In estrogen-only hormone replacement therapy for a patient with an intact uterus, which step is recommended to reduce endometrial cancer risk?

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Multiple Choice

In estrogen-only hormone replacement therapy for a patient with an intact uterus, which step is recommended to reduce endometrial cancer risk?

Explanation:
Estrogen stimulates endometrial growth, so in someone with an intact uterus, estrogen-only HRT increases the risk of endometrial hyperplasia and cancer over time. Adding a progestogen counteracts this by transforming the endometrium to a secretory state and promoting regular shedding, which limits proliferation. This endometrial protection is why a combined estrogen–progestogen regimen is recommended for someone with a uterus. If the uterus had been removed, estrogen alone would be appropriate. The other options don’t provide this protective effect against endometrial proliferation.

Estrogen stimulates endometrial growth, so in someone with an intact uterus, estrogen-only HRT increases the risk of endometrial hyperplasia and cancer over time. Adding a progestogen counteracts this by transforming the endometrium to a secretory state and promoting regular shedding, which limits proliferation. This endometrial protection is why a combined estrogen–progestogen regimen is recommended for someone with a uterus. If the uterus had been removed, estrogen alone would be appropriate. The other options don’t provide this protective effect against endometrial proliferation.

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