At a national meeting of the North American Menopause Society I did an interview with Dr. James Liu on the risks and benefits of using estrogen after a hysterectomy. It’s one of many interviews I did in preparation for writing my book, The Estrogen Window. If you’re thinking about taking estrogen after a hysterectomy, or if you’re already taking it, this information will help you!
Dr. Liu is Chair of OB/GYN at the University Hospitals Case Medical Center in Cleveland, Ohio.
Dr. Mache Seibel: Why do women who have had a hysterectomy take estrogen by itself without a progestin or progesterone?
Dr. James Liu: Well, the need for women with a uterus to take a progestin with estrogen is typically done to protect the uterine lining from developing endometrial cancer. Once the uterus is removed and the woman requires estrogen for hot flashes, we no longer need to use progesterone since there is no risk of uterine cancer. There are some benefits of not using progestin in that the woman will not experience the same types of symptoms she gets after ovulation which is associated with progesterone – so there would be less mood changes, less constipation and maybe less issues with water weight gain.
MS: So, she doesn’t need the progestin or any type of progesterone substance, and can take only estrogen. Now, one of the big worries that women have is that estrogen causes breast cancer. I wonder if you could comment on that because it’s the “big elephant in the room” as you called it.
JL: Yes. The randomized clinical trials which involved over 10,700 women and lasted for about seven years, looked at breast cancer as one of its primary endpoints. Those women took either a conjugated equine estrogen (Premarin) alone or a sugar pill. The women that had the estrogen treatment alone after the period of seven years actually had a lower incidence of breast cancer than those who took the sugar pill.
MS: So, the women who took estrogen only, in this case it was a conjugated equine estrogen Premarin, actually had less breast cancer than the women who took the sugar pill.
JL: That’s correct. If for some reason they developed breast cancer as they were taking placebo or the estrogen alone, the downstream effects of getting the breast cancer, the death rates were much lower for those women that had been previously exposed to conjugated equine estrogen versus those that were on placebo.
MS: Just to summarize, if a woman has had a hysterectomy and only needs to take estrogen, particularly in this case it was the conjugated equine estrogen, she has less risk of getting breast cancer than if she took nothing. And if she gets breast cancer, she is at less risk of dying from the breast cancer, than if she didn’t take it.
JL: That’s correct. This is a finding that isn’t well publicized. Unfortunately, the information is buried in a Lancet Oncology journal, and so the news media didn’t pick up on it; clinicians, like your OB/GYN or Family Practice would not necessarily read this typically.
MS: Thank you very much.