Hello. From my understanding, all the research on controlling/preventing endo is with progestin which is synthetic form of P (ex norethidrone). however, with HRT, generally progesterone is recommended. I’ve had endo excision including removing my uterus and ovaries so I’ve been in surgical menopause and trying to figure out if I should stay on progestin or try progesterone. My questions are: 1. can progesterone also be helpful in controlling/preventing endo? 2. is it “safer” for someone with an endo history to take progestin over progesterone?
When should endometriosis be re-evaluated?
I’m 33years old. I was diagnosed with stage 1 endometriosis via laparoscopy in 2021 when doing fertility treatments. My symptoms were/are infertility, pain with sex,
November 5, 2025
Those are excellent and really thoughtful questions and ones that come up often after surgical menopause for endometriosis. You’re right that most of the research on suppressing or preventing recurrence of endometriosis focuses on progestins, which are synthetic forms of progesterone like norethindrone acetate or dienogest. They tend to have stronger and more predictable effects on suppressing endometriosis activity.
That said, natural micronized progesterone, the bioidentical form, is often used in hormone replacement therapy for its more favorable side effect profile and potential benefits for sleep, mood, and cardiovascular health. However, evidence that it suppresses endometriosis growth is much more limited compared to progestins.
For your specific situation after complete excision with removal of the uterus and ovaries, the risk of recurrence is lower, but residual microscopic disease can still respond to estrogen exposure. Because of that, many clinicians will continue a progestin rather than switch to progesterone, particularly if the goal is continued suppression of any remaining endometrial cells.
To summarize:
Progestin has stronger evidence for endometriosis control or prevention.
Progesterone is better studied for general HRT safety and tolerability but less proven in suppressing endometriosis.
The choice often depends on your symptom control, tolerance, and whether any residual disease was suspected at surgery.