Do you recommend progesterone for endometrial protection in a young woman on estrogen replacement therapy for iatrogenic menopause after definitive radiation therapy for locally advanced cervical cancer?

For women with a uterus, I give a combination of estrogen and progesterone therapy, even after definitive radiation therapy. Transdermal preparations have the advantage of bypassing first-pass effect of the liver, but oral combinations are also acceptable.

Our group published a relevant review on this topic

Pepin et al., PMID 39448037

A potential algorithm a clinic can use is reproduced here

Fig. 1. Practical approach to initial diagnosis and management of radiation-induced premature ovarian insufficiency (POI) in a radiation oncology practice.