Hormone Therapy Hint: Progesterone Protects the Uterus from Estrogen

Endocervical Polyp

In perimenoapsue and menopause taking estrogen can cause wide ranging side effects. However, the effects on the lining of the uterus is not one of the benefits. Estrogen can cause bleeding, spotting, polyps, precancer and even lining cancer of the uterus. Whether these things will occur will depend on many factors, including lifestyle, prior therapy, your diet, and your genetics. But we know that for the uterus the treatment with estrogen alone increases the risk of endometrial hyperplasia (lining thickening) and endometrial carcinoma (uterine lining cancer) by many times. In some studies the risks of thickening were doubled and the risk of lining cancers rose from 1/000 to 1/1000.  And further good news is that cancers which appear this way seem to be more treatable and less aggressive.But there is a way to avoid this side effect.  There is a protected effect of progesterone therapy. Exactly the type and timing of the progesterone therapy would be up to your gyno, and many factors have to be considered. Even the progesterone IUDs may work for some women's endometrial protection, so if you have one as you enter menopause, you may be covered. Months of estrogen therapy is less likely to produce harm than years, and thus a period of adjustment with one hormone verses the double hormone is possible.  There really is no other menopausal benefit to progesterone therapy, it is only used for this lining protection, and women without a uterus have no need for the progesterone therapy. Many studies show progesterone therapy with the estrogen is what raises the breast cancer risk, so there is a lot to gab about with your gyno, but generally this 'unopposed' estrogen therapy (estrogen with no progesterone) is not recommended. A polyp hanging out of your cervix may be from the cervix, or actually from the lining of the uterus. Endocervical polyps are not likely to be an effect of estrogen, usually the estrogen causes lining polyps which wouldn't be seen on an exam, but require an ultrasound to be seen. Cone in to discuss with your gyno if you still have questions.

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