I have been using progesterone cream for about 1 year and each biopsy since then still shows simple hyperplasia.

Hi Catherine,

I am so very pleased at the great info in your newsletter. Would you please print an answer to my question as I have never seen it addressed in any of your newsletters and many many women have this problem.

I have simple uterine hyperplasia. It has been an ongoing problem now for almost 4 years. I keep having biopsies done and they all come back as simple hyperplasia. Not atypical or worse. I have been using progesterone cream for about 1 year and each biopsy since then still shows simple hyperplasia. Have you ever heard of any one getting rid of the hyperplasia with progesterone creme or is a hysterctomy inevitable?

Please answer this in your newsletter as I have talked to so many women who haven’t seen this issue addressed.

Thank you so much,

Eloa

Dear Eloa,

In actual fact, I did touch on this subject in a previous newsletter and, only a few weeks back, included a success story provided by one of our ladies. Nonetheless, now’s as good a time as any to explore this subject in more depth for your benefit, and that of our readers.

To begin, let’s first examine a woman’s reproductive cycle and its two distinct phases:

• Follicular Phase (Day 1 ~ Day 14)
• Luteal Phase (Day 14 ~ Day 28)

The hormone estrogen dominates in the Follicular Phase (proliferative - prepares the uterine lining), while progesterone dominates the Luteal Phase (secretory - maintains the uterine lining).

Estrogen is the hormone that stimulates cell proliferation, or the growing phase of the cells in the uterus. Progesterone is the hormone that stops growth and stimulates ripening (see diagram below).

(Printed with Permission - ‘Ask Dr Sandra Cabot Newsletter, Edition 3′)

Forty eight hours after ovulation has taken place and progesterone levels have surged, all endometrial cell proliferation should stop. This is nature’s way of protecting women against endometrial cancer.

We know that estrogen drives continued proliferation of the endometrium. We also appreciate that the only known cause of endometrial cancer is unopposed estrogen.

In the event a woman fails to ovulate, or her progesterone levels are too low to oppose estrogen’s proliferative action on the uterus month after month, endometrial hyperplasia results and, eventually, this can lead to endometrial cancer.

Endometrial hyperplasia means the uterine lining is thickened (due to an overgrowth of mucosal cells). Symptoms often include irregular vaginal bleeding, heavy or prolonged menstrual cycles, and post-menopausal bleeding in older women.

Simple hyperplasia (without atypia) means the lining of the uterus is thick but the basic structure of the endometrium is relatively unchanged.

On a more positive note, simple hyperplasia is the most benign type of hyperplasia, and the least likely to progress to cancer.

In your case, Eloa, at least as you describe it, no precancerous cells were found (simple hyperplasia).

When the cells themselves appear abnormal, then the phrase “with atypia” is added. Atypia means that the cells themselves have become abnormal. This is a similar case to cervical dysplasia. Although these cells are not cancerous, there is an increased probability that they will become so. We can think of them of “going towards” cancer, but not yet “arrived”.

A diagnosis of endometrial hyperplasia can only be made by a pathologist who examines a sample of tissue removed from the thickened lining by a sampling procedure such as endometrial biopsy or dilatation and curettage (D&C).

The key to reducing our risk is to make sure we have some kind of “bleed” in which the lining of the uterus is shed at least every 3 months, preferably more often.

Possible treatments for endometrial hyperplasia include:

• Hormone therapy. Progesterone can be used to counteract the effects of estrogen on your uterine lining.
• Dilation and curettage (D&C). This is a minor surgical procedure in which the endometrium is scraped away and removed from your uterus. A D&C can sometimes cure simple hyperplasia.
• Hysterectomy. If precancerous changes are found in your endometrium, your doctor may offer you the option of a hysterectomy (surgical procedure to remove your entire uterus), which will eliminate any risk that endometrial hyperplasia will progress to endometrial cancer.

Dr. Helene Leonetti’s study effectively proved that progesterone cream protects the uterine lining (the endometrium) as well as synthetic progestins do. Her study comparing PremPro with Premarin and progesterone cream was published in a major peer-reviewed medical journal (JAMA 2002; 287:216-220. Anasti JN, Leonetti HB, Wilson KJ. Topical progesterone cream has antiproliferative effect on estrogen-stimulated endometrium. Obstet Gynecol 2001; 97 (Suppl 4): S10).

In Dr. Leonetti?s study, uterine tissue was examined before, during, and after using either PremPro (Premarin plus Provera) or a combination of Premarin and progesterone cream. The group using progesterone cream was found to be as well protected as the PremPro group.

I believe the discussion point here is not whether progesterone offers protection against endometrial hyperplasia, but rather HOW MUCH progesterone needs to be administered to maintain a healthy estrogen-to-progesterone balance.

Basing my comments on the limited info presented above, whatever dosage of progesterone you are using, Eloa, it evidently IS NOT opposing your estrogen load. In general terms, women sometimes need to move up to a 10% cream that delivers 100mg per application to realise more positive outcomes.

I can provide you with my own success story. Several years ago, I was diagnosed with endometrial hyperplasia subsequent to a course of HRT (estrogen implants coupled with an artificial progestin, Provera). A ‘day stay’ in the hospital for a D&C and course of 10% progesterone cream got me back on track and has kept me within normal limits. At that moment in my life, I was seriously contemplating a hysterectomy.

The key here is ‘opposing’ your estrogen load with progesterone, and this, of course, will vary for each and every women. Hence, the need to tailor your progesterone dosage to your individual health needs.

At all times be ‘up front’ and honest with your treating physician. And make sure he or she monitors you closely while on progesterone supplementation.

If precancerous changes are found in your endometrium that have not responded to progesterone supplementation or other forms of therapy, then perhaps one could argue a hysterectomy is the proper course of treatment. Until then, Eloa, you might want to hang on to your uterus.