What is the role of progesterone after hysterectomy?

Hi all,
I was having a hard time with panic attacks, insomnia and a bit of depression after my TAH. Before surgery I was taking prometrium for my pms symptoms and it was wonderful. Well, after surgery of course I was only given the Climara patch 1mg. My Dr. tried to force anti-depressants on me, and I was having no part of it. I get so tired of that being their only recourse to complaints anymore. So I said to my Dr., "If my body made progesterones before surgery as well as it did estrogens, why don't I need that now?" So that's when she put me back on prometrium and I really began to straighten out. I'm sleeping again, panic attacks have ceased. Does anyone know if there is any danger in haveing progesterones after hysterectomy? Are the risks of breast cancer or heart disease higher with progesterones mixed with estrogens? I just know that I feel better, but do not really understand the role of progesterones right now. Thanks for any knowledgeable help. Sharon

Hi Sharon. You ask the million dollar question. Progesterone is the hormone responsible for the uterus shedding its lining every month. Many doctors (the majority it looks like sometimes) believe that once you have no uterus, you no longer need progesterone. Progesterone was given to women on estrogen therapy because estrogen alone seemed to cause cancer in the lining of the uterus. Adding progesterone seemed to prevent this. Again doctors thought "no uterus-no need of progesterone". We know now, of course, that that thinking is antiquated and just plain wrong. Progesterone does so much more than just give us a period. It actually offsets some of the nastier symptoms of estrogen - like bloating, headaches, and insomnia. You are a perfect example of that.

The question about breast cancer is a little more difficult. Trish did an article on it in the hormone jungle and knows more than I. There was a study published in JAMA about six months ago or so that establed that an estrogen/progestin combination does increase the risk of breast cancer. The thing to remember is that the study was done exclusively with a synthetic progestin (provera). As far as I know, there has never been a study done with a bio-identicle progesterone.

Hope that helped a little. It seems from reading posts, that doctors seem a little too eager to prescribe anti-depressants. That's too bad.

Progesterone has a bad rap because of two things I think. One is when it floods your system naturally, it's not so great. The other is that progestins (synthetics quite unlike the natural), the only kind you used to be able to take orally, really have adverse effects. So, most doctors I think thought that it would be a relief for women to be off progestins. So when you don't "need" it to prevent uterine cancers, then you'd be happy without it. And for some that's very true.

But a lot of us around here found that a bit of progesterone makes a huge difference in how we feel. Progesterone uses the same receptors in the brain as Xanax the anti-panic medicine, so there's definitely a connection that they're still exploring. Progesterone has more effect on the health of vaginal and labial tissues.

While progestins (Provera, etc.) nullify some or most of the good effects of estrogen on cholesterol levels, bio-identical progesterone has much less of a negative effect. The studies are on women with uteruses, so we can take even less of it, just enough to balance things. It is true that progestins increase the risk of breast cancer somewhat (bio-identical a bit less so). I wrote an article that covers that at http://www.hormonejungle.com, it's a relatively slight increase, so it depends on your other risk factors. Progesterone seems to increase the building of bone, while estrogen mostly stops bone loss. And progesterone can be converted by your body into testosterone, so you get the benefits of that without the problems with the synthetic.

The main thing I think is to find the lowest level that your body responds well to.

Hi Ladies!

I'm one of those gals who started with the progesterone to see if it would in fact stop the anxiety and irritable symtoms which started back after I went off the Paxil(anti depressant) and Ativan(anti anxiety med).(My "anxiety" is not the heart pounding kind, please bare with me, it's hard to describe) It was approx 3 months later that the weird feeling and insomnia, headaches returned, so I opted to try Promentrium. I asked my GP for a prescription, he was reluctant but gave in and prescribed 100mg to take at bedtime. This helped with sleep, but within a few days, the headaches got worse and major breast tenderness occured. I also was so dragged out the next day, and was starting to feel more depressed.

This frightened me, as I went into a major depression before my hyster 3yrs ago. At that time I started to suffer from mental distress, which they called anxiety and panic attacks. No one prescribed any HRT,which now I understand was the culprit, as my one remainging ovary was shutting down from another huge cyst. Atfer I asked for a hyster, premarin was finally prescribed at 1.25mg.

I am now wondering if the promentrium was just to high of a dose for me, and in fact could maybe help with the anxiety instead of the anti depressant I'm back taking. I am so afraid of stopping the Paxil as it is such a life saver at this point. My pyschyatrist seems to think that I'm on to something, and has referred me to one of his collegues, an endocrinologist. Unfortunately she is so booked up, I can't see her until Dec. I think it's worth a try to discuss this with her and see if in fact I have been possibly right all along.

I never had a depression or any kind of mental problem until my cysts started on my ovaries. My mother even agrees with me, as I have been looking back into my past to see if I was a troubled child or something in my early years. She actually helped shed some light onto this, when she remembered I was alittle nervous and weepy at 12 or so just before my periods first started. Once the cycles where on the way I was back to a normal mental state again, and all the anxiety disappeared until now. Co-insidence? I think not! Thankyou for listening to my dilema....I'm hoping that I can find a compounding pharmacist around here, but it seems in Canada, they are unheard of!

It's like that inner voice keeps telling me to follow my instincts on this one, and persue it untill I've exausted all other avenues. Can anyone relate?.... Urssy

Urssy, "You go girl!" I can hardly wait for the results of your visit to the endocrinologist - December is such a long wait, but what a great Christmas gift if all turns out to be what you suspect and on with a solution!!!! Have you checked into being given and earlier appt. if there's a cancellation? Never hurts to ask!

Hi Hypermom!

Thankyou for replying. Yes, infact I'm going to call tomorrow to see if they can fit me in any earlier. It would be wonderful, if I could get on an HRT custom made for my body.

I did experience the same mental anguish when they removed my first ovary 15yrs ago, but it all passed in a few months. I guess my remaining ovary kicked in to save me then. Some doctors still hestitate to relate our mental state of mind with any gyny problems! Even when it is so evident, after a surgery of this nature or endometriosis. They need open there eyes at what is happening as the "baby boomers" are hitting meno age and even earlier in there lives are stricken with reproductive problems! I pray that this endocrinologist can find my answer once and for all.

I replied to one of your posts a few weeks ago, I don't know if you remember though, I think it was about the promentrium too! Thankx again for your concern and support, it REALLY helps to know after these few years that I'm not alone with searching for answers that seem so hard to reach.

xxx Urssy

I think Less is More should be etched into the gate leading into the Jungle. I think the lowest dose that balances us, rather than some standard one size fits all dose is the way to go. It really does sound like too much progesterone. I use the cream. The breast tenderness comes and goes, mostly goes. I tinker it upward I tinker it downward, but I'm using only an 1/8 of a tsp or so a day.

Estrogen seems to be the main culprit in producing anxiety, so it makes sense that finding a way to balance it would help. I usually take mine 1/2 in the morning and 1/2 at night. occasionally I try all in the morning because that would be so much easier, but I get that high anxiety feeling intensely. When I increase the progesterone too to go with it, the anxiety drops but I get that dopey feeling. As soon as I go back to 1/2 and 1/2 with progesterone in the evening, I'm better.

Yes, Urssey, I remember your reply to my post about prometrium and tender breasts. I am keeping all my fingers and toes crossed for you. My Dr. dropped my Vivelle from 1 mg to .075 (Dot - nice!) and dropped the prometrium from 200 mg. to 100 mg. My breast are still tight and tender, but I don't have to carry them around with my hands anymore. I recently read someone else had to do that too! I work at a school so I'm not on summer vacation anymore, less time to check the message board, but I check in everytime I get. Take care and I'll be watching for your posts.

Hey Hypermom! I work in a school also...but don't have the summers off, 4wks holiday though finally. Email me anytime, and we can compare stories, OK! xxxurssy

Urssey, you must be a school secretary or custodial worker! Do ya gotta an e-mail address, huh? (I think that's how the kids at school would say it.) Don't think our Hyster Sisters are interested in our school stories - hormone balancing should be enough for them to deal with!