Endometrial protection during estrogen MHT
In women with an intact uterus on estrogen MHT, a progestogen is mandatory to prevent endometrial hyperplasia and cancer. Preferred agents: micronized progesterone or dydrogesterone per NAMS 2022 and IMS 2016.
2 drugs
Drugs used for this condition
- ADydrogesteroneFirst line · Progestogens — pregnadiene derivativesPer NAMS 2022 and IMS 2016, dydrogesterone 5–10 mg daily or 10 mg for 14 days per month provides endometrial protection during estrogen MHT. The breast cancer and VTE risk profile of dydrogesterone is closer to micronized progesterone than to synthetic progestins such as medroxyprogesterone acetate. Fixed combination with estradiol is available as Femoston.
- AProgesterone, micronizedFirst line · Progestogens — progesterone derivativesFirst-line for endometrial protection during estrogen MHT per NAMS 2022, IMS 2016, BMS 2024. A progestogen is mandatory in women with an intact uterus. Compared with synthetic progestins, micronized progesterone has a more favorable profile for breast cancer risk and thromboembolism. Dose 100–200 mg at bedtime, cyclically (12–14 days per month) or continuously.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit