Can estrogen therapy increase the risk of endometrial hyperplasia?

Yes, it can, especially if estrogen is used without enough progesterone to balance it.

Estrogen stimulates the uterine lining to grow. Over time, that can increase the risk of endometrial hyperplasia, which means the lining becomes abnormally thick. Here at Alloy, that’s why women who still have a uterus generally need progesterone or another progestogen along with systemic estrogen, regardless of whether it’s taken as a pill or through the skin. Progesterone helps protect the uterine lining and lowers the risk of hyperplasia and endometrial cancer.

You can read more here in our article on endometrial hyperplasia in menopause and in our guide to estradiol pills and why progesterone is often prescribed with estrogen.

If you’re looking at treatment options, our progesterone page explains how it’s used to protect the uterine lining when paired with estradiol.

Progesterone

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Best for protecting your uterine lining when paired with estradiol.

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One other thing that matters, if you have unusual bleeding, spotting, or bleeding after menopause, that’s worth getting checked.

This answer was created using the following resources:

• Estradiol Pill

• Evamist® Estradiol Spray

• Endometrial Hyperplasia in Menopause: What Is Normal? Alloy Health

• Oral Estradiol Pills for Menopause: Uses, Safety & Dosages

• FDA Updates Hormone Therapy Labels: What Women Should Know

• Oral vs. Transdermal Estrogen: Which HRT Form Is Right for You?

• Alloy | Kudzai Dombo

• Bioidentical vs. Synthetic HRT: Benefits, Types & Myths