Surgical Menopauseis caused by the removal of the uterus and ovaries. Women who have had hysterectomies, with ovaries removed or not, usually receive Estrogen replacement only. This is because many doctors think that the only role of Progesterone in the body is to prevent excess estrogen stimulation of the uterine lining. Why prescribe progesterone, they think, if a woman doesn’t have a uterus?
But progesterone has receptors in many parts of the body—brain, bones, breasts, vagina. Some progesterone is converted to testosterone, estrogen or cortisol if the body finds it necessary, so progesterone has another role as a back-up hormone. Progesterone plays a role in metabolism, sleep regulation and bone-building as well. And we don’t even know all about what progesterone does yet!
After surgical menopause, women who receive estrogen-only replacement may continue to complain about bloating, swollen breasts, fatigue, “crying for no reason”, lack of libido and easy weight gain. Their frustrated and busy ob/gyn doctor sends them back to their primary care physician for anti-depressants, diuretics, diet advice and assurances that “nothing is really wrong with you— you probably just feel bad about losing your uterus—it will pass.”
Some testosterone can help the libido. The estrogen dominance symptoms can be relieved with natural progesterone. I have recommended ProGest cream to women who feel like this, and they have resolved their complaints.
During natural menopause many women experience a drop in progesterone levels before they experience a drop in estrogen levels. This is because progesterone is made primarily by the corpus luteum, the remains of a follicle after ovulation. When there is no ovulation, there is no corpus luteum. Only a small amount of progesterone remains, made by the adrenal glands. This would be fine as long as estrogen levels dropped simultaneously, but they don’t always. Sometimes estrogen levels continue relatively high for several years, since some estrogen is still made by the ovaries and an estrogen called estrone is made in fat cells. This is nature’s way of easing us into menopause, but it can get out of balance.
Estrogen dominance symptoms after menopause include intermittent bloating and swollen breasts, fatigue, depression, lack of libido and easy weight gain. Progesterone enhances thyroid metabolism and estrogen interferes with thyroid. Estrogen dominance can mimic hypothyroidism.
The more weight a woman carries, the more likely she is to be estrogen dominant. In fact, obesity is a risk factor for hyperplasia and endometrial cancer, because of estrogen dominance. Unopposed estrogen made by the woman’s own body may stimulate the lining of the uterus and thicken it with blood. For this reason, any unexpected bleeding more than one year after periods have stopped should be checked by a doctor.
Heavy women, who are less likely to be on estrogen because their own estrone relieves hot flashes, may nevertheless need to take progesterone for awhile after menopause to protect their uterus from hyperplasia. One way to check for this is to take the “Progesterone Challenge”. It would probably be better to work with adoctor on this and to take a prescription level of progesterone or progestin. (ProGest cream would be too low a dose.) Progesterone or progestin is given for 10 days and then stopped; if a period or any bleeding results, then there is some blood being built up in the uterus. Natural progesterone should then be used for several months to a year, cyclically, until this withdrawal bleed stops.
For other women, estrogen dominance just doesn’t occur. Instead, periods get lighter, fewer and far between until they disappear. Hot flashes, night sweats, sleep disturbance, anxiety, depression, and vaginal dryness may be their complaints. Their doctor will most likely prescribe standard H.R.T. which is the most commonly prescribed drug in the world—PremPro or PremPhase, combinations of Premarin and Provera. Premarin is a conjugated estrogen (combination of estrogens) derived from Pregnant Mare’s Urine—thus the name. Provera is a synthetic progestin.
Many women feel much better on H.R.T., but others don’t. They have side effects like bloating, sore breasts, fatigue, nausea, depression and headaches.They do not realize that You CAN Take HRT Without Side Effects! It’s just not the standard prescription. Natural estrogen and natural progesterone made from wild yam and soy molecules are exact copies of our own hormones, and they can be prescribed in physiologic doses that result in NO SIDE EFFECTS!
In 1998, Solvay Pharmaceuticals brought micronized natural progesterone capsules to the market in a new product called Prometrium (Trademark). Prometrium capsules contain 50 or 100 mg. of progesterone suspended in peanut oil (beware those who are allergic to peanuts). Prometrium can be prescribed with the estrogen patch or micronized estradiol capsules to provide natural hormone replacement. Natural hormones are made from soy and/or wild yam molecules called diosgenin, which is very similar to human hormones. Natural hormones are made in a lab, and they are an exact copy of our own hormones. When prescribed in physiologic doses, they act just like our own hormones and have no side effects. (Allergy to soy does not seem transferrable to these products, usually.) This regime has been promoted extensively by Dr. Christiane Northrup, author of Women’s Bodies, Women’s Lives.
Another way to take natural hormones is in cream form, transdermally, which results in a time-release effect like the patch, but without the bother of wearing a piece of plastic. Dr. Carolyn Shaak of Needham, MA, my gynecologist, is developing a product line containing several different standardized dosages of estradiol, natural progesterone and testosterone. In the meantime, such creams can be prescribed by any doctor and made up at a compounding pharmacy near you. The Women’s Pharmacy in Madison, WI, can supply such creams by mail order.