Re-evaluating the role of progestogen therapy after the menopause

Abstract

An estrogen-progestogen regimen of hormone replacement therapy has become widely used in recent years, primarily as a means to protect the endometrium from the carcinogenic effects of unopposed estrogen therapy (ERT). In this article, we evaluate the probable effects of this regimen on mortality from endometrial cancer as well as mortality from other chronic diseases. We conclude from this analysis that ERT is to be preferred to combination therapy for postmenopausal women without a uterus, primarily because it is predicted that ERT confers a significantly greater benefit on heart disease risk. In women with a uterus, if progestogens are to be prescribed, they should be given in the lowest possible dose needed to achieve the desired histologic changes in the endometrium, since the predicted loss in heart disease benefit from adding the progestogen is substantial.