Why You Still Need Progesterone After a Hysterectomy—And What Happens If You Don’t

You Don’t Need a Uterus to Need Progesterone

When women undergo a hysterectomy, especially one that includes ovary removal, most are told they only need estrogen therapy afterward. The rationale? “You don’t have a uterus, so you don’t need progesterone.”

This thinking is not only outdated—it’s flat-out wrong.

According to hormone expert Dr. Felice Gersh, progesterone is essential for total hormone balance—regardless of your uterine status. That’s because progesterone receptors exist throughout the body, and its effects stretch far beyond reproductive health.

In this post, we’ll dive into why progesterone still matters, how it works with estrogen, and why skipping it can lead to brain fog, mood swings, inflammation, and more. If you're on estrogen-only HRT post-hysterectomy and still not feeling right—this might be the missing piece.

The Myth: No Uterus = No Need for Progesterone

Let’s bust this myth right away.

In conventional medicine, progesterone has traditionally been prescribed to protect the uterine lining from overstimulation by estrogen. So if the uterus is removed, many providers stop prescribing progesterone altogether.

But here’s what they’re missing:

Progesterone plays a vital role in multiple systems, including your brain, bones, heart, immune system, skin, and mood regulation.

Just because the uterus is gone doesn’t mean those systems no longer matter.

Your body is a symphony of hormone receptors—and leaving out progesterone is like playing music without half the instruments.

The Whole-Body Benefits of Progesterone

Progesterone isn’t just a reproductive hormone. It’s a neuroactive steroid, vascular protector, immune modulator, and more.

Here’s what it does:

Neuroprotective Function

• Promotes creation and maintenance of the myelin sheath, which insulates and protects brain and nerve tissue
  
  

• Modulates GABA receptors, producing calming, anti-anxiety effects
  
  

• Reduces risk of neuroinflammation, cognitive decline, and mood disorders
  
  

Cardiovascular Health

• Increases nitric oxide production, enhancing blood vessel elasticity and circulation
  
  

• Supports heart rhythm regulation and vascular tone
  
  

• Helps balance the effects of estradiol on endothelial function
  
  

Bone Strength

• Works synergistically with estrogen to stimulate osteoblasts (bone-building cells)
  
  

• Supports bone density preservation in postmenopausal and surgically menopausal women
  
  

Anti-inflammatory and Immune Modulation

• Suppresses chronic inflammation
  
  

• Enhances immune system regulation and cell repair processes
  
  

Genetic Regulation and Cell Growth Control

• Acts as a brake on estrogen-driven cell proliferation
  
  

• Supports proper gene expression and cellular balance
  
  

If you’ve ever felt anxious, inflamed, or unbalanced on estrogen-only therapy, it’s because your body needs progesterone, too.

Why Progesterone Is Necessary After a Hysterectomy

Most women on estrogen-only HRT post-hysterectomy report feeling… okay, at best. They’re relieved some symptoms are gone, but many still struggle with:

• Brain fog
  
  

• Mood instability
  
  

• Sleep disturbances
  
  

• Weight gain
  
  

• Anxiety or restlessness
  
  

• Loss of motivation or drive
  
  

That’s because estradiol without progesterone creates an incomplete hormonal picture.

Progesterone buffers estrogen, regulates its receptors, and calms the overstimulation. Without it, you may feel like your foot is on the gas—but there’s no brake pedal.

And this isn’t just about symptoms. Over time, estrogen dominance (even from HRT) without progesterone balance can accelerate aging, inflammation, and systemic stress.

The Importance of Cyclic Progesterone Dosing

At Steel City HRT, we don’t just throw hormones at you—we mirror your body’s natural rhythm.

That’s why we often recommend cyclic progesterone therapy:
✔️ 14 days per month (just like your body would naturally produce pre-menopause)

Benefits of cycling include:

• Supports monthly hormone reset
  
  

• Prevents receptor burnout or saturation
  
  

• Mimics the natural rise and fall of progesterone
  
  

• Helps patients feel more “in sync” with their body
  
  

• Promotes emotional regulation, better sleep, and metabolic stability
  
  

Daily dosing can sometimes lead to plateaued effects, but cycling maintains sensitivity and balance.

Why Bioidentical Progesterone is the Superior Choice

Not all progesterone is created equal.

Bioidentical progesterone (micronized progesterone) is chemically identical to what your ovaries produced. It’s available as:

• Capsules
  
  

• Topical creams
  
  

• Vaginal gels or suppositories
  
  

• Compounded options
  
  

This differs from synthetic progestins like medroxyprogesterone (used in the WHI study), which can cause:

• Mood disturbances
  
  

• Cardiovascular risk
  
  

• Breast tenderness and bloating
  
  

At Steel City HRT, we only prescribe bioidentical progesterone, carefully monitored and customized to your needs. The goal is to support—not suppress—your natural biochemistry.

What Happens If You Skip Progesterone?

Many women start with estrogen-only therapy post-hysterectomy. At first, they feel some relief. But over time, symptoms creep back in.

Here’s what can happen:

• Insomnia and restless sleep
  
  

• Irritability, anxiety, or weepiness
  
  

• Cognitive decline or brain fog
  
  

• Weight gain or bloating
  
  

• Diminished libido
  
  

• Vascular stiffness or elevated blood pressure
  
  

• Slower bone regeneration
  
  

Sound familiar?

In countless patient success stories, adding progesterone transformed the entire HRT experience—restoring calm, clarity, and control.

Steel City’s Perspective: Full Balance or Nothing

We don’t believe in halfway hormone therapy. Your uterus may be gone, but your brain, bones, heart, and emotions still need progesterone. We’ve helped hundreds of women reclaim their lives—not just by relieving symptoms, but by rebuilding true hormonal harmony.

If your provider told you progesterone isn’t necessary post-hysterectomy—it’s time for a second opinion.

Take the First Step Toward Real Hormone Balance

📞 Call 719-669-4223
💻 Or book your personalized consultation now

Let our hormone therapy specialists guide you through a treatment plan that supports your whole body, not just the parts you still have. You deserve to feel whole—again.

Frequently Asked Questions (FAQ)

Q: Do I still need progesterone if I’ve had a hysterectomy?
A: Yes. Even without a uterus, progesterone supports your brain, bones, heart, immune system, and mood.

Q: How should I take progesterone?
A: Cyclic dosing—14 days per month—is ideal. This mimics natural rhythms and optimizes hormone receptor balance.

Q: What form of progesterone is best?
A: Bioidentical progesterone (e.g., oral capsules, creams, compounded options) is safer and more effective than synthetic progestins.

Q: What are signs I might need progesterone with my HRT?
A: Brain fog, anxiety, poor sleep, weight gain, or persistent mood issues are all common signs.

References (APA 7 Style)

Gersh, F. L. (2022). Menopause: 50 Things You Need to Know. New World Library.

Prior, J. C. (2015). Progesterone for treatment of menopausal symptoms: A review. Women’s Midlife Health, 1(1), 1–14. https://doi.org/10.1186/s40695-015-0004-9

North American Menopause Society. (2023). Hormone therapy and the role of progesterone. https://www.menopause.org

Simoncini, T., & Genazzani, A. R. (2006). Neuroprotective effects of sex steroids. European Journal of Endocrinology, 154(2), 187–192.