Prescribing Vagifem or Estrace vaginal estrogen

Hello Doctor,
I have a question based on a helpful response you gave me earlier.  When Vagifem or Estrace is prescribed for a post menopausal woman with a uterus, should a progestin always be prescribed as well?  I've been taking Vagifem for 2 years without a progestin, and now I have to undergo an endometrial biopsy because of some buildup of the lining of my uterus (I have no bleeding....it showed up on an TV ultrasound...small changes and endometrial thickness of 5mm).  Is stopping the Vagifem enough to reverse the buildup, or do I need a course of progestin to shed what's there?  Thank you.

[Elaine Brown, MD]

Hi!
Typically it is not necessary to prescribe progesterone in addition to Vagifem because the blood levels are so low.  If you were my patient, I would be tempted to give you 14 days of progesterone (Prometrium seems to have fewer side effects) and then repeat the ultrasound before doing a biopsy.  If you wanted to continue Vagifem, I would consider scanning again in 3 months to see if the lining was building up again.  If so, you could stop the medication, or consider a small daily dose of progesterone.
Hope this helps!
Dr B

[Ruthiejb]

Thank you so much, Dr. Brown.  You're always extremely helpful.