I am 29. I recently had a D&C following the miscarriage of my first pregnancy. After the D&C, my doctor prescribed Premarin to prevent scarring of the uterus, which I was told was a routine practice, but I have not found any information about this in my research. I am taking 1.25 mg twice daily for 25 days. Should I be concerned about taking such a high dosage of estrogen without progesterone? Should I have other concerns? Is it common for doctors to prescribe estrogen to D&C patients?

--Jenn

By thickening the uterine lining rapidly, estrogen can decrease the chance of the raw uterine walls sticking together after a procedure such as a D&C. However, prescribing estrogen after a D&C for miscarriage in order to prevent scar tissue is not a common practice, at least not in the United States. The chance of significant scar tissue forming after a D&C is about 30 percent, but this figure is not high enough to warrant estrogen being prescribed after every D&C. Usually, estrogen therapy is reserved for cases in which a hysteroscopy or D&C is done to treat scar tissue from a previous procedure or infection.

In the specific case of estrogen being prescribed to prevent recurrent scar tissue after a hysteroscopy to treat such scar tissue, high doses are prescribed for three out of four weeks, with progesterone added the third week. This regimen is usually continued for two consecutive months. If the estrogen is given without progesterone for only a few weeks, it is unlikely to cause any increased risk of cancer of the uterine lining. (That's the reason progesterone is prescribed along with estrogen in the more common scenario of menopausal hormone replacement therapy.)

You should ask your doctor for specific reasons why he prescribes estrogen after a D&C. In my 10 years of practice I have never myself, nor have any of my colleagues, prescribed estrogen to prevent possible scar tissue. It is not the standard of care in the United States, nor is it recommended in any of the major OB-GYN textbooks.