The major hormone in HRT is oestrogen. Progestogens are needed within HRT to protect the endometrium (the lining of the womb) from the effect of oestrogen.
We know from many studies that taking oestrogen on its own for long periods of time can result in abnormal thickening of the lining of the uterus starting as endometrial hyperplasia which can develop dyplastic changes and even turn into cancer after long periods of time so its important progestogens are given in HRT to protect the endometrium from that effect.
What are the different regimes for using progestogens in HRT?
There are two different ways of giving progestogens within HRT and it depends on where the woman is in her background entering into this process.
For a woman who is mid to late perimenopausal and still having menstrual cycles HRT is given in a sequential preparation and with that the woman will experience a bleed every month.
However, if the woman is into the menopause and her periods have stopped altogether for 12 months HRT is given in a way where progesterone is given all the time and there is no bleeding.
Within sequential HRT oestrogen is given throughout the cycle and progesterone is given for 12 to 14 days within that cycle and after completing that 12-14 days there is usually a withdrawal bleed at the end of it.
With the continuous combined intake in a woman who has gone through the menopause oestrogen is given throughout the cycle and progestogen is also given throughout the cycle and that is intended not to be associated with a bleed.
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