We help our patients know and understand the side effects of progesterone replacement
This week we are continuing our conversations about the risks vs. the benefits of hormone replacement therapy. We have covered the risks of replacing estradiol and testosterone, and this week we will cover the risks associated with replacing progesterone, and if those risks outweigh the benefits.
Progesterone is given only to women who have a uterus after menopause, because it is only needed for the health of our uterus. After our ovaries stop producing estrogen and when we replace that hormone, then progesterone is needed to balance estradiol’s effect on the uterine lining. Doctors choose either progesterone or progestin to balance estradiol. Most of the population doesn’t need progesterone after menopause unless they have a uterus and are taking estrogen.
Women who don’t have a uterus, who have had a hysterectomy, don’t have that issue, so progesterone is with held when estrogen is replaced.
For women who do have a uterus and have gone through menopause, there is still a need to protect the uterus. The body automatically does that before menopause by cleansing the lining of the uterus once a month. That does not happen spontaneously after menopause. Women are sometimes given progesterone (or a progestin) daily to suppress the lining of the iuterus from growing, and others are given progesterone a week to ten days every few months to stimulate a period and clean out the lining of the uterus. Careful choice of the type of estradiol and progesterone, as well as the delivery method is important.
The type of progesterone-like replacement with the highest risk is a “progestin.” The next highest risk is oral bioidentical progesterone. The least highest risk is non-oral bioidentical progesterone. Similar to non-oral estrogens, non-oral progesterones, given as a vaginal tab, a cream, a transdermal gel, or a subcutaneous pellet, non-oral types of progesterone are lower risk than any oral progesterone. Progesterone is the replacement hormone with the fewest side effects, and some of them are medically protective. The choice to take progesterone or a progestin as well as the choice to take constant or cyclical progesterone to cause bleeding is a matter of discussion between you and your doctor.
The non-medically dangerous side effects include: lethargy, fatigue, hunger and hair loss. Generally, these symptoms are avoidable or treatable with other interventions. You might ask why a woman would consider taking progesterone if these side effects might occur; data suggests progesterone can lower the risk of heart disease, stroke, and breast cancer. Most women would take that trade-off in a heartbeat.
My theory on any hormone replacement therapy is to try to find the safest way to take a hormone as well as the safest type of that hormone, and see if it works for you. If it doesn’t, then work with your doctor to find the next best alternative.
Risk of side effects doesn’t mean that they will happen, but that there is a chance it will happen. I spend time with my patients to help figure out their lifestyles and the goals of treatment, and then recommend their best path forward. Ultimately, it is a woman’s decision to replace progesterone, just as it is for the other post-menopausal hormones. If you can’t take progesterone in any form, then your options include a Mirena IUD that will keep your uterus safe for five years, or an ablation that burns out your lining. Some of my patients choose not to take progesterone at all, and to have an ultrasound and biopsy of the lining of the uterus every year. Creative problem solving is the skill of a good doctor. Hopefully, this podcast will help your discussion with your doctor be much less stressful.