- Premature labour prevention (cervical insufficiency — progesterone pessary/vaginal)
- Hormone replacement therapy (HRT) — combined with oestrogen in menopausal women with intact uterus (to protect endometrium)
- Secondary amenorrhoea (absent periods)
- Dysfunctional uterine bleeding
Adult Dosing
ART luteal support (vaginal)
200–400 mg vaginally BD–TDS starting from oocyte retrieval
Continue until 10–12 weeks gestation if pregnant
Threatened miscarriage (oral)
200 mg PO BD (micronised oral)
Continue 12–16 weeks or as clinically directed (PROMISE / PRISM trial evidence for symptomatic bleeding)
Premature labour prevention (cervical insufficiency)
Vaginal progesterone 200–400 mg nightly from 16–24 weeks to 34–36 weeks
Specialist obstetric care
HRT (with oestrogen)
200 mg PO at bedtime for 12–14 days/cycle (cyclical HRT) or 100 mg OD (continuous HRT)
Ongoing — review annually
Secondary amenorrhoea
200–300 mg PO for 10 days
Withdrawal bleed expected 2–7 days after completing course
Pediatric Dosing
Specialist gynaecological use only in adolescents
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No specific adjustment — metabolised hepatically |
Hepatic Adjustment
Avoid in severe hepatic disease — reduced metabolism and risk of accumulation
Pregnancy & Lactation
Pregnancy: Category B
Natural progesterone used widely in early pregnancy for ART support and threatened miscarriage. Micronised progesterone (Susten/Naturogest) has extensive safety data in pregnancy — no teratogenicity. Essential for luteal phase of IVF cycles.
Lactation: Caution
Natural progesterone passes into breast milk — progestogen-only preparations postpartum are generally acceptable; however, timing and dose should be guided by breastfeeding specialist/obstetrician. Suppresses lactation at high doses.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Enzyme inducers (rifampicin, carbamazepine, phenytoin) | Reduce progesterone levels — reduced efficacy | Moderate |
| Ketoconazole / itraconazole | May increase progesterone levels | Minor |
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Side Effects
Common
- Drowsiness/somnolence (especially oral route at night — caused by metabolite allopregnanolone — actually used therapeutically in bruxism/insomnia)
- Dizziness (oral)
- Breast tenderness
- Nausea
- Vaginal discharge/irritation (vaginal route)
- Bloating
Serious / Discontinue If
- Thromboembolic events (lower risk than synthetic progestogens)
- Depression (mood changes)
- Ectopic pregnancy (monitoring required in ART cycles)
Contraindications
- Undiagnosed vaginal bleeding
- Severe hepatic disease
- Porphyria
- History of progesterone-sensitive breast cancer (active)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Susten 200mg | Sun Pharma | 10 cap ₹265 |
| Naturogest 200mg | Zydus | 10 cap ₹245 |
| Gestofit 200mg | Aristo | 10 cap ₹225 |
| Utrogestan 200mg | Besins/Besins Healthcare India | 15 cap ₹395 |
Monitoring Required
- Serial beta-hCG (ART/threatened miscarriage)
- Ultrasound for fetal viability
- Endometrial thickness (HRT use)
- Mood assessment (depression)
- BP and weight (HRT use)
Patient Counseling Points
- Oral capsules taken at bedtime cause drowsiness — this is normal (do not drive after evening dose)
- Vaginal capsules: insert high into the vagina at bedtime; white residue next day is normal — do not douche
- Do not stop suddenly in ART/pregnancy cycles without medical advice — important for early pregnancy support
- Report bleeding, severe abdominal pain, or fever in early pregnancy — requires urgent assessment
- HRT use: report any unexpected vaginal bleeding — needs investigation
Stop Googling drug references mid-consultation
EasyClinic auto-flags Susten interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Anitha Krishnamurti, DGO, DNB (Obstetrics & Gynaecology), Senior Consultant
Last reviewed: 2026-04-01
References
- PROMISE Trial (NEJM 2015)
- PRISM Trial (NEJM 2019)
- ESHRE IVF Guidelines 2023
- BNF — Progesterone
- FOGSI Guidelines on Progesterone Use