Dear Pharmacist,
I took your column regarding hormone replacement to my doctor. He’s never ordered progesterone, just estrogen because of the hysterectomy. For eight years, I’ve suffered with occasional hot flashes, mood swings, insomnia, and I can’t lose weight. Anyway, three days later, his nurse called to say he did some research, and wanted to add bio-identical progesterone to my compounded prescription cream. Two weeks later, I feel remarkably better.
--S.H., Boca Raton, Florida
Answer: You’re lucky your doctor is open-minded. This is an important topic so I’m revisiting it. Should a woman with a hysterectomy just take estrogen, or estrogen along with progesterone? It’s not black and white. Some physicians refuse to recognize the importance of progesterone once the uterus is taken out! That’s unfortunate because women could suffer needlessly.
For new readers trying to understand this, let me back up. In early November, my syndicated column informed women with a hysterectomy that taking “unopposed estrogen,” (meaning estrogen without progesterone) wasn’t always a good idea.
Many doctors today assume the hormone progesterone has only one use- to protect the uterus. But that is wrong, there are progesterone receptors throughout the entire body, and like every other human hormone, it has far-reaching effects. Does it make sense to deprive the body of the benefits of progesterone, just because one particular organ that used it was surgically removed? When you deprive a person of progesterone, an insufficiency develops and may lead to chronic fatigue, depression, anxiety, brain fog, insomnia, hot flashes, inability to lose weight, dry skin, thinning hair, bone loss, PMS, fibroids or migraines. Progesterone is known to relieve these problems, whether or not a uterus is present. It can benefit men sometimes too.
There remains confusion about progestin (drugs) versus progesterone (a natural, bio-identical hormone that humans produce). Progestin drugs have been associated with birth defects, whereas progesterone is the major hormone of pregnancy. Progestins, in some studies, may be associated with higher risk for breast cancer, heart attack and stroke, whereas progesterone is not. Progesterone stimulates production of thyroid hormone, important to every aspect of life, whether or not a uterus is present. It’s needed for brain health, progressive doctors administer this post-stroke in hospitals. In men (who don’t have a uterus) progesterone inhibits 5-alpha reductase, which can help with BPH (benign prostatic hyperplasia). Progesterone is incredibly protective to breast tissue.
According to two large European studies, women with or without a hysterectomy who use bio-identical hormones have no increased risk of any disease. So even though the current medical “standard of practice” still says to give unopposed estrogen, and some physicians still adhere to this, me and other health experts completely disagree. For the record, if people didn’t disagree with “standards of practice” we’d still blame ulcers on stress, and use leeches for blood lettings. We are born with many hormones and they are best kept in balance. It’s dangerous to mess with Mother Nature.
