Hyperplasia

by Cathy
(Canada)

3 years ago I was diagnosed with simple and complex hyperplasia without atypia. Dr. put me on Provera which I suffered through for 18 months until I quit cold turkey. Went to a naturopath who had me on supplements and things were not too bad until this past April when I started on a two month period of heavy bleeding and clots and ended up extremely anaemic.

Had an ultrasound while still bleeding and showed thickness of 1.4cm. Went to an integrative MD who put me on 75mg progesterone cream twice daily and bleeding stopped within 48 hours. Have since had one period which was heavy but without clots and lasted a more manageable six days. Had an ultrasound last week and lining in now 6mm but gynecologist still recommends hysteroscopy and D&C.This has me really nervous.

Is it necessary? Does the fact that the cream stopped the bleeding indicate a benign process of hormone imbalance which can be corrected with continued use of progesterone? Any thoughts to put my mind at ease would be most appreciated. Thanks.

Comments for Hyperplasia

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Aug 04, 2011
Hyperplasia
by: Wray

Hi Cathy Your integrative MD knows what he's doing, stick with him and not the Obgyn! Oestrogen is a mitogen, it stimulates cells to grow. Vital in stimulating the endometrium each month to grow and thicken ready for a possible fertilised egg. But in excess it stimulates cells to continue growing. MMP?s are enzymes that break down protein. They play a role in the breakdown of endometrial tissues at the end of the menstrual cycle. If they are over active, as would be the case with excess oestrogen in the body, as oestrogen stimulates their production, the result is a pathological reaction. A high level of MMP's can lead to inflammation and excessive bleeding in the uterus. If a low level of progesterone is present, and a high level of oestrogen, the lining will continue to grow. With a high level of MMP's the lining will also continue to break down. Progesterone suppresses both MMP's and oestrogen. The amount you were given was good, although I generally recommended 400mg/day and over, especially if the bleeding is heavy and continual. I'm taking a guess you are now in Peri-menopause when our cycles become erratic, varying from very light to flooding, often with clots. This is normal and certainly doesn't warrant a hyst! For more info see this excellent website here. Please have a vitamin D test done, you live in Canada where levels are often very low, see here, here, here and here. It's essential for the normal functioning of our reproductive system, and much more. Please see the Vitamin D Council, GrassrootsHealth and Birmingham Hospital websites for more info. Take care Wray

Aug 05, 2011
Hyperplasia
by: Cathy

Faye, thank you so very much for taking the time to respond. Yes, I am perimenopause at 51 years of age. I have been under a terrible amount of chronic stress for years. My husband has MS, my daughter has a thyroid nodule (which I'm desperate to avoid surgery for-any ideas?) and my 80 year old mother has suffered from severe depression for the past three years. The last thing I needed is for my own health to decline. Since I first posted, I started to have a brown discharge 3 days after the gyn's ultrasound which showed the 6 mm lining. It lasted a couple of days then turned into a full bleed which is still ongoing 9 days later. Would you expect this on progesterone? Should I ask for an increased dose? Sorry for all the questions but I'm just about at the end of my rope with everything that's going on around me. Thanks!

Sep 15, 2013
how to keep dose level with natural progesterone pills
by: Judy

I commented earlier but could not find it. But, at 300mg natural compounded progesterone I am having bleeding breaking through after a couple of weeks on it. From reading here I should ask the integrative doc to go to 400mg. But how do I keep 400mg level all day if I take the pill at 10pm at night. Is taking once a day enough if the dosage is correct? I am doing this to stop the endometrial hyperplasia once and for all. I really do not want the hysterectomy. I am 62.
Once I get a total stop in the bleeding with not spotting or anything. Is it safe to say on 400mg for 6 months, stop for a month and the gyn would do a biopsy again. My D & C showed it wasn't the precancer kind. I do get nausea unfortunately and although I have some good days, I can't predict a nausea day.
Thanks for reading and look forward to your thoughts. Hoping to see the integrative guy early this week.

Sep 18, 2013
how to keep dose level with natural progesterone pills
by: Wray

Hi Judy Progesterone should be used a minimum of twice a day as levels begin dropping after about 13 hours. Oral progesterone is the least effective Delivery system, "The liver and gut region removed a mean of 96 per cent of the progesterone entering these tissues", see here. It means you are getting no more than 30mg/day, if that. This will not stop any hyperplasia or bleeding. It needs to be 400mg/day in a form that is absorbed well, i.e. injections, suppositories or a cream. Progesterone alone won't be enough either, you need to take NAC, taurine, vitamin D and the bioflavonoids. There's more about these on our Menstruation page. I suspect your vitamin D is too low, please have a test done. I'm not sure if you're in Peri-menopause or Menopause? But it's safe to use progesterone daily, particularly if bleeding is erratic and you normally have none. I haven't found it takes as long as 6 months to correct the hyperplasia, but 400mg/day is safe for that long. Some women are using far higher for over a year, see here, here, here and here. There's no need to stop using the progesterone for a biopsy, in fact I wouldn't advise it, as symptoms can come back. The nausea could be caused by excess oestrogen, which is what happens when we fall pregnant. Or it could be your blood glucose is dropping too low. Take care Wray

Sep 22, 2013
hyperplasia follow up
by: Judy

Wray,
Thanks for answering. No e so I didn't realize it was there and was searching again and found it
I called the integrative doc and now I am doing 300mg oral at 10pm and 150mg back up at 10am. That has stopped the bleeding, no hint of pink or anything, for three days now.Even though I understand the pills are not the best delivery system. I am taking 10K Vit D3 each day.Have been as low as 22 but now am at 45 or so. I have only seen him twice and it wasn't til I phoned & asked him what the Thyroid level was since he said sluggish that he said TSH was 6. Usually it is much lower so surprised he didn't ask me more about what I was used to seeing. I feel I got into this condition due to huge stress period of time which dropped thyroid levels and progesterone. So I did up the Thyroid med same time as upping progesterone and so far so good. Will it damage my liver if I stay on the pills at the 450 in the two doses? If the 450mg keeps the bleeding from happening does this mean the endometrial layer will not build up at all? And how do I back off the dose? And can I get all the way back off with no bleeding? That is the goal right? If my thyroid levels are ok and I can try to work on not internalizing the stress. Can I get back to normal menopause with no hormone supplementing? Umm, I had a late menopause..just turned 58 when it stopped completely. Three normal years except for the raging stress thing. Then break through bleeding, spotting for a year and , heavy bleeding started in June. Have been on a roller coaster and want off!! Oh, on this high dose I am pretty tired all the time with a few hours of feeling normal and with energy as I approach the next dose. Will that go away or only if I back off the dose slowly? I know I am all over the place here. If I stay at 450mg, don't bleed for 6 months. Can I back off over a couple of months with no return to bleeding? I sure appreciate your wisdom here as I've been very lost about it trying to research and feel I have to be on top of it with the integrative guy I am seeing.

Sep 22, 2013
hyperplasia, another query
by: Judy

Oh , I just reread and notice you said that it doesn't take as long as 6 months to correct hyperplasia. What would you expect in my situation? Stay at 450 for 3 months. Back off by how much per month? What happens if the bleeding starts up as I back off? How do I keep the progesterone above the estrogen to keep from being estrogen dominant?

Sorry for second response. As you can see my mind is spinning for over thinking and lack of real collaboration with any one so far.

Sep 22, 2013
hyperplasia -oral vs cream
by: Judy

Wray;

If my body responds to the 300mg oral natural compounded progesterone at night plus another 150mg oral 12 hrs later. And , that means I am only getting say 45mg between the two doses after the gut loss. Does that mean if I used the cream progesterone, I could use as little as 45mg of the cream during a 24 hr period and stop the hyperplasia just the same? I would love to use less and have it work and not overwork my liver. And how would it work, apply it twice a day or three times a day?

If you are using progesterone to stop hyperplasia and bleeding, and while on a certain dose the bleeding kicks in again. Is it better to let it bleed for a couple of days whether light or heavy on the dose you are one, then go ahead and up it to stop.

How much NAC, Taurine, and Biflavonoids? Vit D pretty sure you'd want 10KIU per day.

Forgive another query on this subject. Appreciate you listening.

Sep 27, 2013
hyperplasia follow up
by: Wray

Hi Judy I do agree about not taxing the liver by taking all that progesterone. I'm delighted it's actually stopped the bleeding though. But oral progesterone does make one tired, in fact doctors often give it to help with sleep. I always recommend 400mg/day to stop bleeding, which is usually does in a few days. But that's in a cream or suppository form, not oral. Then to begin reducing very slowly, by 16-33mg per day. You can by all means stop the progesterone once you've reduced it, but it is good for ageing, see here, here, here, here and here. The page on menstruation gives details of how much of the nutrients to take, and why they work. Take care Wray

Sep 28, 2013
Hyperplasia-supplement dosage queries-continued
by: Anonymous

Wray,
I am in a quandary now. For about 8 or 9 days the 300mg oral at 10pm with 150mg at 10am stopped the bleeding cold. Yesterday around 8am I had some thin brownish show briefly and the rest of the day nothing. Today same thing only more show at around 8am..seems to have stopped but the day is young. Also picked up slight am nausea. The integrative med guy I am seeing seems to like the oral but offered cream for the am dose so I would not be so sleepy. Figured I'd hang in since it stopped. But, now the show. First he put me on 150 mg a day and at first it seemed to help and two days of no show then increase again. With 300mg same thing only a bit longer. Split 450mg held for over a week and now show. I know once it starts it will be more each day. So do I yet again up the dose? Take it 3 times a day instead of two? Should I let whatever bleeding is happening go for a week and stay on the same level of progesterone? Then up it or change form. The last week I have had nights with some hot flash activity..that means estrogen is definitely suppressed, right? We also upped my thyroid meds when the p dose was upped to 450 for the day.

Also, he has given me vit c and vit d and efa's and a multi vitamin to take. The multi does have some cruciferous veggies in it. Also he wants me to take DIM to better channel the estrogen but I have yet to take it fearing its effect on the thyroid. I read your notes on taurine, nac, and bioflavonoids. Curious why the bioflavonoids and not the Vit C? My integrative med guy seems to love vitamin C therapy. If I tried those things along with keeping up with the D, that would keep bleeding stopped better than what I am doing?

Why am I having any color of showing at all on the dose I am on. It baffles me that the progesterone isn't higher than the estrogen. Or is it that I need to let lining shed. I am afraid to let the big bleeding start up. I was hoping to correct the hyperplasia and get back to feeling normal. You can't back off the dose unless you've had at least 3 months of no showing at all right? I don't fully understand the process or if I am doing well.

All you answers have been appreciated and I am learning from them. Sorry for having so many questions, I just wish I understood better if I am on the right track.

Sep 28, 2013
hyperplasia-couple more questions
by: Judy

Wray;

When you say 400mg per day with cream or suppositories...do you mean a total of 400...as putting on cream of 100mg 4 x per day? Or 400 with each application? The oral I am 300 then 12 hs later 150. And, how much loss is in the cream application method. I know oral it is quite a bit.

Also on my last comment I'd asked about the supplements and I see you gave me a link with answers. Mainly, it will help stop bleeding?

Just why am I breaking through. Darn!

Sep 28, 2013
breakthrough bleeding-what does it mean for endometrial buildup
by: Judy

Wray;

Apologize for repeated questions!!

One of my fears as I go through this process of correcting the hyperplasia is that each time I get the break through bleeding while on the high dose progesterone, I worry that the endometrial buildup will change from the non cancerous kind to precancerous or cancerous. Is this a concern if my hyperplasia and the fibroid activity is thus far without atypia. The gyn's plan was to put me on 40mg Megesterol (sp?) for 6 months, go off and then re-biopsy the growth. My assumption is that if you don't bleed for 6 months then there won't be regrowth.

Per prior entries I felt safer going with natural progesterone and found the integrative med guy.

So do I worry about the bleed or showing activity being a bad sign or just make adjustments in the progesterone dose?

Sep 28, 2013
how to dose progesterone cream for 400mg per day
by: Judy

Wray;

Its Judy again. After the great results for 9 days or so the bleeding is picking back up. (300mg pill at 10pm and 150mg pill at 10am). Thinking of asking the doc to let me try progesterone cream three times a day..every 8 hrs. How does that work? If I want say 450mg like I am doing with the pills..then put 150mg of cream on each time? Or maybe just do 400mg because the 450 I am taking now has so much lost?
Can I presume the local compounding pharmacy does the right kind of cream? I understand there are differences that matter of having progesterone or having things that your body converts to progesterone with the former being the better.
I am feeling so disturbed that I won't be able to solve this hyperplasia and get my old menopause back??

Sep 29, 2013
Hyperplasia-supplement dosage queries-continued
by: Wray

Hi Judy Stop using the oral and use a cream, you are getting very little progesterone via oral dosing. Please take the NAC, taurine, vitamin D and the bioflavonoids. The bioflavonoids work to strengthen capillaries, maybe the vitamin C will help, but I've not seen a paper on it and uterine bleeding/hyperplasia. Vitamin C should be taken with the bioflavonoids too, it boosts it's effect. Why did he up your thyroid meds because of upping the progesterone? This helps speed metabolism, so you should be able to reduce the meds. A lack of vitamin D adversely affects the thyroid, and yours was low. Please switch to a cream, 400mg/day plus take all those nutrients too. Take care Wray

Sep 29, 2013
how to dose progesterone cream for 400mg per day
by: Wray

Hi Judy I saw this after I'd posted my other reply. But my answer is the same, use a cream! When I say 400mg/day I mean 400mg/day, not each application. It should always be used a minimum of twice a day, levels begin dropping after 13 hours. I've no idea if your compounding pharmacy makes a good cream. They usually don't bother about natural or organic ingredients, if you're happy with that then go ahead. The cream needs to be very thin for the progesterone to absorb well, too thick and it doesn't. Most of the progesterone is absorbed via the skin, take a look at the Saliva Tests we run. You'll notice from a low of ±20pg/ml it goes to nearly 3000pg/ml and over in a month. Progesterone has been used successfully for Cancer. It will not cause it unless too little is used when all it does is stimulate oestrogen, see here. Avoid all offers of Contraceptives! Take care Wray

Sep 29, 2013
hyperplasia dosage follow up
by: Judy

Wray;

Having miseries today. Last night strong hot flashes and some today too with the lower pill.
For 400mg with the cream...twice a day I'd put on 200mg each application? Or is it better to divide by 3 and do it every 8 hours?

Upped thyroid because the tsh was 6 high for me just happened it was done at the same time as upping the progesterone due to break through bleeding.

Now I do feel heart palpitaty and nervous and very sleepy along with flashes. Some showing but minor at present. I presume I am having symptoms of estrogen dominance and shouldn't ride it out but rather up dose and use cream.

I am listening to what you are saying just need some support around here I think. I am hoping the compounding pharmacy will be ok since I want to stay local.

Thanks,
Judy

Sep 30, 2013
hyperplasia dosage follow up
by: Wray

Hi Judy The gut is very long and very complicated. Ranging from neutral, to extremely acid, to alkaline along it's length. Who knows what this does to a hormone travelling through. Maybe more gets destroyed than usual, or on other days less. This would cause fluctuating levels of progesterone, and no way of controlling it. I've found with hot flushes it's best to apply the cream every hour if need be. Or whenever it feels like one is starting up, but with a minimum of twice a day. I would always advocate using more progesterone if symptoms get out of hand, I can't see any point in suffering needlessly. But you don't really need more than 400mg/day, possibly 500mg, what you do need is to get all the progesterone, not the small amount you are now. Oral progesterone can make one sleepy, in fact doctors often give it for insomnia. In which case it's best taken at night only. I hope the compounder can help with a cream. Take care Wray

Jun 15, 2014
(GCT) A Follow Up for You on My Hyperplasia Cause
by: Judy

Dear Wray,

You very kindly answered questions I had about high dose progesterone therapy. So, I thought I'd write and let you and any readers know how my situation turned out.

Originally I presented with abnormal uterine bleeding which biopsy showed to be endometrial hyperplasia without atypia. After D & C I followed a high dose natural progesterone regimen. I did have a cervical polyp removed and had a fibroid with a broad base which was not removed. I believe the integrative doc I went to for the natural progesterone handled my case a bit sloppily and he upped my thyroid meds after I was weeks into the therapy. I believe that was the cause of the rather impressive heart palps I had which in the end spelled the end of the progesterone therapy. This was after I switched from pills to cream.

I never understood I was looking at two kinds of bleeding after the D & C. During progesterone therapy no lining built up at all, it was a nicked fibroid that bled. After progesterone therapy was stopped (after 8 weeks on it), the lining went from 0 to 5cm in 4 weeks and menstrual type bleeding resumed. Fibroid bleeding was bright red and like a vessel bleeding, not menstrual looking. So the progesterone did work, I just didn't realize it with all the other bleeding.

In the end, my new gyn could not explain why I was so estrogen dominant and why so much lining. She thought something was missed and recommended hysterectomy. I took her unease seriously and sought out a gyn/onc for a 2nd opinion. Long and short, he agreed and I had a daVinci robotic complete hysterectomy. The bleeding never stopped leading up to it and I felt increasingly estrogen dominant.

In my case I could easily see why estrogen would be up because with hypothyroid folks like me, progesterone is down and I felt that my adrenals were not putting out their part of the hormone balance due to stress. But, I did know that cysts on the ovary can stimulate estrogen production. I had three ultrasounds and asked everyone if the ovaries were ok...it was yes, yes, yes.

The labs done after the hysterectomy revealed that the real cause of my estrogen dominance was a granulosa cell tumor in one of the ovaries.

So I just wanted to put out that sometimes if a woman is presenting with endometrial hyperplasia especially with strange estrogen dominant symptoms to be sure and check for granulosa along with other things. I do not know if an MRI would have shown it or not. I do not know if doing the inhibin A and B bloodwork would have shown the presence of the tumor. Mine was found on post surgical dissection of the ovary. Granulosa is not the commonest of ovarian tumors and so maybe doctors don't instinctively look. But, granulosas do crank out the estrogen; its what granulosa cells do to mature the eggs cells.

With all the confusion with the fibroid bleeding, at least I finally did realize that the progesterone therapy did stop the build up of lining. And, I am sure when the problem is being out of balance due to factors like thyroid or adrenal problems or poor dietary practices causing estrogen dominance ( I learned a lot trying to fix myself) that progesterone therapy is a very effective treatment.

Good luck and good health to everyone! And Thank you Wray for taking the time to answer my previous questions and for all the knowledge you share here on your site.

Judy



May 31, 2015
how are you doing post hysterectomy
by: hannah

hi, I ve been diagnosed w complex hyperplasia WITHOUT atypia focal glandular crowding abnormal endometrial proliferation at 6 monthly interval biopsies the past couple years. history of v heavy prolonged bleeding since I turned 40 (turning 46 soon). gained a ton of weight the past few years and am at least 30 - 40 pounds overweight. don't like what ''ve seen in my own research as well as observations about oral or topical or local progesterone use , don't know if herbal solutions are only going to postpone trouble and not sure if I have patience for any more considering the last cycle was the most horrendous I've ever had..I am seriously considering elective hysterectomy as a definitive although not happy solution. two questions i'd be grateful for your input : ovaries in or out ( my ultrasound shows no cysts or fibroids an uterus not enlarged) there seem to be enough arguments for both sides 2. how are you doing mentally physically emotionally post hysterectomy? are you thrilled with life after? Or regretting it? Thanks so much.

Nov 29, 2015
Eendometrial hyperplasia & Progesterone
by: Lyngal

I am postmenopause and recently starting spotting a tiny bit. An ultra-sound showed the uterine lining measured at 7mm. I started using Dr. John R. Lee's ProgesterAll to try to get the lining thinned out. My gyno agreed to try it for 3 months then get another ultra-sound. My question is, would the ProgesterAll have any affect after only 3 months or would it take longer?

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