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Breakthrough bleeding on HRT

It is common to have irregular bleeding on HRT.

It may take 3-6 months for bleeding to settle after starting HRT and also when you change the preparation. Some preparations will give a cyclical bleeding which is predictable and expected.

Majority of women will have no underlying serious cause

If symptoms persist beyond 6 months it is advised to see your GP or practitioner to have pelvic ultrasound scan if necessary biopsy of the endometrium. Always remain up to date with your cervical screening. You may need examination by a specialist or GP and in some patients where the lining of the uterus is thickened hysteroscopy may be needed to find the cause of bleeding.

In most women the bleeding can be managed by altering the dose and route of the hormones.

Talk to a healthcare professional to help in managing the type and dose of the hormones. Some women may notice reduction in bleeding by increasing the dose of progesterone or reducing the dose of oestrogen. Progesterone can also be given as a hormone coil in the womb called Mirena and is less likely to have bleeding.

In early stages of menopause, it is recommended to take sequential HRT which gives cyclical bleed and later switching to continuous preparation. This will avoid the irregular bleeding pattern in the earlier stages of menopause.