I had a complete hysterectomy when I was 44 years old. Should I use progesterone cream along with the estrogen?

Hi Catherine,

I am a 66 year old female. I had a complete hysterectomy when I was 44 years old. I have been on Premarin since that time. I’ve never had my hormone balance checked. My friend is advising me that I should use the progesterone cream to prevent breast cancer. Should I use the cream along with the estrogen?

Thank you,

Sally

Dear Sally,

You might find my response to Denise last week interesting reading. Particularly on the origins of Premarin (pregnant mares urine).

For those of our subscribers who need clarification on this subject, a hysterecomy is a procedure which involves the removal of the uterus and is sometimes done along with an oophorectomy, which is the removal of the ovaries.

Women will tell you menopause is tough enough to deal with when it occurs naturally, but when surgically induced these changes are sudden and quite distressing, particularly when it happens in our 20s, 30s or 40s.

Upon entering menopause, a woman’s aging ovaries continue to produce certain amounts of estrogen and androgens (testosterone) for at least ten years after the start of menopause. Progesterone production drops to virtually zero when ovulation ceases, generally years before the onset of menopause. This natural transition through menopause can, for some women, include hot flashes and night sweats caused by the drop in estrogen production. But they usually don’t have the extreme symptoms that come with the abrupt surgical menopause.

Pre-menopausal women who have a hysterectomy with bi-lateral oophorectomy (removal of ovaries) will undergo an ?instant? menopause, due to the loss of hormones (estrogen, progesterone, testosterone) produced by the ovaries.

Recent studies show that the symptoms of surgical menopause are more severe and prolonged compared to symptoms during natural menopause when ovarian function gradually diminishes.

Estrogen linked to cancer

It is an established fact within the medical fraternity that the only known cause of endometrial (uterine) cancer is unopposed estrogen (estrodiol and estone being the more potent estrogens). And in order to block the proliferative effect of estrogen on the lining of the uterus to maintain acceptable uterine thickness, doctors routinely prescribe an artificial progestin (they continue to ignore the 1995 PEPI trials that clearly demonstrated that bioidentical progesterone can protect against uterine cancer).

The presumption here is that if your uterus has been removed, so too, according to medical practice, has your risk of uterine cancer (but not necessarily your risk of ‘other’ estrogen driven cancers). This practice of prescribing potentially harmful drugs such as estrogen replacement therapy (ERT), which may cause and promote cancer, and not balance its action in the body with some form of progesterone, may fall within medical guidelines as being ’safe’ (for your doctor perhaps!) but such an approach has yet to be proven guaranteed safe for the millions of women world-wide who could potentially be putting their lives at risk without even realising it.

This practice of prescribing ERT fails to take into consideration that estrogen, without progesterone to inhibit proliferation of cells, is a setup for many reproductive cancers such as breast cancer, whether you have a uterus or not.

Furthermore, isn’t it time we called a halt to such practice that sees women like you, Sally, on a course of ERT over 22 years and not one single test ordered by your treating physician to gather a snapshot of your hormone levels?

Just last Friday I caught up with a childhood friend whom I don’t get to see very often. She reported much the same scenario. Hysterectomised years ago … on estraderm patches … health deteriorating … wants to get off ERT but the likelihood of a resurgence of her debilitating symptoms holds her back … no real medical follow-up.

I pointed out to her that in cases of hormone dependent cancers, it is critically important to maintain optimal levels of natural progesterone and avoid the factors that would promote too much estradiol.

Judging by what I read and hear, doctors continue to ignore the fact that bioidentical estriol combined with bioidentical progesterone is indeed a safe and effective hormone replacement alternative for women who have undergone a complete hysterectomy.

This is in light of the recent US and UK findings (and the Swedish decision this month) that conventional HRT (not to be confused with bioidentical HRT), once prescribed to millions of women to ease the immediate symptoms of menopause and to prevent osteoporosis and heart disease, has been found to increase the risk of heart disease, cancer and blood clots, and perhaps has legal implications for the manufacturers of HRT drugs.

At the end of the day, Sally, you (and women like you) are assuming all the risks! Methinks this salient point needs to be hammered home more vehemently …