From the Research
The endometrial lining should be shed approximately every 1-3 months in individuals who don't have regular menstrual cycles, as supported by the most recent evidence from 2022 1. For those not menstruating naturally, this can be achieved through a progesterone withdrawal regimen. The importance of regular shedding is highlighted by the risk of endometrial hyperplasia and cancer associated with unopposed estrogen stimulation, as discussed in a 2020 study 2. Key factors that increase the risk of endometrial hyperplasia include obesity, chronic anovulation, and polycystic ovarian syndrome, whereas the use of oral contraceptive pills or progesterone-containing intrauterine devices can decrease this risk, as noted in the 2022 review 1. A 2016 study emphasizes the need for therapeutic options in managing endometrial hyperplasia, particularly for those wishing to preserve fertility 3. In terms of treatment, a 1999 study showed the effectiveness of combined therapy with progestogens and gonadotropin-releasing hormone analogues for atypical endometrial hyperplasia 4, while a 2004 Cochrane review highlights the importance of adding progestogen to estrogen therapy to reduce the risk of endometrial hyperplasia and improve adherence to therapy 5. Given the potential for progression to endometrial cancer, regular monitoring and appropriate management are crucial, with hysterectomy being the definitive treatment for endometrial intraepithelial neoplasia (EIN), as outlined in the 2022 Clinical Expert Series 1. Therefore, regular shedding of the endometrial lining every 1-3 months is recommended for individuals without regular menstrual cycles, with the choice of treatment depending on individual risk factors and the desire to preserve fertility.