One-third of all American women over the age of 60 have had a complete hysterectomy? In fact, this is the second most common surgical procedure after C-section. Most women who have their uterus and ovaries removed are never offered hormone replacement therapy for symptomatic relief or disease prevention. Those who are lucky may find a doctor enlightened enough to prescribe hormones. Unfortunately, estrogen only is what is typically prescribed, and this is a problem! While estrogen replacement is essential countless ways, estrogen replacement alone, without the addition of progesterone, can cause a whole host of negative side effects and unwanted health challenges.
In this blog, I’ll discuss why hormone balance is important, the many health benefits of progesterone (aside from uterine health), and the critical differences between natural progesterone and synthetic progestins.
The Importance of Estrogen Progesterone Balance
Progesterone is your body’s natural ‘estrogen balancing’ hormone. Every cell in your body has receptors to both estrogen and progesterone…so both hormones must be present and in proper balance for your body to function optimally. In addition, all of your body’s hormones affect and are affected by each other. If there is an imbalance between estrogen and progesterone, none of your other hormones will work properly. For example, if you have more estrogen than progesterone, your thyroid hormone will not work as well.
Why Women Who’ve Had a Hysterectomy are not Prescribed Progesterone
One of the main functions of progesterone is to protect the lining of the uterus from the effects of estrogen. Estrogen causes growth and thickening of the lining of the uterus which progesterone keeps in check. If a woman with a uterus is interested in hormone replacement, she should always receive a progestin (which is a synthetic and altered form of progesterone, see below) in combination with estrogen (i.e. Prempro, Combipatch). The main reason for this is to prevent the development of abnormal uterine bleeding and uterine cancer.
If a woman undergoes removal of her uterus, there is no need for her to be concerned about developing uterine cancer. As such, conventional medical wisdom claims that progesterone replacement is not a necessary part of hormone replacement therapy. What conventional doctors fail to understand is that progesterone is an essential hormone for the optimal function of every other organ in a woman’s body.
The Health Benefits of Progesterone
Even if women lack their uterus, are still many valid reasons why progesterone replacement (with estrogen) is beneficial:
The Crucial Differences Between Progesterone and Progestins
It’s unfortunate but true that many doctors lump all hormones into the generic category of ‘hormones’ when discussing hormone replacement therapy with their patients. This is especially true in the case of progesterone. That’s why doctors who do prescribe hormones for menopausal women almost always prescribe progestins, not natural progesterone. If your doctor tells you that progestins are the same as natural progesterone, they are absolutely wrong!
Comparing the molecular structures side by side, it doesn’t take a scientist or doctor to see there is a clear difference between them. And, even though this difference may be subtle, it has a huge impact on the differential actions of these two very different hormones. Simply put, the only positive effect of progestins on a woman’s body is to protect the uterine lining from the proliferative effects of estrogen. In every other respect, progestins do the opposite of natural progesterone…and hence their numerous negative side effects.
This graphic provides a basic comparison of progesterone and progestins. The laundry list of negative side effects of progestins is even longer than what is depicted. To this list, you can add mood disorders, weight gain, thyroid hormone dysfunction, gall bladder disease, insomnia, fluid retention, decreased sex drive, and fatigue.
The bottom line is…if you’re a woman whose had a complete hysterectomy and is on estrogen replacement only, you should speak to your doctor about adding natural progesterone to your hormone regimen. This can be done by adding Prometrium (which can be obtained through a regular pharmacy) or compounded bioidentical progesterone in the form of cream, gel, troche or capsule.