Why Progesterone Replacement Therapy is Prescribed with Estrogen

If you’re considering hormone therapy for menopause symptoms, you may have noticed that most doctors recommend taking progesterone replacement therapy with estrogen unless you’ve had a hysterectomy. Many people wonder why this is. You might wonder if you really need progesterone to treat menopause symptoms like hot flashes. Let’s talk about why our providers frequently prescribe both progesterone and estrogen for women in menopause.

What is Progesterone Replacement Therapy?

Progesterone replacement therapy may be an important part of your menopause care plan.

Progesterone replacement therapy is just like any other hormone replacement therapy (HRT) in that it supplements and replaces natural levels of a hormone in your body. In this instance, the hormone is progesterone. Like other types of HRT, it comes in many forms and doses. For women who still have their uterus, progesterone is almost always prescribed with estrogen therapies.

What Does Progesterone Do?

Progesterone is a type of sex hormone in your body, like estrogen and testosterone. Many people refer to progesterone as the “pregnancy hormone,” as it’s important for making the uterus a good environment for a fertilized egg. It also does many other things during pregnancy, like helping your breasts get ready to produce breast milk.

However, progesterone has many other functions in the body. Progesterone and estrogen work in tandem to regulate the menstrual cycle before menopause. Estrogen grows the uterine lining (the endometrium) and helps your body get ready for ovulation. Progesterone, on the other hand, helps prepare the uterus to receive a fertilized egg and, if you don’t become pregnant, levels drop and cause you to have your period.

During menopause, both estrogen and progesterone levels drop and become more sporadic. This is what causes irregular periods and other symptoms associated with perimenopause. As you produce less and less, you stop having periods altogether and reach menopause.

Progesterone Replacement Therapy Paired with Estrogen for Menopausal Women

Fluctuating and declining hormone levels are the cause behind menopause symptoms like hot flashes, night sweats, mood changes, and sleep problems. These symptoms can range from bothersome to debilitating for some women. If you experience symptoms that interfere with everyday life, our hormone doctor may recommend starting a hormone replacement therapy regimen to help reduce your symptoms. If you still have your uterus, you will likely need to take both progesterone and estrogen for menopause treatment. This is also known as combination hormone replacement therapy.

Why You Need Both Estrogen and Progesterone if You Still Have Your Uterus

You might be wondering why progesterone replacement therapy is so important if you still have your uterus. The reason is that estrogen alone, while effective for treating many menopause symptoms, can cause the lining of your uterus to become too thick. Before menopause, the uterine lining thickens and then your body sheds it during your period, but this process stops after your last period. The problem is, if the uterine lining becomes too thick, it can increase the risk for endometrial cancer. Therefore, estrogen-only therapy may increase your risk for uterine cancer.

Progesterone comes to the rescue here because it stops the thickening process. This hormone keeps estrogen in balance to reduce the uterine cancer risks associated with estrogen replacement therapy. Therefore, if you still have a uterus, progesterone replacement therapy is essential for reducing risks associated with estrogen-only treatments.

Are There Risks of Estrogen and Progesterone Replacement Therapy?

Like any other medication or treatment, there are risks to taking combination hormone replacement therapy. Specifically, researchers believe that higher progesterone levels can increase the risk for breast cancer. Data from the Women’s Health Initiative suggest that combining progesterone and estrogen can increase a woman’s risk for developing breast cancer by about one-tenth of a percent per year.

While the risk is relatively low, it’s important to weigh this drawback against the potential benefits of combination therapy. Also, many experts suggest not taking progesterone unless needed to reduce risks of uterine cancer from estrogen-only treatments. Though, it’s important to understand that hormone replacement therapy is a really individualized treatment. There is no one approach that fits all women. Therefore, you should talk about your individual circumstances with our providers.

Is Progesterone Replacement Therapy Ever Prescribed On Its Own?

We’ve talked a lot about combining estrogen and progesterone replacement therapy to treat menopause symptoms. However, you might be wondering if progesterone is ever used on its own for menopause. This isn’t a very common treatment plan because most menopause symptoms are due to low estrogen levels. However, some studies have found that progesterone alone can help reduce hot flashes, night sweats, sleep disturbances, and other common symptoms of menopause. Still, estrogen replacement therapy is currently the most effective option for treating these symptoms for menopausal women, which makes it the go-to treatment solution.

Who Doesn’t Need Progesterone Replacement Therapy for Menopause Symptoms?

Not everyone needs to take progesterone with estrogen for hormone replacement therapy. In fact, estrogen alone comes with fewer long-term risks for women who do not have a uterus. In these cases, our providers may recommend estrogen-only therapy because there is no need to worry about the increased risk for endometrial cancer. As we mentioned, the risk of adding progesterone to your treatment regimen is a slightly increased risk for breast cancer. Therefore, if you have had a hysterectomy, typically we recommend estrogen-only options to reduce this risk.

How Does Combination Estrogen and Progesterone Replacement Therapy Work?

If your hormone doctor prescribes combination hormone replacement therapy, this means you will take both estrogen and progesterone to help treat your menopause symptoms. There are a couple of different ways to go about this. One may work better for you than the other. Our doctors can discuss your individual needs and find a treatment plan that works best for you. However, here are some things to know about continuous and cyclical menopausal hormone therapy:

Continuous Combination Hormone Replacement Therapy

Continuous combination hormone therapy means you take both estrogen and progesterone replacement therapy for treatment. This option is where you take both bioidentical hormones every day to reduce symptoms and health risks during menopause. This often makes treatment simpler and easier to use for many people, as the treatment is the same each day. Continuous HRT also reduces or eliminates vaginal bleeding, which can occur with cyclical hormone therapy.

Cyclical HRT

Cyclical hormone therapy looks a little different for everyone, and there are many ways to go about this treatment plan. For instance, some women take estrogen only for a certain period of time, usually about 14 days, then use progesterone and estrogen for about 11 days. For the remaining three to five days, they do not take hormones. The idea is to mimic hormone levels during an average menstrual cycle. However, other women take estrogen every day for several months (usually about three months) and then take progesterone replacement therapy with estrogen for about two weeks or so after that time. Your hormone doctor can help you determine if this type of hormone replacement therapy is right for you.

One of the benefits of cyclical HRT is that it can reduce your exposure to progesterone over time, which may help offset some of the risks associated with progesterone replacement therapy. However, some of the disadvantages include a more complicated treatment plan to remember and maintain, as well as possible menstrual-like bleeding on the days you take progesterone and estrogen together. So, it’s important to discuss the options with our providers and find the option that works best for you.

Get Individualized Care from an Experienced Hormone Doctor at HerKare Women’s Clinics

Our professionals at HerKare are here to help you improve your health and quality of life through personalized treatment plans. We understand the need for individualized care tailored to you and your lifestyle. Our providers work hard to find underlying causes of your symptoms and identify treatment solutions that work well for you. If you’re experiencing menopause symptoms, know that our team is here to help you find relief. Book an appointment today at one of our convenient locations to talk to our doctors about your symptoms and treatment options!