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After a Hysterectomy, Should You Use Progesterone?

By Kenneth N. Woliner, M.D.
Posted: Friday, April 22nd, 2011


I got this e-mail from a patient today:

Hi Dr. Woliner,
Yesterday I had my annual ob/gyn exam and pap smear.  Since I was a new patient, the doctor went over my information and in the course of discussing HRT therapy, he asked me what I was using and I told him about the bioidentical hormone replacement therapy (bHRT) of estrogen and progesterone (which I get from a compounding pharmacy) that I was using on a daily basis.

His question to me was, “Why are you taking progesterone?” His comment was that the usage for it was the protection of the uterus (mine was removed many years ago). Am I taking it for other reasons, and if not, should I stop using progesterone and just take the estrogen?

Please review my file and advise me.  Thank you for taking the time to fully answer this question.

- J.K.

J.K.

It’s a good question.  Most doctors realize that when prescribing hormone replacement therapy that ”unopposed estrogen” (even bioidentical HRT), could induce uterine cancer in a postmenopausal women who still has a uterus.  So, doctors commonly prescribe a progestin (in this case, I prescribed bioidentical progesterone), to prevent that bad effect from happening.  But what if you don’t have a uterus anymore?  As you guessed in your e-mail, there are other reasons for taking progesterone.

Low progesterone levels cause classic symptoms including: Hot Flashes, Anxiety, and Insomnia.  In addition to those top 3 symptoms, progesterone insufficiency can cause:

  • hot flashes
  • insomnia
  • anxiety
  • fibroycystic breast disease
  • water retention (such as swelling of ankles or fingers)
  • fat weight gain (or trouble losing fat weight)
  • low libido
  • brain fog and poor concentration
  • muscle aches
  • dry skin or dry eyes
  • hair loss or thinning
  • osteoporosis and osteopenia (thin bones)

I have found that bHRT with Progesterone, though not specifically FDA approved for the conditions listed above,  to be very safe and effective for these symptoms.  Since you were having some insomnia and anxiety, I prescribed progesterone for you.

Bioidentical natural progesterone is not the same thing as Provera (genericname medoxyprogesterone).  Provera was compared head-to-head against natural progesterone and it was shown that Provera did not help alleviate these symptoms, but also caused the following bad side effects:

  • osteoporosis
  • breast cancer
  • decreased HDL cholesterol and increased risk of heart disease
  • weight gain

So, to answer your question, please stay on your progesterone so you don’t get a recurrence of your anxiety or sleep disturbances.

More information about the benefits of natural progesterone can be found at the following website:  http://www.johnleemd.com

- Dr. Woliner



2 Responses to “After a Hysterectomy, Should You Use Progesterone?”

  1. Cat says:

    Thank you…this information was/is very helpful and identical to my situation.

  2. Rebecca says:

    I too am on BHRT without Progesterone because of a hysterectomy many years ago. While it has only been a little over one month ago that I received the pellets, I have not experienced any weight loss and still suffer from insomnia (unable to sleep more than 5 or 6 hours at a time) and stress. While researching the lack of Progesterone as part of my weight loss problem I came across your article and learned the very valuable information that my insomnia and stress (largely to blame for the inability to lose weight) are because of the lack of Progesterone. Thank you both so much for making this information public!

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