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Diagnosed with osteoporosis. Had total hysterectomy and yearly pap smears since surgery. Would adding compounded progesterone be beneficial?

Mar 2016
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Practicing since : 2011
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I have a recent diagnosis of osteoporosis(T score -2.5. I use Triest 1.75 twice a day. Would it help to increase the triest dosage or would adding compounded progesterone be more beneficial.. or do both? I had total hysterectomy in 2001 at age 53 for stage 1-d uterine cancer. Radiation not required. Yearly pap smears since surgery. I am now 64. I am 5'2 in. and weigh 113 lbs. I take calcium supplements and eat calcium. I do Bobypump 2x a week and RPM spinning 3x. I do not understand why the osteopenia advanced to osteoporosis in spite of my efforts. I live in rural Alabama and use the best doctors the area offers but they do not offer suggestions or answers.
Posted Sat, 23 Nov 2013 in Women's Health
Answered by Dr. S Patra 1 hour later
Brief Answer: FOLLOW THE TREATMENT GUIDELINE. Detailed Answer: Hello, Thanks for writing to us. According to T score -2.5, it indicates OSTEOPOROSIS and proper treatment along with dietary supplements (Calcium and vitamin D) are must needed in this stage to prevent pathological fracture. TREATMENT PROTOCOL : 1) HRT (Hormone Replacement Therapy) is not the best option to prevent osteoporosis and fracture. However, natural estrogen (Tri-Est) is preferable alone with above doses (1.75 mg twice daily) as you had already hysterectomized. No progesterone should be added at this stage. Yearly breast check up and pap smear tests are mandatory. 2) Dietary intake of calcium (800 mg/ day) and Vitamin-D are essential along with that. On average, 250ml cows' milk or 150 gm yoghurt contains 300 mg of calcium. You can take foods like cheese, Soybeans, Dark leafy greens (like XXXXXXX spinach, turnips, and collard greens), Enriched breads, grains, Fortified cereals like Raisin XXXXXXX Corn Flakes etc. 3) Other Medicine a) Bisphosphonate - Risedronate sodium and Ibandronic acid etc, b) Strontium ranelate c) Selective estrogen receptor modulator (SERM) like Raloxifene etc are commonly used in the treatment of osteoporosis. In addition, Calcitonin injection or nasal spray is given to regulate bone turnover for prevention of postmenopausal osteoporosis while above drugs are unsuitable. Calcitriol and Teriparatide are other adjunct treatment available nowadays. 4) Hip Protectors - They are shock-absorbing pads that can be worn to cushion the impact over the hip bone while a person fall down. Here, mild exercise is only advisable. Regular moderate to heavy exercise may increase the risk of fracture. To summarize, You must consult with your physician or healthcare provider for complete evaluation and prescription. Hope, I have answered your query. Let me know, if you need further clarification. Wish your good health and take care yourself. Regards, Dr Soumen For future query, you can directly approach me through WWW.WWWW.WW
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Follow-up: Diagnosed with osteoporosis. Had total hysterectomy and yearly pap smears since surgery. Would adding compounded progesterone be beneficial? 10 hours later
I asked for and paid for a specialist in hormone therapy. Your advice is routine for an OB/GYN. Everything I have read about progesterone recommends adding it to improve bone density. I no longer have a uterus so cancer is not a threat. I tried Fosamax for 6 years but it did not improve bone density only maintained it. I want to improve bone density. Why not add progesterone?
Answered by Dr. S Patra 3 hours later
Brief Answer: HORMONAL THERAPY HAS LITTLE ROLE AT THIS STAGE. Detailed Answer: Hello, Thanks for follow up query and additional information. Followings are my comments: 1) HRT (Hormone Replacement Therapy) has minimal role in the treatment of Osteoporosis when it is already developed (Your T score is -2.5). Conjugated estrogen is preferred for menopausal women who have undergone hysterectomy as there is no risk for cancer. It is more potent than progesterone to increase bone mass and reduce bony resorption. 2) Progesterone may counteract the effect of estrogen to develop bone mass and density due to low estrogen absorption. However, you can apply natural progesterone cream (3%) at bed time for 10 to 12 days each month to get effective result. But combined estrogen and progesterone pill should be avoided at this stage. 3) You have to undergo other treatment at this stage where Osteoporosis is already developed and hormonal treatment has little value. a) Selective estrogen receptor modulator (SERM) like Raloxifene is the first line drug to treat osteoporosis. b) Calcitonin injection or nasal spray is quite useful to regulate bone turnover and increase density. c) Dietary supplements with Calcium & Vitamin D should be continued life long. These are the mainstay of treatment at this stage as Bisphosphonate group of drug like FOSAMAX alone was ineffective to prevent osteoporosis. Hope, I have guided you properly and clarified the all things. If you don't have any other query, you can close the discussion. All the best. Good luck. Regards, Dr Soumen
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Follow-up: Diagnosed with osteoporosis. Had total hysterectomy and yearly pap smears since surgery. Would adding compounded progesterone be beneficial? 2 days later
Your second response has been very helpful. I really do not understand this disease or why my best efforts to improve my health have failed. I am discouraged. Can Fosamax be taken again for 5 years? is it necessary to stay off Fosamax for a rest period before starting treatment again? I do not know if other drug therapies are covered by my insurance and Fosamax is an option now. Thank you in advance for your patience and guidance.
Answered by Dr. S Patra 8 hours later
Brief Answer: NEW TREATMENT IS MORE EFFECTIVE. Detailed Answer: Hello, Thanks for your response. 1) In my opinion, you would follow the above said treatment protocol (as T score is -2.5) for Osteoporosis. It will be more effective than FOSAMAX alone. However, it can be taken as adjuvant treatment. 2) There is no necessary to stay off from FOSAMAX (Bisphosphonate) while you start new treatment but you must continue other drug therapy to get effective result which I have mentioned in my earlier text. Dietary recommendation and mild exercise are also important things at this stage. Kindly, consult with your physician or healthcare provider for proper prescription after clinical assessment. You must take opinion from your insurance company. Hope, it helps for your information. Wish your good health. Regards, Dr Soumen
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