Does progesterone alone help after a hysterectomy?

From the Guidelines

Progesterone alone is not typically recommended for women after a hysterectomy, as the primary concern is usually managing menopausal symptoms, which may be better addressed with estrogen therapy or other treatments. The U.S. Preventive Services Task Force (USPSTF) recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy 1. This recommendation is based on the evidence that the benefits of hormone therapy do not outweigh the harms in most postmenopausal women.

Some key points to consider:

• The use of estrogen without progestin has generally been restricted to women who have had a hysterectomy because unopposed estrogen use increases the risk for endometrial cancer in women with an intact uterus 1.
• The USPSTF found convincing evidence that estrogen is of moderate benefit in reducing the incidence of fractures, but it is also associated with moderate harms, including the risk for stroke, gallbladder disease, and urinary incontinence, as well as a small increase in the risk for deep venous thrombosis (DVT) 1.
• Progesterone alone may help with specific symptoms like mood changes, sleep disturbances, or hot flashes after hysterectomy, but it is not typically the standard approach for most women.
• Common progesterone options include oral micronized progesterone (Prometrium) at 100-200mg daily, or progesterone creams applied to the skin.
• Before starting any hormone therapy, it is essential to consult with a healthcare provider to discuss specific symptoms, medical history, and determine the best course of treatment, as individual needs vary significantly after hysterectomy.

In terms of morbidity, mortality, and quality of life, the most recent and highest quality study suggests that the benefits of hormone therapy do not outweigh the harms in most postmenopausal women 1. Therefore, it is crucial to weigh the potential benefits and harms of progesterone alone or any other hormone therapy and consider alternative treatments for managing menopausal symptoms after a hysterectomy.

From the Research

Progesterone Alone After Hysterectomy

• The use of progesterone alone after a hysterectomy is not commonly recommended, as estrogen therapy is often considered sufficient for women who have undergone hysterectomy 2.
• However, some studies suggest that progesterone-only therapy (PT) may be considered in certain cases, such as for the relief of climacteric complaints, but the potential risks of breast cancer must be taken into account 3.
• The decision to use hormone therapy after a hysterectomy should involve an individualized risk/benefit analysis, and the current literature suggests that including a progestogen may not be necessary for most patients 2.

Alternatives to Progesterone

• Estrogen therapy alone is often recommended for women after hysterectomy, as it can help alleviate menopausal symptoms and reduce the risk of osteoporosis and cardiovascular disease 2, 4.
• Other alternatives to hormone therapy, such as phytopreparations, tibolone, and psychotherapeutic drugs, may also be considered for the relief of climacteric complaints 3.
• Testosterone supplemental therapy may also be beneficial for women after hysterectomy, as it can improve sexual libido and pleasure, and contribute to the prevention of osteoporosis 5.

Risks and Benefits

• The use of hormone therapy after a hysterectomy should be carefully considered, as it may increase the risk of breast cancer and other health problems 3, 2, 6.
• However, estrogen therapy has also been shown to have beneficial effects, such as reducing the risk of cardiovascular disease and osteoporosis, and improving mortality rates 4.
• The decision to use hormone therapy should be based on an individualized assessment of the risks and benefits, and alternative therapies should be considered when possible 2, 6.