Progesterone: The Part of HRT Too Many Women Aren’t Told About

The Standard Combo

I’m on HRT, as are many of my friends and clients. I tend to keep up with the latest data and read widely on the subject — not because I know better, but because like so many women, I’ve had questions and challenges that pushed me to dig deeper. Most of my friends, though, aren’t overly concerned with the finer details. They’re busy living their lives and happy with their HRT regime.

Most of my friends in Europe and Asia are on the same combination: a transdermal gel or patch paired with a progesterone (most often the body-identical option, Utrogestan). And those who haven’t been scared off by the supposed negative side effects of testosterone are taking that too. In the USA, the landscape looks different — there’s a bigger mix of options, and synthetic hormones are still used.

The Missing Explanation

What strikes me is how many women don’t really know why progesterone matters — because their doctor hasn’t told them. At best, they might know it can help with sleep if taken at night, but that’s usually where the explanation ends. Helpful, yes. But the far more important detail? That often gets skipped.

And here it is: if you’re taking systemic estrogen (through a gel, patch, or tablet) and still have a uterus, you must also take a progesterone — often prescribed as Utrogestan — to protect the uterine lining. Estrogen on its own stimulates the lining to grow, and if it doesn’t shed, that build-up of cells can increase the risk of endometrial cancer. Progesterone balances this by ensuring the lining sheds safely.

It’s important to note this does not apply to vaginal estrogen. Local estrogen — whether cream, pessary, or ring — works only in the vagina, where it restores tissue health and elasticity. Because it stays local and does not stimulate the uterine lining, it does not require progesterone alongside it.

💡 What Progesterone Does

Protects the uterine lining by balancing the effects of systemic estrogen
Ensures the lining sheds safely, reducing the risk of endometrial cancer
Can help with sleep when taken at night — but that’s a bonus, not its main role

Progesterone may do even more than this, as Louise Newson has discussed on her podcast. Some doctors may recommend it to women without a uterus — not for lining protection, but for the other possible benefits that are still being explored.

What’s interesting is how this seems more common in the UK than in the US. One possible reason? The shadow of the Women’s Health Initiative (WHI). The WHI reported a higher breast cancer risk in women who took combined estrogen and a progestin (a synthetic hormone), compared to estrogen alone. But that study involved synthetic progestins — not body-identical progesterone like Utrogestan — and much of its data has since been reinterpreted or challenged. Still, the fear it sparked has lingered, and it continues to shape prescribing habits today.

Progesterone vs Progestins: What’s the Difference?

This distinction matters — and it often gets lost in the conversation.

Progesterone (like Utrogestan) is body-identical, meaning it’s chemically identical to the hormone naturally produced by the body. It’s generally considered safer.
Progestins are synthetic versions of progesterone. These were used in the WHI study and are not identical to the body’s own hormone. Some, like medroxyprogesterone acetate (MPA), have been linked to higher risks, which is partly why the WHI created such fear around HRT.

The trouble is, when the word “progesterone” gets used loosely to cover both, women are left confused — or worse, misinformed. Knowing the difference is critical.

That said, some doctors believe we shouldn’t vilify all progestins. They may still have a role in treatment for certain women, depending on individual needs, risk factors, and access to options. Like so much in women’s health, it’s complicated — and what works best often comes down to personal circumstances, clear communication, and weighing up the risks and benefits.

Why Communication Matters

I remember hearing on a podcast — and although I can’t recall for certain, I strongly suspect it was Louise Newson’s — that some doctors worry women aren’t “responsible enough” to take their progesterone. But here’s the irony: if they actually explained why it’s so important, don’t you think women would be far more likely to take it?

This is where the bigger problem comes in. Too often in medicine, particularly when it comes to women’s health, there’s still a lingering paternalism — a sense that women can’t handle the full story, or that we don’t need to know the finer details. Historically, women have been excluded from research, dismissed when describing their symptoms, and left out of key medical conversations. Progesterone and HRT are just another example of how the system sometimes decides what women “need to know” rather than giving us all the information and trusting us to make informed choices.

And that’s the heart of it: partial information is not good enough. Women deserve transparency, honesty, and respect when it comes to our health. Because when doctors hold back, whether out of caution, habit, or outdated thinking, the result is the same — women left in the dark, trying to navigate crucial health decisions without the full picture.

A Call for Partnership

It’s time to move away from a model where women are “protected” from the details and toward one where we are true partners in our own care. That means doctors explaining the why as well as the what, sharing risks and benefits openly, and trusting women to make informed decisions about their health. Because when it comes to HRT — and every other aspect of women’s health — we don’t just deserve better information, we deserve the full story.

Resources & Further Reading

📄 Websites & Guidelines

NHS – HRT: Types, Benefits, and Risks
British Menopause Society – HRT & Progesterone Guidance
North American Menopause Society (NAMS) – Hormone Therapy Statement

🎧 Podcasts & Articles

Louise Newson Podcast – Talking HRT and Progesterone with Avrum Bluming
Balance Menopause – Utrogestan FAQs

📝 Related Blog Posts

Vaginal Estrogen: The Simple Fix We’re Not Talking About — shining a light on GSM and the treatment too few women hear about

OMG: The Women's Health Brief