Brief Answer: Not a big fan of bio identical doctors. Detailed Answer: You have not had a menses for approximately five months and are over age 40. There is no way to know if you've had your final menstrual period or not. The brain is working hard to try to stimulate your ovaries which is why you have a couple of small cysts and your FSH measurement is elevated. Most women require some form of estrogen to relieve their menopausal symptoms and there is no reason that they cannot begin HRT prior to the final menstrual period. You do not have to wait to begin treatment. Progesterone by itself is not usually sufficient to relieve symptoms unless you're using huge amounts of it. Your GYN is correct that progesterone cream it's not FDA approved and has not been adequate to counteract estrogen stimulation effect of the lining of the wound. If you have a reassuring ultrasound showing an endometrial thickness of less than half a centimeter and have not had any bleeding then there's no reason that you should need a progesterone challenge with either Provera or progesterone cream. In addition there is a third option which is a micronized natural progesterone in an oral form taken at bedtime which will help to make you sleepy is FDA approved is available as a generic and could be prescribed as an alternative to Provera. Approximately 15% of women do not tolerate Provera well and it makes them feel anxious. Finally the risks of hormone replacement therapy,HRT, have been vastly overstated in the media. There is little downside to 5 to 10 years of therapy. If you have a uterus you do need some form of progesterone but natural progesterone is available in the prescription. The term bio identical is a marketing term not the medical term made popular by a Hollywood star who wrote a book about menopause and staying young. I do not buy into it. I think it is a way of making money primarily. Estradiol the same Hormone that your ovaries made in the reproductive years and is available for four dollars a month at your local Walmart. oral FDA approved progesterone also identical to what your ovaries made in the reproductive years is a little more expensive but still available as a generic. And by the way you do not state that you've been asked to do saliva tests but they are complete waste of time and money except for the person who orders the test.

---

Brief Answer: Oral progesterone works better than cream Detailed Answer: I am still unclear why anyone wants to give you a progesterone challenge test. It will not tell you whether or not you have had your final menstrual period. And with a 2 mm endometrium on US there is virtually no chance that you're going to have anything other than the lightest of withdrawal bleeds if that. You can talk it over with your gynecologist. Perhaps he is just trying to reassure you if you're anxious. You are absolutely correct Provera is a synthetic progestin which 85% of women tolerate well. Progesterone can be compounded or is available commercially at 100 and 200 mg strengths. It is mildly sedating and should be taken only at bedtime. Either Provera or progesterone will counteract estrogen stimulating effect on the endometrial lining. Estrogen causes the lining to thickening grow whereas progesterone causes it to mature and shed. With a 2 mm endometrium there's nothing to shed. You can see my previous answer regarding what I think a bio identical treatment. Not much. Progesterone cream and saliva testing are both expensive and unreliable.

---