Can a 49-year-old female patient without a uterus take progesterone?

No, a 49-year-old woman without a uterus does not need progesterone

Women who have had a hysterectomy should receive estrogen-only therapy, not combined estrogen-progesterone therapy, as the sole purpose of adding progesterone is to protect against endometrial cancer—a risk that does not exist without a uterus. 1

Why Progesterone is Unnecessary After Hysterectomy

The primary—and essentially only—reason to add progesterone to menopausal hormone therapy is endometrial protection. The evidence is clear on this point:

• Unopposed estrogen increases endometrial cancer risk in women with an intact uterus, with a 6-fold increased risk after 5+ years of use 2
• This risk is eliminated in women without a uterus, making progesterone supplementation medically unnecessary 1
• The U.S. Preventive Services Task Force explicitly distinguishes treatment recommendations based on uterine status, recommending estrogen-only therapy for post-hysterectomy patients 1

Potential Harms of Unnecessary Progesterone

Adding progesterone when it's not needed exposes patients to avoidable risks without benefit:

• Combined estrogen-progesterone therapy increases breast cancer risk compared to estrogen alone, with adequate evidence showing a small increase in both breast cancer incidence and mortality 1
• Estrogen-only therapy actually reduces breast cancer risk, with approximately 8 fewer cases per 10,000 person-years compared to no treatment 1
• Both regimens carry similar risks for stroke, DVT, gallbladder disease, and urinary incontinence, but adding progesterone provides no additional protection against these outcomes 1

Clinical Algorithm for Hormone Therapy Decision-Making

For women WITHOUT a uterus:

• Prescribe estrogen-only therapy (e.g., oral conjugated equine estrogen 0.625 mg/day or transdermal 17β-estradiol) 1
• Do NOT add progesterone 1

For women WITH a uterus:

• Prescribe combined estrogen-progesterone therapy 1, 2
• Use continuous progesterone (daily) rather than cyclic regimens, as continuous use reduces endometrial cancer risk (OR 0.2 after 5+ years) while cyclic use increases it (OR 2.9 after 5+ years) 2

Common Pitfall to Avoid

The most common error is reflexively prescribing combination therapy to all menopausal women without confirming uterine status. Always verify whether the patient has had a hysterectomy before prescribing hormone therapy, as this fundamentally changes the appropriate regimen and risk-benefit profile 1.