We have recently settled a claim on behalf of a 57 year old woman where negligence on behalf of a GP in the prescription of HRT (hormone replacement therapy) led to her needing a hysterectomy.
Around 2019, Mrs A. began experiencing menopause-related symptoms of hot flushes, sweating, low mood and low libido.
Between August 2019 and July 2023 Mrs A. was prescribed a variety of brands of HRT, all of which contained both oestrogen and progesterone. Where they were oestrogen only, then progesterone was prescribed alongside it.
In 2021 a pelvic ultrasound scan Mrs A. underwent to investigate post-menopausal bleeding showed a thin endometrium at 2.1mm.
In July 2023 Mrs A. went to see her GP as her menopausal symptoms had become worse. Her GP increased her Evorel patches from 50mg to 75mg . However, her Utrogestan (progesterone) capsules were not prescribed in conjunction with the Evorel 75 oestrogen-only patches. This prescription was repeated in November 2023.
In May 2024 Mrs A. consulted her GP again about post-menopausal bleeding. The GP again did not notice that she was taking oestrogen-only HRT but did refer her for an ultrasound scan. The scan showed a heterogeneous and thickened endometrium (lining of the womb) for a post-menopausal woman, suggestive of hyperplasia (abnormal thickening of the endometrium).
On review of the scan report, the GP noticed that Mrs A. had been taking unopposed oestrogen and advised her to stop. An endometrial biopsy showed atypical hyperplasia but fortunately no evidence of malignancy. However, in view of the increased risk of malignancy in the client’s uterus, a total hysterectomy was recommended which was carried out in February 2025.
Mrs A. instructed Stone Rowe Brewer LLP to investigate a claim against the GP who had prescribed the unopposed oestrogen HRT in July 2023. We obtained a report from an independent expert GP on breach of duty. The GP expert’s opinion was that no responsible body of GPs would support both the initial failure in July 2023 to prescribe a progesterone to the client, which was also missed by other GPs at 2 subsequent follow up appointments. His opinion therefore supported the legal test for breach of duty.
A further report was obtained on causation from an expert gynaecologist. His report confirmed that the client’s exposure to oestrogen without progesterone in conjunction had caused the endometrial hyperplasia and an increased risk of cancer. This risk of unopposed oestrogen in post-menopausal women has been recognised since the 1970s and was firmly established in the 1990s with a large randomised controlled trial[1]. With the atypical hyperplasia, the client had an estimated risk of early endometrial carcinoma of between 37 – 45% (compared to less than 1% associated with her previously thin endometrium in 2021). It was because of this large increase in risk that it was recommended that the client had a total hysterectomy to prevent the occurrence of endometrial cancer.
A Letter of Claim was sent to the GP who originally prescribed the unopposed oestrogen and in their Letter of Response, liability was admitted. The client accepted a settlement offer of £30,000 from the Defendant.
[1] The Writing Group for the PEPI Trial. Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estro-gen/Progestin Interventions(PEPI) Trial. JAMA. 1996 Feb 7;275(5):370-5.