Treatment of Endometrial Hyperplasia in a Woman Taking Hormone Replacement Therapy
Endometrial hyperplasia diagnosed in a woman currently taking hormone replacement therapy (HRT) requires careful management of the existing regimen. Whether the woman wishes to continue HRT, and the specific type of preparation she is using, are central to determining the appropriate course of action.
This protocol addresses women taking HRT who have been diagnosed with endometrial hyperplasia. The type of HRT preparation in use — sequential or continuous combined — is a key determinant of the management pathway, and each carries distinct clinical considerations.
Management involves reviewing and modifying the progestogen component of the existing HRT regimen; the full protocol specifies which preparation-based approach is indicated and what further steps apply for each case.
- Women with endometrial hyperplasia taking a sequential HRT preparation who wish to continue HRT should be advised to change to continuous progestogen intake using the LNG-IUS or a continuous combined HRT preparation.
- Women with endometrial hyperplasia taking a continuous combined preparation who wish to continue HRT should have their need to continue HRT reviewed.
- Consider using the LNG-IUS as a source of progestogen replacement.
- Systemic estrogen-only HRT should not be used in women with a uterus.
- Stopping sequential combined HRT may be sufficient to induce regression of endometrial hyperplasia.