Abstract
BACKGROUND Estrogen induces endometrial stimulation and increases the risk for endometrial hyperplasia and endometrial cancer. Added progestin diminishes endometrial stimulation.The risk for endometrial hyperplasia with hormonal replacement therapy (HRT) dependsof the type of formulation. Unopposed estrogen increases the risk of abnormal uterinebleeding, endometrial hyperplasia and carcinoma in a dose and time dependent manner.When progestin was added for 10 or more days, no endometrial hyperplasia has beenseen with sequential HRT. No increased risk for endometrial hyperplasia has been foundwith continuous combined regimens. During the first year of HRT irregular bleeding andspotting was more likely in continuous combined therapy than in sequential therapy.Howerever, during the second year of the therapy it was more likely under sequentialregimens. CONCLUSIONS Only women after hysterectomy can use unopposed estrogen
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