Oestrogen only vs Combined

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Systemic HRT means that the hormones are absorbed into the blood stream and have an effect throughout the body.
This can be prescribed as an oestrogen only or a combined oestrogen and progestogen regime.

Oestrogen only preparations are given to people who have had a hysterectomy. It can be taken orally in the form of a pill, or transdermally as a patch, gel or spray that delivers the hormones through the skin.
Combined oestrogen and progestogen regimes are given to women with a uterus. Progestogens within HRT can be taken orally, transdermally as a patch or delivered through an intrauterine system.

A progestogen is needed in women who have a uterus because it opposes the stimulatory effect of oestrogen on the endometrium. It therefore provides endometrial protection.
Unopposed oestrogen replacement, in women with an intact uterus, is associated with a significant increase in risk of endometrial hyperplasia and endometrial carcinoma.

Note:

Where there is a history of a subtotal hysterectomy or a hysterectomy following extensive endometriosis, a progestogen may still be required due to the presence of possible residual endometrial tissue.

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