Nine years ago I had a hysterectomy. Would natural progesterone help me?

Hi Catherine,

Nine years ago I had a hysterectomy. I have had the whole gammut of menopausal symtoms. For the past few years I have been prescribed estrogen and testosterone implants. These have helped, but recently I have developed painful vagina and bleeding after lovemaking. Would natural progesterone help me? My estrogen levels are still on the low side.

Thank you,

Leoni

Dear Leoni,

Our inbox is swamped weekly with letters like yours seeking a no-nonsense explanation as to why progesterone replacement therapy is relevant following a hysterectomy.

A more indepth exploration of the real facts about hysterectomy, associated risks, deciding factors, and the need to replace your missing hormones is discussed in my publication ‘A Woman’s Guide to Using Natural Progesterone‘. But let’s briefly clear up some points you and our readers in my response below:

Point #1

A hysterectomy is a procedure which involves the removal of the uterus and is sometimes done along with an oophorectomy (also called ovariectomy) which is the removal of the ovaries.

Point #2

Our ovaries produce the lion’s share of our estrogen, progesterone and testosterone during the years leading up to menopause.

Point #3

The blood supply of the ovaries is a branch of the uterine artery that is cut & tied off (ligated) during a hysterectomy. The loss of this blood supply by the ovaries routinely results in ovary dysfunction or atrophy, and subsequent loss of hormone production within 1-3 years.

Point #4

If you’re had your ovaries removed during a hysterectomy, you will require immediate hormone replacement therapy to offset the health risks and side effects of surgically induced menopause (hot flashes, fatigue, depression, hair loss, headaches, heart palpitation, mood swings, loss of sex drive, vaginal dryness, urinary tract problems).

If your ovaries were left intact following the removal of your uterus, you will more than likely require hormone replacement therapy within 1-3 years.

Point #5

A hysterectomy puts a woman in a higher risk bracket for heart disease, arthritis and osteoporosis.

Point #6

Following a hysterectomy, testosterone and DHEA levels will drop by half of what is normal. Progesterone production will drop to virtually zero. However, a majority of women, particularly those from industrialised countries where we tend to carry more body fat, have enough fat cells to make sufficient estrogen when our ovaries give out. Thinner women may need estrogen replacement therapy.

Point #7

Whether you have a uterus or not, estrogen replacement therapy SHOULD NEVER be given without progesterone.

Point #8

Steer clear of artificial HRT. Ask your doctor to use natural-to-the-body hormones.

Point #9

Bioidentical progesterone, estriol and/or testosterone replacement therapy can be purchased from your compounding pharmacist as individual transdermal creams. But make sure you buy each hormone in a separate dispenser since you’ll need to adjust dosage according to periodic salivary hormone profiles.

Point #10

In time, progesterone supplementation alone may potentially offer women a complete hormone balancing solution to the after-affects of a hysterectomy.

Point #11

Bleeding after lovemaking may suggest cervical erosion (also called cervical ectopy), described as ulcers on the neck of the womb which are liable to bleed. Cervical erosion is listed as a drug interaction / side effect of estradiol replacement therapy.

ALL abnormal vaginal bleeding needs to be investigated as soon as possible to rule out cancer of the womb, cervix, vagina and vulva. Your particular case may or may not require cauterisation.