Understanding Progestogen in Hormone Replacement Therapy (HRT)
Progestogens are synthetic forms of the hormone progesterone, which is needed to balance the effects of oestrogen in HRT. If you still have your uterus (womb), taking progestogen alongside oestrogen is important to protect the lining of the womb (endometrium).
Without progestogen, oestrogen can cause the lining of the womb to build up, which increases the risk of endometrial cancer.
Why is progesterone needed?
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Oestrogen on its own can cause the lining of the womb (endometrium) to thicken, which increases the risk of endometrial cancer.
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Progesterone balances oestrogen by keeping the lining thin and healthy.
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Without progesterone, women with a uterus who take oestrogen are at higher risk of serious complications.
Why it’s important to stay on progesterone
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Stopping progesterone while continuing oestrogen is unsafe if you have a uterus.
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Always follow your GP’s advice and do not discontinue progesterone without medical guidance.
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If you experience side effects or have concerns, speak to your GP – there are different options available to suit your needs.
Frequently Asked Questions
Here are answers to some of the most common questions patients ask us about progesterone in HRT:
Do I need progesterone if I’ve had a hysterectomy? No. If your uterus has been removed, you do not need progesterone. Oestrogen alone is safe in this situation.
Why can’t I just take oestrogen on its own? If you still have your uterus, taking oestrogen without progesterone can cause the lining of the womb to thicken, which increases the risk of cancer. Progesterone protects against this risk.
What forms of progesterone are available? Progesterone can be taken as tablets or capsules, or delivered through a coil placed in the womb (such as the Mirena®). Your GP will discuss which option is best for you.
What happens if I stop taking progesterone but continue oestrogen? This is unsafe if you have a uterus. The womb lining can thicken and lead to serious health problems. Always speak to your GP before making any changes to your HRT.
Can a progesterone‑containing coil replace tablets? Yes. A coil that releases progesterone provides the necessary protection for your womb lining and can also act as contraception. It may be a good option if you prefer not to take tablets.
What should I do if I have side effects from progesterone? Do not stop taking it without medical advice. Contact your GP to discuss your symptoms. There are different types and ways of taking progesterone, so alternatives may be available.
Comparison of Progestogen Options in HRT
| Method |
How it’s taken |
Benefits |
Potential Drawbacks / Risks |
Suitability |
| Oral HRT Progestogens |
Daily or cyclical tablets |
Convenient and widely available Effective at protecting womb lining |
Breast cancer risk: Combined oestrogen + synthetic progestogen increases risk after 1 year, rising with duration. Micronised progesterone (Utrogestan®) appears lower risk than synthetic types (e.g. norethisterone, medroxyprogesterone).Metabolised by liver, not suitable for some women. - Side effects: mood changes, headaches, bloating, breast tenderness. Slightly increased risk of blood clots (VTE)
|
Good option if you prefer tablets and have no contraindications. Regular GP review essential. |
| Vaginal Progestogens |
Inserted into the vagina |
Acts directly on womb lining Fewer whole‑body side effects. Useful for women sensitive to oral medication |
Requires vaginal insertion,may be less convenient, Limited availability compared to oral forms |
Suitable if you have side effects with oral progestogens or need localised treatment. |
| Intra uterine progestogen |
Small device fitted in womb, lasts up to 5 years |
Long‑acting, low‑maintenance, Local protection with fewer systemic side effects. Also provides contraception can reduce or stop periods |
Requires fitting procedure May cause spotting or irregular bleeding initially Some women experience headaches or breast tenderness |
Ideal if you want long‑term protection, contraception, or prefer not to take tablets. |
Key Safety Message
If you have a uterus and are prescribed HRT, you must remain on progestogen alongside oestrogen.
Stopping progestogen is unsafe and increases your risk of womb cancer.
Different types of progestogen carry different risks — including a small increase in breast cancer risk with long‑term use.
Non-urgent advice: Conclusion
There are various forms of progestogen available for HRT, each with its own advantages and potential drawbacks.
Your healthcare provider will work with you to determine the best option based on your health profile, preferences, and the effectiveness of each form of treatment in managing your symptoms.
For more detailed information on the different types of progestogen medications and their specific benefits and risks, visit the following trusted resources: