this post was submitted on 24 Sep 2025
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evening primrose is not exactly evidence based medicine, ibuprofen or acetaminophen are more likely to help with the pain
but I'm wondering why the doctor prescribed 300 mg nightly, that's a larger dose than I would expect 🤔
I take 100 mg / night, and I've heard 200 mg is a common dose as well, but I haven't heard of more than 200 mg being taken typically - you could try talking to the doctor about reducing dose and see if symptoms are reduced?
https://pmc.ncbi.nlm.nih.gov/articles/PMC8296106/
I wonder though if the nipple pain is from the progesterone or the increased estrogen - it's hard to say exactly. I only call out the progesterone because it seems like a higher dose than I'm used to seeing, but increased estrogen can cause breast soreness, too.
You may also find the soreness reduces as you adjust to the dose. For that reason, I definitely recommend keeping a log to help you keep track of symptoms (it can be really hard to figure out the right HRT doses, so a log can be helpful for tracking changes to dose and the effects they had).
With the journal you might be able to track the symptoms you had from perimenopause and contrast it with the symptoms you have from the HRT, then adjust the dose until you find that happy medium where your peri symptoms are well managed but you also aren't dealing with side effects from too much HRT, like breast soreness.
Good luck with finding the right dose for you - sorry I don't have more practical advice, my own soreness from HRT actually caused me to be unable to sleep at times and I never found a suitable treatment ... hell, sometime I still get soreness, my partner accidentally brushed against me in the grocery store the other day and I was like "ow", lol - sometimes I'm just sore, usually when my estrogen and progesterone levels are higher (I cycle mine on a weekly basis).
Yeah I was surprised when she mentioned evening primrose as well, but I'm at my tits' end so I figured I should at least look into it. I did find a paper on PubMed indicating that evening primrose and Vitamin E as combination or standalone therapy could help with cyclical breast pain so plausibly it could be helpful. However that seems to be contradicted by the review article you shared.
I started at 100mg progesterone and that wasn't enough. Tried 200mg for a while and that helped to some degree with the brain fog and night sweats but I was still having long periods of sleeplessness at night. So on her recommendation I went up to 300mg. She said I could technically take up to 400mg but 300 seems to be the sweet spot for symptom relief. But I do think the nipple pain coincides with the increased progesterone.
Thank you as always for such a detailed and well thought out reply! If I figure out a solution for this I'll be sure to share it with you. We deserve better in life than perpetually sore nips!
prog definitely helps with sleep for most folks
I have to take my prog rectally, it turns out the liver filters out most of it when taken orally and you get very little increase in blood levels as a result (read more here), so you might consider trying 100 - 200 mg rectally and see if that helps the sleep issue for you. Personally I find oral is less effective for my sleep than rectal administration, but that varies significantly from person to person.
Night sweats and brain fog screams low estrogen, though - I would have tried increasing estrogen for those symptoms, not progesterone. Maybe see if you could get a cream that would allow you some flexibility in dose timing and amount, then once you know what works you would know a better long term stable dose for your patches. Sometimes low enough estrogen can cause sleep problems too, so it may not be a problem solved by taking more prog if you just need a bit more estrogen.
I'm so sorry you're going through this, but I'm also happy you're staying invested in finding a solution and not just trying to tough it out 💖