Progesterone after hysterectomy: Everything you should know

In a nutshell

Progesterone is one of the main female hormones that is directly linked to your reproductive health. A hysterectomy is a surgery that involves removing the uterus and, depending on the surgery type, other reproductive organs, including one or both ovaries (hysterectomy with oophorectomy). Being a major operation, hysterectomy inevitably leads to certain changes in your body, including hormonal changes. When the ovaries are removed, your progesterone levels can drop significantly as they are the primary organs that produce this hormone. Additionally, progesterone levels may fluctuate even when ovaries are retained due to a disrupted reproductive function.

Although for many years estrogen therapy was the primary treatment for women post-hysterectomy, today, there is growing evidence for taking progesterone after hysterectomy. A combined therapy can provide additional benefits in your cognition, mood, and neurogenesis thanks to the neuroprotective function of progesterone.

Progesterone is one of the primary hormones in the female reproductive system. It plays a significant role in the menstrual cycle, pregnancy, and a range of other physiological processes. Unfortunately, due to a range of conditions and medical interventions, the levels of this hormone can fluctuate, leading to diverse health implications. In this guide, we’ll discuss what happens to your progesterone after hysterectomy and how you should address it.

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What Is Hysterectomy?

A hysterectomy is a surgical procedure during which a surgeon removes the uterus (womb). After the surgery, a woman can no longer have periods or get pregnant, regardless of age.

This surgery is prescribed to females who have issues with their reproductive health. In particular, it might be needed when you have:

• Heavy periods
• Chronic pelvic pain
• Non-cancerous tumours (fibroids)
• Cancer, including ovarian, womb, cervical, or that of the fallopian tubes

The recovery process after a hysterectomy is also long and complex. It can take between 6 and 8 weeks to get back to normal. The exact time can vary depending on the type of surgery and individual factors.

How Does Your Body Change After Hysterectomy?

A hysterectomy is a major surgery that affects the very core of your reproductive health. Respectively, having it can lead to a range of significant changes in your body, such as:

• Permanent cessation of menstruation
• Surgical menopause
• Sexual function suppression (e.g., decreased libido, changes in vaginal lubrication, etc.)
• Bladder and bowel changes
• Changes in body shape and weight distribution

The most significant changes, however, take place in your hormonal system. Although the ovaries are typically preserved during this operation, some females may experience hormonal fluctuations after a hysterectomy due to disrupted reproductive function. Due to this reason, this surgery is not usually recommended for women who already have hormonal conditions, such as PCOS, because their symptoms may remain even after the operation.

Progesterone After Hysterectomy: Understanding Your Hormone Production

Now that you know more about a hysterectomy in general, let’s move on to the main focus of our guide – progesterone after hysterectomy.

So, does your body produce progesterone after a hysterectomy? The answer to this question depends on the type of surgery you had.

There are four types of hysterectomy:

• Total hysterectomy: The most common type, in which both your uterus and cervix are removed, preserving the ovaries.
• Hysterectomy with oophorectomy: Only prescribed to women who have serious gynecological conditions, such as severe endometriosis or cancer, or a high risk of developing one. In this surgery, you have your uterus, ovaries (one or both), and, sometimes, fallopian tubes removed.
• Radical hysterectomy: This is another option for females with cancer. In this operation, the surgeon removes your cervix, uterus, and the top portion of your vagina, as well as the tissues around your cervix.
• Supracervical hysterectomy: Typically used to address noncancerous issues, such as endometriosis or fibroids. In it, you have only your uterus removed, with preservation of the cervix.

As you can see, the majority of surgeries leave your ovaries untouched. This means that your body should continue producing progesterone as usual because this hormone is produced by ruptured follicles after ovulation. That is, if your ovarian function is preserved, your progesterone levels may fluctuate, but it will still be produced.

Yet, there is a case when you will likely have a sudden drop in progesterone after hysterectomy – when one or both of your ovaries have been removed.

Symptoms of Low Progesterone After Hysterectomy

Progesterone is one of the main hormones in the female reproductive system. It plays a huge role in preparing your body for pregnancy and regulating the menstrual cycle. Beyond reproductive support, this hormone also affects a variety of physiological processes in your body, such as immune system modulation, mood stabilization, and bone density regulation.

When the levels of this hormone drop drastically, especially after hysterectomy with ovary removal, this can lead to a range of health implications. The main symptoms that signal low progesterone after hysterectomy can include:

• Hot flashes
• Night sweats
• Vaginal dryness
• Reduced libido
• Sleep issues
• Mood swings
• Bone health issues (e.g., fractures, osteoporosis, etc.)
• Hair thinning/hair loss
• Weight gain
• Bladder issues
• Headaches
• Joint pain
• Brain fog
• Fatigue

If you notice any of these symptoms post-surgery, it’s important to consult with a healthcare provider to test progesterone levels in the medical setting and find treatment options, such as hormone replacement therapy (HRT).

Do You Need Progesterone After Hysterectomy: Assessing the Importance of Treatment

Now that you know about the causes and symptoms of low progesterone after hysterectomy, the next logical question is what you can do to address the hormonal imbalance and whether you actually need progesterone therapy.

So, when do you need progesterone after hysterectomy? For many years, it was thought that there was no need for progesterone treatment post-hysterectomy because there is no uterus, and, respectively, you don’t need this hormone to perform its primary function–thickening the uterus lining after ovulation. For this reason, many women have been prescribed estrogen-only therapy to treat the symptoms of surgical menopause. Nevertheless, now, there is growing evidence for integrating progesterone therapy too. When you have monotherapy, your estrogen is unopposed. This can lead to potential aggravation of certain medical conditions. Interestingly, a combined estrogen-progesterone therapy is mainly used not when your progesterone levels drop drastically (when your ovaries were removed), but when the ovaries are retained. When the ovaries are removed, you enter the surgical menopause, and estrogen is the primary hormone needed to treat its symptoms.

The primary benefits of progesterone after hysterectomy include:

• Better cognition
• Supported neurogenesis
• Emotional health
• Anxiety and depression reduction

While it may not have a significant impact on menopause symptoms, thanks to its neuroprotective effects, progesterone can support the critical central nervous system functions. Additionally, progesterone therapy can help you prevent certain external effects of a hormonal imbalance, such as hair loss.

Side Effects of Taking Progesterone After Hysterectomy

Before deciding whether you need progesterone after hysterectomy or not, it’s also important to consider the downsides. Generally, there are no documented significant side effects of an estrogen-progesterone combined therapy. Still, some women may experience mild side effects of taking progesterone, such as:

• Fatigue
• Mood swings
• Weight gain
• Bloating
• Headaches or migraines
• Changes in libido
• Breast tenderness

Ideally, you should assess all potential benefits and side effects together with your healthcare provider. This will help you find the most appropriate treatment suitable for your specific condition.

FAQ

Does your body produce progesterone after a hysterectomy?

The ovaries are the primary source of progesterone in your body. Depending on the type of hysterectomy you have, you may have your ovaries retained or removed. If they are retained, your body will continue producing this hormone, though its levels may fluctuate. However, if one or both of your ovaries are removed, your progesterone levels will drop significantly.

What are the benefits of progesterone after hysterectomy?

Since there is no uterus post-hysterectomy, the primary function of progesterone–thickening the uterine lining is no longer needed. However, this hormone is known for its neuroprotective effects, which can help support the functions of your central nervous system and thus, lead to better cognition, neurogenesis, and emotional well-being.

When do you need progesterone after hysterectomy?

Although the most pronounced drop in progesterone levels is observed when hysterectomy includes the removal of one or both ovaries, in this case, you will typically be suggested an estrogen-only therapy. This is because progesterone is no longer needed when there is no uterus, and estrogen is the primary hormone needed to treat surgical menopause. However, when your ovaries are retained, you might want to have an estrogen-progesterone combined therapy for added neurological benefits.

Conclusion

As you now know, hysterectomy is a serious surgery that changes the very essence of your reproductive function. The levels of your two primary hormones–estrogen and progesterone after hysterectomy drop significantly. This can lead to a range of healthy implications. Luckily, there are possible treatment options that involve hormonal therapy. 

After reading this guide, you should have a better idea of the deep inner changes that take place post-surgery. You also know about the primary symptoms of low progesterone after hysterectomy to pay attention to for proper early diagnosis. Use this knowledge to support your physical and emotional health after such a major operation. And don’t hesitate to consult with a healthcare professional to find treatment that will work best for you.

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