Are progestins really necessary as part of a combined HRT regimen?

  title={Are progestins really necessary as part of a combined HRT regimen?},
  author={David W. Sturdee},
  pages={79 - 84}
Abstract For many years it has been perceived wisdom that hormone replacement therapy for women with a uterus should include a progestin to prevent the proliferative effects of estrogen on the endometrium and endometrial cancer. But, with the reports from the Women's Health Initiative (WHI) and Million Women Study indicating that such regimens are associated with an increased risk of breast cancer, whereas unopposed estrogen may not increase this risk, or even reduce it, it is pertinent to… 

Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference

Micronized progesterone and dydrogesterone appear to be the safest options, with lower associated cardiovascular, thromboembolic, and breast cancer risks compared with other progestogens, and are the first-choice options for use in ‘special situations,’ such as in women with high-density breast tissue, diabetes, obesity, smoking, and risk factors for venous throm boembolism.

Pharmacotherapies for Menopause Management: Hormonal Options

It is known that benefits may exceed risks for the majority of symptomatic postmenopausal women who at the time of initiation of MHT are less than age 60 or less than 10 years since the onset of menopause and at low baseline risk for cardiovascular events and there appears to be differences in the risk/benefit profiles between different types of hormonal regimens.

Hormones and risk of breast and gynecological cancer

Oral contraception increases breast cancer risk but is protective against ovarian and endometrial cancers and the influence of ovarian hyperstimulation has been controversially discussed and no clear association with these hormone-dependent tumors has been observed.

Hormone Therapy in Normal Postmenopausal Women and After Treatment for Endometrial Cancer

The role of hormone therapy in women with endometrial cancer and risk of endometrium cancer in women on hormones will be discussed in this chapter.

Progesterone-based compounds affect immune responses and susceptibility to infections at diverse mucosal sites

Greater consideration should be given to how the immunomodulatory effects these compounds alter the outcome of diseases at mucosal sites beyond the reproductive tract, which has profound implications for women’s health.

The breast cancer epidemic: 10 facts

The epidemiological evidence of preventable causes of breast cancer is reviewed to highlight the need to understand more fully the rationale behind the increasing frequency and severity of the disease.



Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects.

Differences in chemical structure, metabolism, pharmacokinetics, affinity, potency, and efficacy via steroid receptors, intracellular action, and biological and clinical effects confirm the absence of a class effect of progestogens.

Risk of endometrial cancer following estrogen replacement with and without progestins.

The risk of developing endometrial cancer is increased after long-term use of estrogens without progestins and with cyclically added progestin use, and Continuously added progESTins may be needed to minimize the endometricrial cancer risk associated with estrogen replacement therapy.

Micronized progesterone and its impact on the endometrium and breast vs. progestogens

  • A. Gompel
  • Medicine, Biology
    Climacteric : the journal of the International Menopause Society
  • 2012
Micronized progesterone does not increase cell proliferation in breast tissue in postmenopausal women compared with synthetic medroxyprogesterone acetate (MPA), and experimental evidence suggests that the opposing effects of MPA and micronization on breast tissue are related to the non-specific effects ofMPA.

The case for less-than-monthly progestogen in women on HT: is transvaginal ultrasound the key?

Patients with an initial thin distinct endometrial echo can begin with unopposed estrogen, and the advantage for the successful patient is less progestogen exposure, as little as 24 days per year in most patients, and less bleeding.

Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women's Health Initiative randomized trial.

This randomized trial suggests that continuous combined estrogen plus progestin therapy may increase the risk of ovarian cancer while producing endometrial cancer rates similar to placebo, and provides additional support for caution in the use of continuous combined hormones.

Intrauterine application of progestins in hormone replacement therapy: a review

  • F. Riphagen
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2000
Intrauterine use of progestins, especially levonorgestrel, by purpose-designed systems as part of combined HRT, is a new way of administration and carries good benefits, while some aspects require more clinical evidence.

The impact of different HRT regimens on compliance.

Epidemiological data strongly suggest a substantial improvement of quality of life for post-menopausal women using hormonal replacement therapy (HRT), Nevertheless, reluctance of women to choose HRT is high and general recommendations are difficult to justify.

Estrogen plus progestin and breast cancer incidence and mortality in the Women's Health Initiative Observational Study.

Consistent with WHI randomized trial findings, estrogen plus progestin use is associated with increased breast cancer incidence and prognosis after diagnosis on combined hormone therapy is similar to that of nonusers, and increased breastcancer mortality can be expected.

Hormone replacement therapy and breast disease

There is no robust evidence for an adverse effect on breast cancer survival and there is no direct clinical evidence that this reduces the small mortality benefit derived from the NHS Breast Screening Programme.