The other disadvantage of progestogen is that it may negate some of the advantages of oestrogen in preventing disease of the arteries. Oestrogen appears to reduce fats and cholesterols that circulate in the blood, and progestogen may increase them. So, as long as you need to take progestogen, you might not be getting the lowered risk of heart attack and stroke that you would get from oestrogen on its own. Encouraging news is that the newer forms of progestogens have only minor effects on blood fats.
By contrast, small quantities of progestogen help to prevent osteoporosis. There is also a possibility that it might slightly decrease your chance of developing breast cancer, but as some research has suggested otherwise it is difficult to be sure.
In conclusion, if you still have a uterus, the form of HRT you take must contain a progestogen, but with any luck the new non-oral low-dose varieties will reduce the side-effects, new progestogens may overcome many of the present disadvantages, and the future of no-bleed HRT looks hopeful.
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