Question 72
Dear Doctor N:
After reading your website, I hope you can help me. Just one month ago I had an oophrectomy after years of ovarian cysts, endo. , and adhesions. I still have my uterus, which now I wish I didn't after reading your answers. The surgeon suggested I could have it out, that I wouldn't have to take progestins, but also it was ok to leave it, less surgery risk involved etc. He also suggested I withhold Premarin .625 and Provera 2.5 daily for 2 months because of some evidence of endometriosis. I felt fine for the first 3 weeks. For the last 10 I have had extremely bad headaches that refuse to go away. I have started on the Prem. and Provera for the last 2 days and the headaches still exist. They are interrupting my sleep and interfering with my ability to live the kind of life I would like to have. What to do? Its complicated by the fact that I live overseas in Vietnam (and returned after surgery) I could probably get someone in the States to mail me a new HRT if that would help. At this time I regret my decision to have my ovaries out. I hope you can help me. Thanks so much. Again I appreciate your advice.
Reply:
I cannot begin to tell you how much I hate to hear stories like this. Unless there is a hypothetical plan to have a fertilized egg placed in the uterus at some future time if this is desired by the woman there is no upside as far as I know to retain the uterus when the ovaries are removed. It is possible that you are feeling the way you do because you are sensitive to the progestin and/or oral HRT as both can cause headaches. You could try switching to a patch such as Climera 0.0r mg, or 0.1 mg and taking Prometrium 200 mg at night for 10-12 days a month instead of the Provera to see if this is an improvement. Prometrium is a form of progesterone that is often better tolerated, you may very well have symptoms of progestin sensitivity during the time you are on it. If the Prometrium is effective as far as regulating the growth of the lining of the uterus it will result in an orderly withdrawal bleeding following completion each month and it may be possible to extend the Prometrium free interval to 6, 8 or even 10 weeks with appropriate monitoring of the endometrium.
I would discuss these issues fully with your doctor. You could also discuss having a second surgery to remove the uterus if this is what you feel would ultimately be most comfortable for you. You should also look at question 57 in the Ask Dr N section as it also addresses this.
I would appreciate your letting me know how things turn out.
Dr N