Bleeding on Menopause Hormone Therapy and a Proliferative Endometrium

I’ve noticed several questions here on The Vajenda from women on menopause hormone therapy (MHT) about bleeding and an endometrial biopsy that is reported as proliferative endometrium. They have been told this is normal and nothing else needs to be done; they also have not received an answer about their bleeding.

Proliferative endometrium in menopause is not an expected or reassuring finding in menopause, and this is true whether someone is taking MHT or not. While it is not something to panic about, it is a sign that the uterus is receiving too much estrogen relative to the progestogen (progesterone or progestin). While it is benign and not cancer, it is a risk factor for cancer and needs to be managed appropriately.

The Postmenopausal Endometrium

After menopause, and without menopause hormone therapy, the lining of the uterus or endometrium should be atrophic, meaning thin, with no dividing cells. This is because estrogen stimulates the lining to grow, so without estrogen, the cells gradually shrink and become inactive.

Proliferative endometrium is what happens when the uterine lining is exposed to