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I was amazed when my OB-GYN gave me the complete opposite advice of that of my surgeon. Surgeon said NO progesterone b/c I no longer own a uterus. OB-GYN said I MUST have progesterone in order to balance the ERT and to prevent the endometriosis from coming back. ????????
I figure that the surgeon must be too busy to keep up on the latest HRT news, and especially b/c of all the good information I've found on this web site, I have to agree with the OB-GYN. I was actually ELATED when he told me that he wanted me to take progesterone. He said it should be taken for 6-12 months after a hysterectomy.
Now, he prescribed Prometrium. Yes, it's a bioidentical, but I've read that because it's taken orally, 85% of it is lost by having to go thru the digestive tract and liver. Why make the liver do all that hard work, especially when I could be using a cream to deliver it transdermally? Any thoughts?
Also, he said possible side effects of Prometrium can be dizziness and drowsiness. Sound familiar to anyone?
i have to say prometrium did me worse than good. yes it made me sleepy,,thats y i took it at nite. doc wanted me to try it out to stop all the bleeding,,well,,,it blew me up,,made the fibroid worse
to the point, doc could not do an exam on me. end results,,had a hysto due to fibroid,endo and path report adeno,,,not because of the prometruim,,but it didnt help me any,,and as to it being natural,,i really dont get it,,,that made my body feel so bad for being a natural hormone. anyhow,,my doc did tell me w/no uterus
i wont be needing progesterone,,but i too wonder if it is necessary for balance,,,im not sure,,and i really need to find this out as well,,since im not any hrt ,,just red clover, vit e/ primrose oil, calcium,,,so im wondering if i will have problems w/bio ids,,hope not,,,but i will have to find something when the hormones run out,,or if i can withstand any setbacks,,,so far feeling fine,,,but im not a prometrium fan at all,,,to me it is not natural,,,but thats my experience.
Progesterone is a precursor hormone, which our bodies can convert into other hormones as needed. We can make our own progesterone from dietary cholesterol. For some of us, combined with estrogen (and possibly testosterone) HRT, that is enough. Others seem to feel better supplementing with progesterone.
Endo is a special case... many DRs do prescribe some form of progesterone or progestin after a hysterectomy for endo, to help keep it from re-growing. There doesn't seem to be any consensus about whether oral or transdermal progesterone works better at keeping endo remnants at bay.
See how you feel on the Prometrium. I couldn't take it, nor can I use progesterone cream for more than a few days without feeling awful. But many women don't feel right without it. We are all different!
can you help me again...i started on wednesday nite,the climara patch .5mg, i also started on progesterone cream 3%, since then i have been sooo bloated to the point of its causing me pain in my surgical area and difficulty with my breathing properly..my feet swelling and everything..yet my mental status was great..i took the patch off saturday and just used my cream, well i started to get restless and anxious and last nite i decided i would just go back to the premarin,because i used that at the first week of my surgery and had no problems..i woke up restless and put on my progesterone cream and have been feeling okay until this afternoon very teary eyed..the bloating seems slighty better its not affecting my breathing and less edema to my feet..when i woke up i told myself im not going to take any estrogen and just use the cream...i cant figure out if the patch or the cream is giving me this bloat ...i cant take the bloat i have gain 5 pounds in 3 days..my doctors just arent any help at all. she didnt want me to use the cream to begin with and when i go in for my 6 week check up with this bloating problem she will of course blame it on the progesterone cream, do you think it is the cream....and what tests should i ask her to check for me tomorrow...blood levels to see what is going on with my body. i have no trust in these doctors and afte tomorrow i dont plan on going back to them, i just need to know if my cuff is healing properly and then i plan on following up with my family practise...i just know if i dont get this bloat under control i cant go back to work next monday because i have belly pain after a couple hours of being on my feet...i dont want this to get any bigger and dont know if i should take the progesterone cream tonight, it does help me sleep but if it is causing the swelling i can take a sleeping pill instead of the cream for my restlessness because i just cant get any bigger....i wont be able to walk...thanks...i thought progesterone was a natural diuretic....
(((Connie))), if you switch around between the different HRT's so fast, it's not possible to tell which one is doing what. That's why it's best to pick one thing and stick with it for a few weeks before changing anything.
I'm concerned about your having so much edema that it affected your breathing. If that's still the case I'd urge you to get in to see a DR right away.
Everyone is different.... For some women, progesterone can act like a natural diuretic, but for me, it caused me to bloat and swell more.
Considering how badly you feel, I'd consider getting back with your DR and re-evaluating what should be your next step.
You're so newly post-op that any edema needs to be evaluated: yes, it could be the progesterone cream, or it could also be a sign of something more serious (and systemic). Having trouble breathing is a sign of fluid in the lungs. If you've got that much edema -- been there myself -- it can be hard to breathe unless you're sitting up.
Progesterone creams tend to build up in your bloodstream; that, coupled with "tinkering" during a time when the hormones are still pretty topsy-turvy, can explain at least some of your symptoms. There are so many women for whom progesterone is definitely NOT the way to go. It's hard, though, in this early post-op period (and I'm talking six months here) to be sure where your balance will lie.
Since your symptoms could be due to anything from some late complication of surgery to a blood clot in one of the veins to lymphedema, it may need to be explored with your FP doctor. All your GYN will see is the results of her surgery -- and that's what you needed. But this is a "systemic" sort of thing that really requires the overview of a PCP, and I would urge you to call them SOON.
(((Sherrie))): Your situation may be totally different. As someone with stage IV endo, I knew that I'd been "estrogen-dominant" for some time. I went onto Prometrium only after my hyst, for the first three months, and did really well with it. Certainly, the "party line" is that if you don't have a uterus, you don't "need" progesterone. That's assuming that estrogen is being supplemented, first of all (the progesterone is to oppose the estrogen's tendency to form endometrial overgrowth -- hyperplasia). Those of us with endo don't just have endometrial tissue inside the uterus, we have it outside as well -- and it manufactures its own estrogen. That's why those of us with significant endo need progesterone. There hasn't been a whole lot of study of it, though, which is a problem; there's not much that I can point to in the medical literature that verifies it. Obviously, in this medical climate, the doctors have to do what they are told is "safe," i.e. proven by medical research. Given the WHI studies, progestins (and by extension) progesterone are looking riskier, and since there's not much literature on its use with endo patients, doctors are often reluctant to prescribe it.
I'm glad your OB-GYN is more attuned to the specific needs of endo and HRT: it's a loaded subject at best, and for those of us with endo, it's like being between a rock and a hard place -- you may need supplemental estrogen (which can be a good sign that they got a lot of the endo at surgery) and do just fine. Or you may turn out to be one of those ladies who cannot take any, finding that it triggers their old endo problems.
I also believe that anything you can do to strengthen your immune system and reduce inflammation helps. Endo is in part an inflammatory process, and there is some thought that following a careful diet, etc. can make a difference in your symptoms. You may also be one of the lucky ladies whose endo is completely eradicated with the surgery. We all hope for that!
As far as the liver effects, it is true that the dose is absorbed partly by the liver. Also, it has a short half-life. Prometrium is in a peanut oil base, so it's obviously out of the question if you're allergic to peanuts.
Compounders can create progesterone creams and/or time-released capsules (less "dump" on the liver, more into the bloodstream). I seem to do OK on the Prometrium. It doesn't make me dizzy or sleepy, particularly, although I know it has that effect on many. I found it made me a bit more "mellow" -- in fact, I'm using it that way as I stop taking Welbutrin (just to see if it helps some other problems I've been having). I can't say if my endo is back, or I'm dealing with adhesions. I won't say that I'm pain-free these days -- but it's still nowhere near the level of pain that I had before my surgery. I actually didn't have it for endo -- the thought of a hysterectomy had never occurred to me -- but it turned out endo was at the core of my problems. Neither my doctors nor I expected a miracle -- too many problems earlier for that -- but I think the combination of good surgery, no estrogen for three months, and continuing progesterone, has made a difference in my outcome. It's been two years next month. I've not had a perfect outcome, by any means. But in other ways I count myself lucky. A permanent reduction in pain was more than I expected!
(((Lena))): There's a site that really explains well why progesterone (or either of the others, estrogen and testosterone) just isn't for some ladies. It's Your Menopause Type. There's a detailed questionnaire that may help explain your particular needs. Although the site is geared toward "natural" menopause, I've found it useful again and again as I continually adjust my HRT according to my needs.
Big . HRT is a real minefield. But the more you understand your own particular needs, the better you'll feel. And keep researching and asking questions! Our Resource forum has a number of links, books, etc. that may help you research your options even further.
Well i ended up going to the emergency room on sunday nite because i still felt so bad and i was worried about the breathing part...Okay this is why i just cant deal with doctors anymore, I did have a temp on top of all this i found out when i got there of 101, chest xray clear, sats were 96%, my bp was 168/104,which i have never had a high bp before this surgery, he saw my legs swollen and my belly..He says i had all the signs of a emboli and sometimes they are so small they dont show on the xray,but because my oxygen sats were okay it didnt warrant a cat scan of my lungs..you all have to realize i have hmo....so he said take some lasix for the water retention, ah did that the day before didnt work thats why i came in...He did order a cat scan on my abdomen,(which i am scheduled for the 22nd)...thats all he did..nothing for the temp,even though my white count was elevated also...I had an a regular schedule appointment with my gyn yesterday.. okay her answer was IBS, take a fleets...okay im having stools already 3 x's a day, and i never had this before my surgery...she never addressed the temp,bp or breathing,says oh probly from the swelling..she did my pelvic and said my cuff was healing fine and when she pushed my abdomen from underneath and on top together, i went through the roof...oh your still healing, but gave me the okay for hot tub and sex...but be gentle...i said oh okay you cant even stick your finger in there why the heck would i want to have sex...So going to the doctors well they are just useless..I have so much swelling that i have pain in my right groin, she also said i might have a hernia, like it was no big deal...said guess we will wait till the 22nd for the cat scan..so i just deal with this all until then, and i go back to work on the 19th...great huh?? hey also she didnt know what estrogen dominance was when i asked her...she told me i dont need the progesterone cream because i dont have a uterus...i havent had narcotics in 3 weeks and just started taking them again because the swelling is so big its pressing on stuff down there and i am having more pain lately then post op...linda your right about the hormone thing, i put a patch on and im leaving all alone and just dealing with the side effects, giving it some time...i do feel alot better though, think it has to do with reading the bible,had to turn to him, he is the only thing that is going to get me through all this....so i am just trying to take it easy and do the waiting game until the 22nd...i swear these people are just so not there...can you believe it...will let you all know whats up after the cat scan... <admin. snipped legal reference> ...i just hope and pray that nothing gets worse until then....
thanks guys again the hystersisters have been way more help than my doctors again...