The rise in HRT use in recent years means that more women are experiencing relief from distressing and disturbing menopausal symptoms.
However, unscheduled uterine bleeding is a common side-effect of HRT use, so this increase has also led to increased numbers of menopausal women experiencing troublesome bleeding.
Starting HRT may cause bleeding, usually waiting for 3-6 months to see if bleeding settles is ok if there are no factors alerting the clinician that it needs to be investigated sooner. If bleeding is persistent lasting longer than 6 months without settling, happening after sex or starting more than 1 year after the last period occurred, having a feeling of pain or pressure would normally warrant further investigation.
The oestrogen component of HRT causes endometrial proliferation, and the progestogen suppresses growth and induces endometrial atrophy (and therefore stops bleeding). Erratic bleeding is common in the first 6 months of HRT use or within 3 months of a change in dose, affecting around 40% of users.
Mechanisms that lead to abnormal bleeding on HRT are poorly understood, and may relate to hormones stimulating existing pathology, for example endometrial polyps that may be a common cause of bleeding.
Not taking HRT correctly or poorly absorbing it may affect bleeding patterns. Some medications may also affect the way HRT works.
If you experience unscheduled bleeding during HRT use , discuss this with a clinican experienced in Menopause, often altering your doses or formulations may be all that is needed. I specialise in menopause care, if you have been started on HRT and not been reviewed or don't feel confident that your treatment is right for you
Getting it right first time isn’t an exact science as we are all different, this is why an individualised approach is important.
Regards
Amanda
