Q & A: Endometriosis/Hysterectomy
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Endometriosis/Hysterectomy

Q:

I had a full hysterectomy because of endometriosis and was put on Climaval 2mg. My symptoms, which were due to endometriosis, returned after several months. I have recently had a laparoscopy to check if the endometriosis was again present, but was told that they could not see any problems. My doctor has changed my medication because I was experiencing hot flushes and a number of other symptoms. He has now put me on Elleste Solo MX80.

The reason I am writing is that I am not sure if the estrogen I am taking is in fact feeding the endometriosis. Would I not be better off taking natural progesterone instead of estrogen? I would be grateful if you could get back to me on this matter. Thank you.

   
A:

With the caveat that I am neither a gynecologist nor a surgeon, I would have some important questions and observations from what happens in the USA.

What are the generic names of the hormone replacements you took? What were your symptoms of endometriosis?

During a normal cycle, estrogen dominates until ovulation. This is when the endometrium grows thicker. If the woman ovulates, progesterone levels begin to rise. Progesterone has two very important effects on the endometrium:

  1. It stops the thickening of the lining of the womb; and
  2. It matures the endometrium so that it is ready to receive the fertilized ovum or be completely, or safely, and with a minimum of pain shed when the period begins.

If only estrogen is present without progesterone, the endometrium, in the uterus and elsewhere, may continue to proliferate. In answer to your question, progesterone seems like a better approach. Adding more estrogen will likely make the endometriosis worse.

It is common for a women to develop thyroiditis or hypothyroidism (which don't always show up on the labs they get). The last statistic I heard for this is about 10-17% for women in their 50s.

The most common thing that happens to a low thyroid woman is PFH (Periods from Hell, my patient explained as she described the ones that are crampy, clotty, heavy, painful, last for 10 or more days.) Too often, the GYNs here don't seem to recognize this simple fact that was written about in 1899, so the poor women either get put on birth control pills, Medroxyprogesterone, or the doc waits until it gets bad enough for her to beg for a hysterectomy and be thankful for the hot flushes.

In any event, these women are often told they have fibroids (if you have a uterus, you'll have fibroids. Most are silent.). Or they have endometriosis (if you have endometrium, it is probably implanted on everything. A lot of women get it, and no pain.) The hysterectomy will be done because of the bad periods. I have asked every women who had that kind of hysterectomy if they tried her on thyroid before surgery. None have said yes. In the USA, about 60% of all women have a hysterectomy by the age of 60.

While I cannot treat via the Internet, I think your idea makes a lot more sense. Natural progesterone doesn't cause endometrial proliferation, and actually limits it. It is also good for bones. I would ask your gynecologist to let you try that. To me, it seems a better way to go.

Don Michael, MD

 

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  Disclaimer: Opinions expressed here are for informational purposes only and do not constitute a physician-patient relationship. The information should not be considered as medical advice or as a substitute for a visit to your healthcare provider. You are strongly encouraged to seek the advice and supervision of a physician or other certified practitioner regarding any medical issue.

 

 

 

 

 

 

 

 

 

 

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Updated 09/29/2010