Progesterone and Simple Hyperplasia w/ no atypia

by Sharon
(Sydney, Australia)

Hi Wray, back in 2003 I had an endometrial polyp. It was removed. No big deal. In 2006, I knew from the symptoms of heavy clotting and bleeding that I had another one, but upon ultrasound, the lab couldn't find anything.

Flash forward to 2010. Period that continued for 2 weeks and got so heavy that I was filling a super tampon every 45 minutes. I ended up in emergency, where they prescribed ridiculous doses of norethisterone to control the bleeding until they could get in to do an ultrasound.

Sure enough, the ultrasound revealed a 2cm polyp, which I'm sure had been in there since 2006. When they went to take it out, they found behind it a "polyp wall" with 10 smaller polyps. Biopsy revealed endometrial hyperplasia without atypia. For this, they leave you on synthetic progesterone for 3 months and then go back in to see if the hyperplasia has cleared.

In the interim, I have consulted with a GP involved in natural therapies and a women's health naturopath. Testing has revealed estrogen dominance, insulin resistance, vit D deficiency and iodine deficiency. I assume I am a bit hypothyroid, even though the tests for that came back normal. All these causes made sense when I stopped to consider that both my mother and her mother have now had post menopausal breast cancer that was estrogen positive, probably brought on by estrogen dominance. My whole family also suffers from one form or another of high blood sugar: some having type 2 diabetes.

I have cut out refined sugar and bad carbs and have been loosely following the rules of leptin resistance dieting and have lost about 16 lbs. As a result, I wasn't fat to begin with, but all the weight has come off my mid section. Of course, I'm also taking vit d sups, iodine sups and iron for the anemia from all the bleeding. I'm feeling much better.

I have the follow up biopsy today (nervous), and my surgeon is trying to tell me that if they find hyperplasia again, it will require either hysterectomy or mirena iud. Of course, I disagree. It has taken a full 15mg /day of norethisterone to control bleeding/spotting over the past 3 months, which is quite a lot.

Over the next few days, I will be stopping the synthetic progestin and starting on a natural cream, despite my surgeon's insistence that I need the iud.

I am just a little confused by the info out there as to what dose and frequency I should be on to control endometrial overgrowth. My doc wanted to put me on 75mg troche which I rejected in favor of cream. I live in Australia, and it's a little harder here to get reliable, accurate info from the medical community. Even harder to get any support in regard to natural progesterone.

I have observed that over the past 3 months on the progestogen I have been getting spotting/bleeding the first week of each month, which matches with my cycles prior to all this happening. I am 42, but given evidence of cycles, my guess is that I'm not actually particularly perimenopausal.

So I'm trying to figure out if I should only be taking the progesterone cream from days 14 to 28 or some other method. Also, I had a bad adjustment period when going on the norethisterone. When I change dosage abruptly I tend to get very bad estrogen dominance symptoms, so I am trying to figure the best way to transition from synthetic to natural.

I read somewhere that starting with large doses of progesterone will get you over the estrogen receptor stimulation faster, so I am planning 100mg / day, but now wondering if that's too much?

If you or anyone has any thoughts on the matter I'd love to hear them. My docs are good but I can't help feeling their info is a bit out of date.

Comments for Progesterone and Simple Hyperplasia w/ no atypia

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Dec 01, 2010
by: Anonymous

I can tell you that I use 100 mg of natural progesterone cream per day and have been using that amount for over a year now. If I lower the amount I still have hot flashes.

I know that Wray always suggests 100 - 200 mg of progesterone daily.

I wish you great luck in your journey.

Dec 04, 2010
Progesterone and Simple Hyperplasia w/ no atypia
by: Wray

Hi Sharon Progesterone does stop heavy, continual bleeding, but the amount needed is 400-600mg/day. 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. It also prevents hyperplasia and cancer, please see our page on Cancer and progesterone. It is essential to use a high amount of progesterone, between 400-600mg/day. If the bleeding is continual, use it both daily and hourly. Using it hourly keeps the level high throughout the day. If there is a cycle, it?s best to ignore it and use the progesterone daily, hourly too, until the bleeding is under control. The progesterone can be used to regulate the cycle once bleeding has stopped, see How to use progesterone cream. It doesn't surprise me you have low vitamin D levels, over 50% of us have. But particularly in Australia with their daft recommendation to cover up when in the sun and use suncreens. The sun is vital for making vitamin D, a low level reduces the benefits of progesterone, parathyroid hormone increases, slowing the thyroid down, both insulin resistance and diabetes occur. It seems your whole family need to get tested, please see the Vitamin D council website for more info. We should be taking a minimum of 5000iu's per day, more if severely deficient. The IUD will fill you full of progestins, suppressing ovulation, so no progesterone will be made. I'm pleased you're resisting it! I don't believe troches are a good delivery system, it seems they are used extensively in Australia. See this page we have for more info on Progesterone application methods. Please read our page on Oestrogen Dominance too. Take care Wray

Dec 06, 2010
by: Wray

Hi there Thanks for the words of encouragement! It's not an easy journey, especially if you can't find a health practitioner to help you. Take care Wray

Sep 16, 2013
Natural progesterone thoughts
by: Debbie

Hi Sharon , I too live in oz and have just been diagnosed with hyperplasia . I am wondering if natural progesterone has been successfully for you . Thank you

Feb 29, 2016
Follwing up after far too long!
by: Sharon

Hi all.

This is Sharon, the original poster.

It has been a long while since I've been on this page. I ran across my own post again only because, after 6 great years of relief from the whole hyperplasia thing, I am having problems again.

However, I wanted to mention that I tried the natural cream at high doses, as recommended, and all that resulted was very incosistent application of the progesterone, although I was applying it evenly at even intervals. I was getting migraines again, and knew heavy bleeding was not far behind.

In the end, I decided to try the Mirena IUD, since I could always have it taken out again if it caused problems.

Well, lo and behold... Within a mere 2 hours of it being placed, some longstanding problems I had had since I got my period when I was 14 were under control! As the weeks went on, everything was improving!

My whole life, since puberty, I had had migraines, heavy bleeding, mood swings, and horrible PMS. The Mirena IUD got rid of all of these completely and in mere hours, for the first few, such as moods and migraines. It was ASTOUNDING.

Not only that, but I had always heard that the Mirena made women GAIN a LOT of weight. The opposite happened for me. I LOST a lot of weight, my hair began to grow better and thicker. For the first time in my life, I didn't have to worry about leakage and heavy, long periods. They were a non-issue. And... NO MORE MIGRAINES!

I feel compelled to mention this, because the Mirena pretty much ONLY gets a bad rap online, and my experience was the EXACT opposite... ALL good. I suspect I was SO high in oestrogen that it set me back to some sort of "normal". I think with most women it overloads their system with too much synthetic progesterone, which is probably nearly as bad as too much oestrogen, and certainly uncomfortable at the very least.

I had the first IUD for 3 years. During this time, my marriage broke down. I went to see my gyno, because I was heading back to the US, home of expensive and questionable healthcare. Her firsthand experience with the IUD for hyperplasia is what led me to get it in the first place. Her firsthand experience of the results was that she had 2 other patients around my age (mid-40s), and after 3 years, the IUD no longer protected them and the hyperplasia was back… so being at the 3 year mark myself, she wanted to change it and make sure the hyperplasia was at bay, via a fresh dose of progestins in the IUD. It was, and I got a brand new IUD to replace the first.

This is where the story starts to go downhill. About 2 or 3 months after the second one was placed, I began to get hip pain in my right hip. This came and went, and it aligned with a time when I started waterskiing again, so I figured it was just from that, and didn’t think much of it, although somewhere deep inside, I had an inkling it had something to do with the IUD. But the thing saved me from so much BAD, that I was trying to ignore that relationship for as long as possible.

Flash forward to this month, February 2016. Acute condition affecting my right hip, my other hip and my lower back. I’m almost 48 years old. Looking at it, it looks like a lower back episode.. which it is. But delving a little further, what is the CAUSE? Judging from the dozens of similar examples online, I am guessing the IUD and am considering having it removed.

Coinciding with this is a sudden weight gain, as well as my vision becoming a bit worse, and some joint pain and periodic swelling of extremities (not severe, and no it’s not a heart thing). I am guessing my natural oestrogen production is waning, and that the synthetic hormone is starting to do what it does to so many.
I have come back here today because I need to figure out my next step. Bioidentical progesterone cream use is much more prevalent in the US than in Australia, so I might be in luck there. But if I weigh some back pain (I have a high pain threshold, so I’ve only taken ibuprofen for it twice in 1 month, it’s not unbearable… it is the PROGRESSION of symptoms such as this and possible autoimmune or thyroid conditions that scares me) against massive bleeding episodes, migraines and possible cancer and thus ultimate hysterectomy, if the bioidentical stuff doesn’t work… I’m tempted to put up with the back pain.

I have absolutely NO REGRETS about getting the IUD. It gave me COMPLETE relief for 6 years from cancer, migraines, bleeding and bad moods. I would not trade those 6 years for all the progesterone cream in the world. If I had it to do over again, the only thing I would do differently is not hesitate to get the IUD in the first place, and save myself the stress of suffering and wondering, until I did.

If you are very high in estrogen, I would recommend trying the IUD and using it for what it is worth, until your body rejects it, and then reevaluate. You may have an experience like mine, or you may know immediately it is not for you, in which case, you can have it removed.. or even remove it yourself… it’s apparently pretty easy to do.

Now, if anyone has any advice on the next great move, please let me know. Oh, and take at least 5000IU of Vitamin D3, and throw some magnesium in with that. It helps immensely and has been proven to decrease the incidence of endometrial cancers by quite a large margin. I’m about to switch to vitamin D3 cream because the pills have been successful, but are starting to bother my digestion.

If you’ve had experiences with either the cream or the Mirena, I would LOVE to hear them. Chime in!

Mar 25, 2016
Fellow aussie using bio identical cream
by: Gaye

Hi Sharon,

I am an Aussie too, 47 years old and just embarking on my journey with bio-identical progesterone cream prescribed by a holistic GP and obtained from a compounding pharmacy.

For the past year I have been bleeding erratically....periods going from spotting to light to heavy and back to spotting again....sometimes for weeks on end or with only a week's break in between.

I am currently waiting for ultrasound, blood, and saliva test results and am on the public waiting list for an endometrial ablation. Last year I had a hysteroscopy (which showed nothing except a thickened endometrium) and they wanted to give me a mirena IUD but after doing my research I said no. I get anxious at the best of times and I would worry too much about the things that could go wrong with it while it was in me. An ablation is apparently highly effective and will last for up to 5 should be long enough to see me through menopause.

In the meantime I am trying the bio identical cream to try and reduce the eostrogen doctor has prescribed 1g of 5% cream nightly.

Only started it on the 8th March...stopped it 7 days later because a normal period came and resumed on day 6 as per instructions however I am having spotting and light bleeding again already!! Apparently it can take a few cycles to take effect so I'm willing to try.

Hope you've had some success?


Mar 27, 2016
Following up again
by: Sharon

Hi Gaye.

Just following up again since you asked.

I had my hip pain investigated, which turned out to be lower back degeneration of a very normal kind.

After one visit to a chiropractor and one visit to a physical therapist, the back pain is completely gone and life resumes as normal.

I also had my gyn check out the IUD placement via ultrasound, and everything looks normal. I decided sometimes a back ache is just a back ache.

You know, you hear a lot of bad things online about a lot of these treatments. Ablation was a consideration for me also, at the beginning of this journey. Both the IUD and ablation get some pretty bad press online.

My doctor, who works for one of the biggest healthcare networks in California, which does its own private research and who also sees huge amounts of patients told me that the women she has treated overwhelmingly are satisfied with the Mirena IUD, and that I should remember that bad press on the Internet is much more prevalent than good press. I thought that was a good point, and I appreciate her personal experience.

As for ablation, I myself would never choose an irreversible surgical option over a reversible one. The Mirena can be put in and tried, and easily taken back out if you experience too many negatives from it, and you could use ablation as a second option. I encourage you to think about that, as there is not a whole lot of risk involved.

My experience with the cream was that I was not able to get consistent results with it, and I pretty much got no results, except migraines.

The Mirena delivers the progestins in VERY small doses only to the problem area. Yes, it's synthetic. Yes, it MAY be better to use bio identical hormones. But when you're having strange, annoying, and worrisome bleeding, and a tiny piece of plastic makes all that go away and makes all your bleeding problems disappear overnight and for 6 years afterwards and still counting, you start to not worry so much about the synthetic hormones.

A side note here too... My breasts were really cysty before the IUD, and every time I had a mammogram I had to worry about suspicious things they would find. Post-IUD, no more cysty breasts.

Again, while some women don't do well with the Mirena, for me it fixed long standing health issues. Even my back pain, purported by some to be caused by the IUD, seems to have turned out to be just a symptom of getting old, and was temporary at that.

My course of action with my gyno's guidance is to probably have one more IUD placed when this one runs out, and that will get me to menopause, at which point random bleeding will most likely not present as a problem anymore. The good thing being that instead of surgical intervention like ablation or hysterectomy, I've had a temporary and reversible fix that I can opt out of at any point.

I encourage you to explore more options before going down the ablation path!

Apr 01, 2016
following up Sharon's reply
by: Gaye

Hi again Sharon,

I am pleased to hear your back pain was just that....back pain! Yes it is an age thing...I am 48 this year too and sporting a chronic wrist problem from simply cleaning my shower late last year!

Thanks so much for your last post. I have carefully considered your experience with the mirena as well as talking to some friends who have it.

Since my last post I have had the ultrasound and blood results (still waiting on saliva result). Ultrasound showed endometrial hyperplasia (no surprises there) and a small (probably benign) cyst on the left ovary which has resulted in my GP referring me back to a gyno. Blood test showed a "normal" eostrogen level which only proves that my levels are fluctuating wildly as the last blood test showed a sky high level of over 4000!! Yes doc it's called the peri menopausal roller coaster!

To cut a long story short I will continue using the bio identical cream until I have my initial consult with the Gyno next week even though the cream has done nothing to ease my symptoms so far. The way I look at it at least it is getting some progesterone into my system but nothing like the levels I must need.

Interesting that you mentioned the progesterone cream gave you migraines...I have always been prone to a hormonal migraine each month but a few days ago I had a whopper that landed me in bed all day. Coincidence? Not sure.

I am seriously considering trialling the mirena as it can be inserted without the need for a general anasthetic and as you and my friends say....just as easily removed if it causes problems and I will still be on the waiting list for an ablation just in case.

So....for now the saga continues. Hoping to hear that things have improved for you? Did you find an option for the D3? I currently take 2000iu per day as well as a compounded script to treat pyrolurria (zinc and vit b6 deficiency but that's another story). I need to research how pyrolurria may be affecting hormonal balance too but sometimes we just have to take little baby steps in the right direction or else it's all too overwhelming. For now I just need to control the bleeding so that my husband and teenagers can have normal mum back again!



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