In 2002, a Women’s Health Initiative (WHI) study in menopausal women ages 50-79 showed that combined estrogen/progestin therapy (Prempro) was linked to the increase of blood clots, breast cancer risk, heart disease and stroke. Needless to say, the outcome of this study made women wary to take any hormone replacement therapy. And women stopped taking hormone replacement therapy in droves.
Yet, new information from 2011 and 2012 has shown that hormone replacement therapy may be beneficial, especially estrogen therapy. The newest published study showed that 50,000 women may have died from heart disease unnecessarily over the 11 years since the WHI results were presented. These data showed that women who had a hysterectomy and took estrogen only therapy may have had cardiovascular benefits from estrogen therapy that weren’t seen with the combination hormone therapy (Prempro).
If you’re post-hysterectomy, here’s some information that can help you evaluate estrogen therapy.
What is a hysterectomy?
A hysterectomy is a surgical procedure to remove all or a part of a woman’s uterus. In some cases, the ovaries and cervix are removed as well.
What are the main reasons for getting a hysterectomy?
The problems that may lead to a hysterectomy can include cancer, uterine fibroids, endometriosis, pelvic pain, adenomyosis and irregular vaginal bleeding.
Many of the reasons that women have hysterectomies are caused by hormone imbalance. The root causes of many of the issues that lead to hysterectomies are due to an imbalance between estrogen and progesterone. Too much estrogen, especially relative to the amount of progesterone can cause estrogen dominance. This hormone imbalance can set off abnormal periods, the growth of fibroids, endometriosis and has recently been associated with breast cancer as well.
Before 2002, 90% of women received estrogen to treat hormone symptoms and to prevent osteoporosis and heart disease. Today, only 10% of women use estrogen.
The main reason progestin is added to hormone therapy is to protect the uterus. Once women no longer have a uterus, progestin is no longer needed. When doctors prescribe estrogen for post-hysterectomy women, they typically receive estrogen alone without progestin. Estrogen alone was never proven to be unsafe, but women were scared off the hormone by media reports. What was proven to be unsafe was the combination of estrogen WITH progestin.
In 2011 and 2012 researchers looked more closely at the WHI data and determined that hysterectomized younger women aged 50-59 who were given estrogen only therapy had a decreased risk of breast cancer and heart disease. Estrogen only therapy has been shown to have a lot of other positive health benefits including reduction of Alzheimer’s disease and osteoporosis.
Progesterone or Progestin.
Progestin has long been shown in studies to have negative cardiovascular effects. In fact, progestins cancel out some of the positive effects that estrogens have on cholesterol and other risk factors for heart disease.
Progesterone on the other hand is a whole different story. In a woman’s body estrogen and the hormone progesterone are usually present in a natural balance. Gynecologists, myself included, are taught to prescribe only estrogen once a woman has a hysterectomy, but it may be time to rethink this policy.
Progesterone has benefits that go far beyond the uterus. Progesterone helps our brain function, protects our blood vessels and our hearts and strengthens our bones. In some studies, adding progesterone to estrogen has been shown to decrease the risk of breast cancer.
When women have a hysterectomy they should consider using estrogen, skip the progestin but do add progesterone to best preserve their cardiovascular, brain, breast and bone health.
Estrogen only therapy, when started in women between the ages of 50 and 59, has been shown to have a beneficial effect on the reduction of risk of cardiovascular disease. Women who have had hysterectomies should strongly consider estrogen therapy. Newer studies show that estrogen therapy may be safer in terms of the risks of strokes and clots when it’s prescribed through the skin rather than being taken in a pill form.
The newest frontiers will include the possibility of adding progesterone to estrogen therapy – even in women who have had a hysterectomy. The many benefits of progesterone have been amply demonstrated in the scientific literature and I believe that women who have had hysterectomies should benefit from our latest knowledge.