Question 4 - Hysterectomy & Progesterone

Dear Sirs,

I am scheduled for a LAVH. I am not having a BSO, unless the Dr finds my ovaries to be unhealthy at the time of surgery. My question to you is: Can I take Prempro after my surgery? I am taking it now and it agrees with me just fine. I am 47. I ask this because everything I read says that if you don't have a uterus,then you don't need progestins to help with the shedding of the uterine lining. However,everyone says that it is fine to use a natural progesterone cream, so if natural progesterone is ok, then why not synthetic progestins added to the conjugated estrogens? Can it harm you, if you continue to take Prempro 0.625 conjugated estrogens with 5mg medroxyprogesterone?
Thank you and hope you can help me with this, no one knows!

Reply:

There is some early evidence that suggests that if taken every day, MPA the progestin in Prempro may interfere with the cardioprotective benefits of estrogen. I don't think anyone knows for sure yet, but it may be prudent to avoid the daily use of MPA until studies that are currently underway shed more light on this issue.

I would suggest you speak to your physician about just taking the conjugated estrogens and if you don't feel as well then consider changing back. You need to remember that women who undergo a hysterectomy, particularly if the ovaries are removed, may require individualized HRT to retain their previous quality of life.

Based on my own experience and interpretation of the current literature, I do not believe there is any benefit to progesterone cream. I discussed this issue with a number of colleagues whom I respect as being experts in the field of menopausal medicine recently, while at the North American Menopause Society conference in September of this year. The consensus among them, was that it was of no value other than to those who made a profit by selling it.

Please let me know how the surgery goes and how you're doing.

Dr N