Is progesterone therapy indicated in a patient with a history of hysterectomy (surgical removal of the uterus)?

From the Guidelines

Progesterone therapy is generally not necessary for patients with a history of hysterectomy who have had their ovaries removed, as estrogen-only therapy is typically sufficient and safer. However, some patients with hysterectomy may still benefit from progesterone for its effects on mood, sleep, or other symptoms. If the ovaries were preserved during hysterectomy (hysterectomy without oophorectomy), the patient will continue to produce progesterone until natural menopause occurs. In these cases, micronized progesterone (100-200mg daily) can be used if necessary, based on the patient's specific symptoms, risk factors, and preferences, with regular follow-up to assess effectiveness and adjust dosing as needed 1.

Key Considerations

• The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women, as well as the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy 1.
• Estrogen-only therapy is typically sufficient and safer for patients with a history of hysterectomy who have had their ovaries removed.
• Progesterone therapy should be individualized based on the patient's specific symptoms, risk factors, and preferences.
• Regular follow-up is necessary to assess effectiveness and adjust dosing as needed.

Treatment Options

• Estrogen-only therapy: oral estradiol (0.5-1mg daily), estradiol patches (0.025-0.1mg/day), or estradiol gel (0.25-1g daily).
• Micronized progesterone (100-200mg daily) for patients who may still benefit from progesterone for its effects on mood, sleep, or other symptoms.

From the Research

Progesterone in Patients with a History of Hysterectomy

• The use of progesterone in patients with a history of hysterectomy is not necessary for endometrial protection, as the uterus has been removed 2, 3.
• Estrogen therapy alone is often recommended for these patients, as it has been shown to have a favorable benefit/risk balance and may even provide cardiovascular protection 2, 3.
• The addition of a progestogen to estrogen therapy may increase the risk of breast cancer and is not necessary for most patients who have undergone a hysterectomy 3.
• However, in some cases, a progestogen may be added to reduce the risk of unopposed estrogen-dependent conditions, such as endometriosis or endometrial neoplasia 3.
• For women who have undergone a bilateral oophorectomy, hormone replacement therapy (HRT) is often necessary to manage menopausal symptoms and prevent long-term health consequences, such as osteoporosis and cardiovascular disease 4, 5.
• In these cases, estrogen therapy alone or in combination with a progestogen may be recommended, depending on the individual patient's needs and medical history 4, 5.
• It is essential to note that the decision to use HRT in women with a history of hysterectomy should be made on an individual basis, taking into account the patient's unique medical history, symptoms, and risk factors 3, 4, 5.