How to make progesterone shots less painful

Natalie Castillo-Rubio
Expert Reviewer: Natalie Castillo-Rubio
Natalie is an IVF nurse with 15 years of experience and founder of Moonlight Injections, an injection service in Orange County that supports IVF patients overcome the stress surrounding injection medications.
Progesterone in oil injections for IVF - some women say not so bad, some say terrible. To avoid being in the latter group, make sure you follow these 9 tips for how to make progesterone shots less painful.
Tips on how to make progesterone in oil injections more bearable
Tips on how to make progesterone in oil injections more bearable
Progesterone shots are the most notorious medication that are included in the IVF process. Why?

Well, the needle is the biggest one you'll use out of any of the IVF shots, the medication itself is THICK which makes it take a longer amount of time to actually be injected, and you have to inject right in your behind. 🍑 😳

Progesterone is used in the late stages of the IVF process when you are preparing for an embryo transfer. Want to learn more about the IVF process? Check out our complete guide to IVF.

Whether you're doing a fresh transfer or a frozen embryo transfer (FET), this will likely be one of the final medications you'll be taking as part of your infertility treatment. 

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What is progesterone used for in IVF?

For medicated transfer cycles, physicians prescribe progesterone for luteal support to help make sure the uterine lining will be thick enough to be receptive for the embryo transfer & it also helps them to time the date of the embryo transfer as well. 

Estrogen makes the uterine lining thicker (measured in millimeters), while progesterone primarily makes the endometrium denser and receptive to implantation.

Do all IVF patients use progesterone in oil for their FET?

No, not everyone does progesterone shots. 

Some patients do a natural cycle, which means they do not take medications for the transfer stage. Their RE will follow the natural estrogen & progesterone levels their body produces to time the transfer according to the body's natural luteal phase. 

And then there are patients that use progesterone but not in the form of an injection. 

Progesterone (P4) supplementation actually comes in a few different forms that may be prescribed by your physician. 

  • Progesterone in oil injections (Progesterone generic brand)
  • Progesterone suppositories (Endometrin, Crinone)
  • Progesterone capsules (Prometrium)

The most commonly prescribed progesterone types for embryo transfer cycles are the progesterone in oil injections and the suppositories.

Between the options of using progesterone shots versus progesterone suppositories, studies have shown that these different methods of progesterone supplementation have comparable pregnancy success rates and no difference in miscarriage rates. 

Why are the Progesterone in Oil shots so notorious? 🤷‍♀️

  • Oil is thick which makes it more difficult to inject & takes longer to do than other IVF shots
  • PIO needs a big needle that has to be injected right into your glute muscle
  • Some women can have pain, swelling, or small knots in the muscle from these injections

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How do you make progesterone in oil less painful? 🙈

Here are our tips:

✅ Get an injection buddy

Ask your partner or a friend to help you out. Injecting yourself in the behind can be a tough contortion on your own. 

✅ Warm up the vial

Warm up the vial a bit in the crease of your elbow or by rolling the vial back and forth in your hands.

The oil is thick but warming it a little can help thin it out & make it easier to inject.

When it comes to how you heat up your PIO, there is a right way and a wrong way.

Natalie Castillo-Rubio who is an IVF nurse and founder of Moonlight Injections, a nursing injection service that supports IVF patients in Orange County, warns, "Never use microwave or hot water to warm as this may change the efficacy of the medication you are injecting."

✅ Relax your glute

Lay down flat on your stomach so your glute muscle is not contracted.

Can't lay down? Natalie recommends, "If you have to stand for the injection, make sure to bend your knee on the side you are injecting to help relax the muscle and avoid tensing up."

So slightly lift the leg on the side that you'll be injecting to take the weight off that glute muscle and keep it relaxed.

If you relax your glute before and during the shot, it will be less sore.

✅Confirm you're injecting the progesterone in the right spot!

The area you're meant to inject progesterone in oil is a bit higher on your behind than a lot of people think!  

Natalie has some tips here on how to know where the correct site is to inject the progesterone in oil.

"To locate the correct injection site for an intramuscular injection: split the left or right cheek into four quadrants. Then find the upper, outer quadrant.

Some also identify this area as the top corner of a back pants pocket. This is the location to inject."

✅ Use numbing cream or an auto-injector

Not all patients do this but if you think you need it, go for it.

✅ Use a warm compress after injecting

Warmth and moisture will help the oil to absorb once it's been injected. 

Natalie tells us, "Use a wash cloth, run under hot water and massage the inject site. The heat and moisture will help the muscle to absorb the medication a little better than dry heat since the medication is oil based.

This can be done not only following in injection but periodically, throughout the treatment cycle."

✅ Massage the injection area afterwards

Make sure to massage the injection site for a good 5 minutes after the shot to help break up the oil & encourage absorption. 

A heating pad also helps!

✅ Walk if off

Going for a short walk afterward can also help with soreness.

✅ Switch sides

Switch between the left and right glute every time you do your injection so that one side doesn’t get the brunt of it.

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You've got this!

Make sure to get tips and advice from your care team & pharmacist as well to make the injections as manageable as possible.

❓Anyone else have any tips? Share in the comments below!

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