 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:
- It stops the thickening of the lining of the womb; and
- 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
For More Information:
|
