Do I Really Need to Take Progesterone After Menopause?

Q: Do I Really Need to Take Progesterone After Menopause?

Hello Ms. <br>Liu： Normally, if there has been no menstruation for over a year and there is no hormone replacement therapy, any subsequent uterine bleeding must be carefully evaluated for the possibility of endometrial hyperplasia or even endometrial malignancy. <br>Although the

Do I need to take progesterone?

Hello Dr.
Huang: I have been menopausal for a year and a half.
Last December, when I wiped after using the restroom, I noticed slight bleeding and a little bit of blood streaks.
The next day, I visited a gynecologist and had an abdominal ultrasound, which showed a 1 cm thick endometrium, a 1.7 cm fibroid in the uterus, and an 1.8 cm cyst on the ovary.
Since I have not had sexual intercourse, a pelvic exam was not performed.
The doctor mentioned that I should still have menstruation and prescribed me progesterone for two weeks (one pill in the morning and one in the evening), suggesting that it would induce a menstrual period.
A few days ago, I experienced intermittent bleeding, and sometimes I felt a dull ache or slight discomfort in my lower abdomen, but it was not severe.
The bleeding increased, especially when I felt discomfort in my lower abdomen.
I called the doctor for advice, and they told me to continue taking the progesterone until my next visit for another ultrasound.
At that follow-up, the endometrial thickness had decreased to 0.4 cm, but the doctor advised me to continue taking progesterone (one pill a day), stating that since I have not had sexual intercourse, the main concern is endometrial hyperplasia, which could lead to endometrial cancer, and that taking progesterone would be beneficial.
They suggested I continue until I reach true menopause.
I would like to ask if it is really necessary for me to continue taking it? It has already been prescribed for a month.
Should I keep taking it? Thank you for your guidance.

Liu Xiaojie, 50~59 year old female. Ask Date: 2020/01/31

Dr. Huang Yiwen reply Obstetrics and Gynecology

Hello Ms.
Liu: Normally, if there has been no menstruation for over a year and there is no hormone replacement therapy, any subsequent uterine bleeding must be carefully evaluated for the possibility of endometrial hyperplasia or even endometrial malignancy.
Although the ultrasound shows that your endometrial thickness has returned to normal after the bleeding, the likelihood of endometrial hyperplasia or malignancy is indeed lower.
Additionally, since you have not engaged in sexual intercourse, there may be some inconvenience if a further endometrial biopsy is required.
Therefore, I recommend that you first have a blood test for CA 125.
It is also acceptable to take progesterone.
In summary, postmenopausal uterine bleeding should not be taken lightly; it requires careful and thorough follow-up and examination.

Reply Date: 2020/01/31

More Info

After menopause, the body undergoes significant hormonal changes, primarily a decrease in estrogen and progesterone levels. The question of whether to take progesterone after menopause, especially in the context of experiencing abnormal bleeding or changes in the uterine lining, is a nuanced one that requires careful consideration of individual health circumstances.

In your case, you have been experiencing some light bleeding and have been prescribed progesterone (in the form of a progestin) to help manage your symptoms. The primary purpose of prescribing progesterone in postmenopausal women is to counteract the effects of estrogen on the endometrium (the lining of the uterus). Without the balancing effect of progesterone, estrogen can lead to endometrial hyperplasia, which is a thickening of the uterine lining that can increase the risk of endometrial cancer.

Given that your doctor has noted a thickened endometrial lining (1 cm) and has prescribed progesterone to help mitigate the risk of hyperplasia, it is important to follow their guidance. The fact that your doctor has advised continuing progesterone until you reach a more definitive postmenopausal state indicates a cautious approach to your reproductive health. The reduction in the thickness of your endometrial lining to 0.4 cm after starting progesterone is a positive sign that the medication is having the desired effect.

It is also worth noting that the presence of a uterine fibroid and an ovarian cyst (the 1.7 cm fibroid and the 1.8 cm cyst) can complicate the clinical picture. While these conditions are often benign, they can contribute to abnormal bleeding patterns. Your doctor’s recommendation to continue progesterone is likely aimed at ensuring that any potential risks associated with these conditions are managed appropriately.

Regarding the duration of progesterone therapy, it is common for healthcare providers to recommend continuing treatment until a woman has been in menopause for a certain period (often defined as 12 months without a menstrual period). This is to ensure that the endometrial lining remains healthy and to prevent any potential complications.

In summary, based on the information provided, it seems prudent to continue taking the prescribed progesterone as directed by your healthcare provider. This medication serves to protect your endometrium from the potential adverse effects of unopposed estrogen, particularly in the context of your recent symptoms and findings. Regular follow-up appointments and ultrasounds will be essential to monitor your condition and make any necessary adjustments to your treatment plan.

If you have concerns about the side effects of progesterone or any other aspects of your treatment, it is important to communicate openly with your healthcare provider. They can provide personalized advice based on your medical history and current health status. Remember, managing postmenopausal symptoms and ensuring reproductive health is a collaborative process between you and your healthcare team.

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