Progesterone, progestins and the endometrium in perimenopause and in menopausal hormone therapy

• Published in: Climacteric : the journal of the International Menopause Society Vol. 21; no. 4; pp. 321 - 325
• Main Author: Gompel, A.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.08.2018; Taylor & Francis Ltd
• Subjects: Breast - drug effects; Breast Neoplasms - chemically induced; conjugated estrogens; Endometrial cancer; Endometrial Neoplasms - chemically induced; Endometrium - drug effects; Estrogen Replacement Therapy - adverse effects; Estrogen Replacement Therapy - methods; Female; Health risk assessment; Hormone replacement therapy; Humans; Hyperplasia; Intrauterine devices; IUD; levonorgestrel-releasing intrauterine device; Menopause; Menopause hormone therapy; micronized progesterone; obesity; Perimenopause; Progesterone; Progesterone - adverse effects; Progesterone - physiology; Progestins - adverse effects; Progestins - physiology; Randomized Controlled Trials as Topic; transdermal estradiol; Menopause hormone therapy; endometrial cancer; hyperplasia; levonorgestrel-releasing intrauterine device; conjugated estrogens; micronized progesterone; obesity; transdermal estradiol
• ISSN: 1369-7137; 1473-0804; 1473-0804
• DOI: 10.1080/13697137.2018.1446932

It is well established that unopposed estrogen for hormone therapy in postmenopausal women (MHT) induces a dose-related stimulation of the endometrium associated with an increased risk of hyperplasia and endometrial cancer. Progesterone acts physiologically to counteract the proliferative effects of estradiol during the menstrual cycle. In MHT, progestogens protect the endometrium against the proliferative effects of estrogens in women with a uterus. Recent data suggest that, whereas micronized progesterone is apparently safer for the breast, it could be less efficient than synthetic progestin on the endometrium. An update on progestogen and endometrial safety in MHT is the subject of this review.