Subtotal hysterectomy

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Following a subtotal hysterectomy, it is possible, in theory, that the residual cervical stump may still contain endometrium.
There is limited evidence to guide practice in relation to the role or need for a progestogen to protect any residual endometrium in the remaining cervical stump.
It is common practice to consider sequential progestogens for up to 3 months. If no bleeding occurs oestrogen only HRT can be used. However if bleeding occurs continuous combined HRT is required. This is sometimes referred to as a progestogen challenge or a progesterone challenge.
Ongoing progestogen intake should be prescribed if bleeding occurs because this suggests the remnant cervical stump may contain residual endometrial tissue.

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