Estrogen Therapy Without Progesterone: When Hormone Prescribing Errors May Lead to Endometrial Cancer

South Carolina Medical Malpractice Attorneys for HRT Related Uterine Cancer

Hormone replacement therapy (HRT) has helped millions of women manage bothersome menopausal symptoms, including hot flashes, night sweats, sleep disruption, and vaginal dryness. When prescribed appropriately, hormone therapy can significantly improve quality of life. However, like every medication, it must be prescribed according to well-established medical standards.

One of the most widely recognized principles of menopausal hormone therapy is that women with an intact uterus who receive systemic estrogen generally should also receive a progestogen to protect the lining of the uterus. Estrogen alone stimulates growth of the endometrium. Without the opposing effect of progesterone, prolonged exposure may lead to endometrial hyperplasia and can increase the risk of endometrial cancer.

At Steinberg Law Firm, we investigate claims involving women who allegedly developed endometrial cancer after being prescribed estrogen without appropriate endometrial protection. Every case is unique and requires expert medical review, but when healthcare providers fail to follow accepted medical standards and a patient suffers preventable harm, a medical malpractice claim may exist.

Why progesterone matters

The American College of Obstetricians and Gynecologists (ACOG) explains that women who still have a uterus and take systemic estrogen therapy generally should also receive a progestin because estrogen alone increases the risk of endometrial cancer while progesterone substantially reduces that risk. Hormone therapy decisions should be individualized and reviewed regularly with the patient.

The relationship between unopposed estrogen and endometrial cancer has been recognized for decades and is one of the foundational principles taught in gynecology and menopause management.

Two concerning situations

We recently became aware of several situations involving unopposed estrogen administration. The first matter involved a woman in her 40s who reportedly received estrogen therapy from an urgent care physician assistant. According to the information provided, she continued taking systemic estrogen for approximately three years without progesterone despite having an intact uterus. She was later diagnosed with endometrial cancer.

The second matter involves an 80-year-old woman who reportedly remained on systemic estrogen without progesterone for approximately one year before developing endometrial cancer. Current menopause guidance generally recognizes that initiating systemic hormone therapy after age 60 or more than 10 years beyond menopause requires careful individualized consideration because risks and benefits change over time.

These reports do not establish malpractice by themselves. However, they raise important questions regarding whether the standard of care was met, whether the patient’s surgical history was confirmed, whether hormone therapy remained medically appropriate, and whether the patient received appropriate counseling and follow-up.

When can a prescribing error become malpractice?

Not every complication from medication constitutes negligence. Likewise, a cancer diagnosis alone does not prove malpractice. Medical malpractice cases require qualified physician experts to evaluate whether a reasonably careful healthcare provider would have acted differently under similar circumstances and whether the prescribing decision contributed to the patient’s injury.

Potential evidence may include prescription records, office notes, informed consent documentation, pathology reports, pharmacy records, and expert testimony.

The Impact of Endometrial Cancer

Treatment often includes hysterectomy, removal of the ovaries and fallopian tubes, possible lymph node removal, radiation therapy, chemotherapy, ongoing surveillance, lost income, emotional distress, and significant medical expenses. Younger women may permanently lose the ability to have children.

Warning Signs of Endometrial Cancer

Early diagnosis often improves outcomes.

Women taking estrogen therapy should promptly report symptoms such as:

• Postmenopausal bleeding
• Bleeding between menstrual periods
• Unusually heavy menstrual bleeding
• Pelvic pain or pressure
• Abnormal vaginal discharge
• Persistent pelvic discomfort

Any postmenopausal bleeding should be evaluated promptly by a healthcare provider.

How Steinberg Law Firm can help

Medical malpractice cases involving hormone therapy are medically complex. They often require consultation with specialists in gynecology, oncology, endocrinology, pathology, and pharmacology. Our attorneys work with qualified medical experts to determine whether accepted standards of care were followed and whether preventable prescribing errors contributed to a patient’s injuries.

If you or a loved one developed endometrial cancer after being prescribed systemic estrogen without progesterone while still having an intact uterus, contact Steinberg Law Firm for a free consultation. We can review your medical records, consult appropriate experts, and explain your legal options.

Medical Sources

• American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
• American College of Obstetricians and Gynecologists. Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia. https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/09/management-of-endometrial-intraepithelial-neoplasia-or-atypical-endometrial-hyperplasia
• The Menopause Society. 2022 Hormone Therapy Position Statement. https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf