Comparison · hormone optimization

Estrogen-Only vs Estrogen + Progesterone HRT

Estrogen-only HRT is appropriate after hysterectomy. With an intact uterus, progesterone is required for endometrial protection. Selection is dictated by uterine status, not preference.

Reviewed by Dr. Laura PurdyMay 29, 2026

Attribute

Estrogen-only HRT

Estrogen + progesterone HRT

Endometrial protection

Not required (post-hysterectomy)

Required (intact uterus)

Candidacy

Post-hysterectomy only

Intact uterus

Progesterone form

—

Micronized progesterone preferred

Cadence

Daily estradiol

Daily estradiol + nightly progesterone

Sleep benefit

—

Micronized progesterone often improves sleep

Choose Estrogen-only HRT

Estrogen-only HRT is appropriate when the uterus has been surgically removed.

Explore pathway

Choose Estrogen + progesterone HRT

Estrogen + progesterone HRT is required whenever the uterus is intact, regardless of menstrual status.

Explore pathway

Educational. Final pathway selection is provider-reviewed via synchronous video consultation against your biomarkers, history, and goals.

Frequently asked

Why is progesterone required with estrogen?

Unopposed estrogen on an intact endometrium increases endometrial cancer risk.

Is micronized progesterone preferred?

Yes — it has the most favorable safety profile and additional sleep benefits.

Next step

Take the optimization assessment.

The adaptive assessment maps your symptoms, history, and goals to candidate pathways — and routes you into provider review.

Begin assessment