Glossary · Treatments

Combination HRT

Also called: EPT, Estrogen-progestogen therapy.

Definition: Combination HRT is hormone therapy that includes both estrogen and a progestogen (progesterone or progestin). It is the standard regimen for women with an intact uterus, where progestogen is required to protect the endometrium from estrogen-driven hyperplasia. Combination can be delivered as separate products or as combined patches/tablets.

Detailed definition

Combination HRT (also called EPT, estrogen-progestogen therapy) refers to any hormone therapy regimen that includes both estrogen and progestogen. It is required for women with an intact uterus because unopposed estrogen substantially increases the risk of endometrial hyperplasia and endometrial cancer. Common combination regimens include: transdermal estradiol patch or gel plus oral micronized progesterone (the modern default in evidence-based menopause practice); combined transdermal patches (Climara Pro = estradiol + levonorgestrel; Combipatch = estradiol + norethindrone); combined oral tablets (Activella, Prempro, Angeliq); estrogen plus a 52-mg LNG-IUD for endometrial protection. Combination HRT can be continuous (estrogen and progestogen daily, producing amenorrhea) or cyclic (progestogen given for 12–14 days each month, producing predictable withdrawal bleeds). Cyclic regimens are more common in late perimenopause; continuous combined is more common in early postmenopause.

Why it matters in menopause

For women with a uterus, the question is not whether to use combination HRT but how to combine. Modern practice favors transdermal estradiol plus bedtime oral micronized progesterone for most women, with the LNG-IUD as a strong alternative.

Sources

External references: Wikipedia.

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