Endometrial Protection: Which Progestogen Is Best?

After a lost decade, increasing numbers of women and providers are recognizing the benefits of postmenopausal hormonal therapy. For women with an intact uterus, endometrial protection is required when systemic estrogen therapy is used. Since activity at the glucocorticoid and androgen receptor may lead to adverse health effects in some women, use of pure progesterone receptor agonists may offer advantages. However, the use of natural progesterone is problematic due to low potency and poor bioavailability with oral dosing. Local therapy with the levonorgestrel intrauterine device (off-label) may be an excellent choice for many women.