Patient guide
Progestogens in HRT: protecting the womb and choosing a type
Oestrogen alone stimulates the womb lining, so women who have a womb take a progestogen alongside it. Several types and routes exist, and tolerability varies. This guide explains the purpose, the choices, how bleeding patterns differ and what to do about side effects.
Last checked: 2026-10-03
Key facts
At a glance.
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Purpose
Progestogen protects the womb lining from overgrowth caused by oestrogen, reducing the risk of womb cancer.
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Options
Oral micronised progesterone, progestogens in combined products, and the levonorgestrel intrauterine system.
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After hysterectomy
Progestogen is usually unnecessary after hysterectomy unless there is a history of endometriosis.
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Creams
Over-the-counter progesterone creams are not reliable womb protection.
Why it is needed
Oestrogen causes the endometrium, the lining of the womb, to thicken. If this is unopposed, abnormal cells can develop, increasing the risk of womb cancer. A progestogen causes the lining to shed or stay thin, which protects it. This is a safety measure, not an additional symptom treatment, although progestogens can also help sleep and bleeding patterns in some women.
Types of progestogen
| Option | How it is used | Points to consider |
|---|---|---|
| Micronised progesterone | Capsule taken by mouth, usually at night | Body-identical; can cause drowsiness, which some find helpful for sleep |
| Synthetic progestogens in tablets | Taken with oestrogen, sometimes in combined products | Several types; tolerability varies; some may cause mood effects or bloating |
| Combined patches | Patch containing oestrogen and progestogen | Convenient; limited choice of doses |
| Levonorgestrel intrauterine system | Fitted in the womb by a clinician | Protects the lining locally, can reduce bleeding and provides contraception; needs fitting and replacement |
Bleeding patterns
In sequential regimens the progestogen is taken for part of the month and a withdrawal bleed follows. In continuous combined regimens, bleeding often stops after a few months, though irregular spotting is common at first. The intrauterine system often leads to light or no periods. Persistent or heavy bleeding, bleeding that starts after a period of none and bleeding after six months of continuous therapy should be assessed.
Side effects and what helps
Some women notice bloating, breast tenderness, mood changes, headaches or acne with progestogens. These effects differ with type and route. If you have problems, ask whether a different progestogen, a lower dose, taking at night or an intrauterine system might suit you better. Avoid stopping the progestogen while continuing oestrogen without advice, because the womb needs protection.
Women without a womb
After a hysterectomy, oestrogen alone is normally used. If the hysterectomy was done for endometriosis, or if there were remnants of lining left, a progestogen may still be advised. Your gynaecologist or menopause specialist can confirm what applies.
Unlicensed creams
Progesterone creams bought online or in shops vary in dose and absorption and are not licensed to protect the womb lining. Professional bodies advise that they are not an adequate substitute. If you are using oestrogen with a womb, use a licensed progestogen, and talk to a clinician if you have used a cream in the past.
When to ask for a review
Return to your prescriber if you have bleeding that is heavy, lasts longer than expected or begins after months without it, if you have persistent mood changes, bloating or headaches that you think are linked to the progestogen or if you are unsure whether you are properly protected. Take your pack or product names to the appointment. If you have an intrauterine system, note the fitting date and ask when it needs replacing. Do not wait for the annual review if something is troubling you.
Frequently asked
Questions people ask.
Quick, plain-English answers to the questions we hear most.
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Do I need a progestogen if I take only vaginal oestrogen?
Low-dose vaginal oestrogen is minimally absorbed and generally does not need one, but ask your clinician if you use it long term.
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Is micronised progesterone better?
It may be better tolerated by some women. Evidence on superiority is not conclusive.
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Can the coil provide the progestogen?
Yes, a levonorgestrel intrauterine system is licensed for this use for a defined period.
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Why am I bleeding on continuous HRT?
Irregular bleeding is common in the first months. Report if it persists, is heavy or starts later.
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Can I switch progestogens?
Yes. Tell your prescriber about side effects and ask about alternatives.
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Will progestogen make me gain weight?
Evidence does not show that HRT causes major weight gain, but bloating and fluid retention can occur.
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Does progestogen affect mood?
Some women notice mood changes, which can respond to changing the type or route.
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What if I stop progestogen but continue oestrogen?
That leaves the womb unprotected. Seek advice before changing your regimen.
Where this comes from
Sources and checking.
This guide is for information, not medical advice.
Your GP or consultant knows your history and can tell you which parts apply to you. If your symptoms are severe, rapidly worsening, or come with red-flag features, seek urgent medical care. Figures and availability change, so treat them as a guide and confirm with the provider.
Published 2026-10-03, next review 2027-10-03.
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NICE guideline NG23, Menopause: identification and management (nice.org.uk)
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British Menopause Society, patient and clinician consensus resources (thebms.org.uk)
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NHS website, Menopause and Hormone replacement therapy (HRT) pages (nhs.uk)
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MHRA drug safety updates and Yellow Card scheme information (gov.uk/mhra)