HRT and bleeding explained - a British Menopause Society video

Dr Paula Briggs, Consultant in Sexual & Reproductive Health, Liverpool Women’s Hospital and Immediate Past Chair - British Menopause Society, answers these FAQs: What are the bleeding patterns that could be expected with HRT? I am taking a cyclical HRT preparation that is giving me a monthly bleed. Can I change to a non-bleed preparation? Is bleeding in the first few months of starting HRT a cause for concern? When does this need to be investigated? What are the causes of irregular bleeding in women on HRT? What investigations need to be carried out if I have ongoing irregular bleeding on HRT? Do I need to stop HRT or change how I take it if I have irregular bleeding on HRT?

[@beatricefrask5230]

Merci beaucoup! Ibam at 9 mm and the US it was no cause of investigation but when I went to France and to the ER, the intern immediately called for investigation.

[@charleedell92]

There is far too much fear around bleeding on MHT - it takes years to develop endometrial cancer, it doesn't just happen after a few months! Even in the past when estrogen alone was used, only a minority ever developed endometrial cancer. I do think women are being scared witless unnecessarily. The combined pill can also be a great option for under 50s - taken every day it can stop bleeding completely as well as treating vasomotor symptoms!

[@leea2112]

I agree !! I am 58 I have been on ovestin vaginal cream for 2 yrs for horrendous bladder and vaginal atrophy that my gp said is perfectly safe hrt I was very apprehensive going on it in the first place but she insisted eastrogen vaginal cream is very safe and I will be ok I use it everynight as I'm in so much pain with atrophy I started very light spotting for 2 weeks due to thrush as I was red raw inside and out after a gp examination i was never given an explanation that hrt cream can give you thrush and atrophy can make you spot too as soon as I used the canesten cream the spotting stopped virtually after 1st application! but this didnt stop my gp from sending me for a internal ultrasound which I was fine about but the sonographer then said oh your womb has thickened to 10mll this happens on hrt I was told by many woman taking it the sonographer said you will need a biopsy I said do you see anything nasty no but you will need to see a gyne !! so along I went to a gyne who tried to do a biopsy without any anesthetic i was told to take a paracetamol an hour beforehand honestly it was like being flayed alive!! But I lay there crying in pain but suffering it to get it over with She failed the biopsy!! then said I will now need a biopsy and a hysteroscopy to be flayed again!! And my app can take 30 weeks wait uk nhs!! I insisted on local anesthetic when I do eventually have this torture done to me again as I cannot take the pain what the failed biopsy did to me sent out in agony bleeding ect asked if I was wearing a sanitary pad by a nurse then thrown out to just find my way home !! I was crying and nearly passed out with pain an elderly lady had been there before me came out crying and collapsed!! Its time this horrendous flaying of woman stopped if it was a man recieving a vasectomy it would be all bells and whistles for them I'm terrified of what they are going to put me through again I cannot eat , sleep, function I'm living in fear lost 2st in weight due to no appetite through the trauma the gyne put me through I'm still breaking down crying daily my mental health is failing me with fear and the nhs think this is acceptable!! 😢😢😢😢😪

[@beatricefrask5230]

So sorry to hear.

[@suzannesutton5636]

So sorry you went thru this!

[@sunshinejones8643]

How does one know if they have fully entered menopause if on cyclical HRT. I am on cyclical, yet my periods appear to be irregular i am 54

[@nohemiwest-phelps534]

How would you evaluate if you need more progesterone versus less estrogen? what target numbers would you look for in testing?

[@jennysiepka9900]

different drs have different opinions... I know one of my favorites (elise Gersh) says that she likes to see estradiol level around 100. This is higher than what others say. I think the average is somewhere between 50-80...

[@nohemiwest-phelps534]

@@jennysiepka9900 Thanks! I was using .05 patch and progesterone 200 mg and my estrogen levels were 48 and I started spotting. We increased my progesterone to 400 mg but it made me anxious. My doctor switched me to .03 patch and my menopause symptoms started coming back mildly so now I am back to .05 and my progesterone is at 300mg and I feel good and no more spotting.

[@gatosemgrife]

Hi! I'm from Brazil. I used contraceptives continuously for almost 20 years without menstruating (Tâmisa 15). Stopped in January 2024 I am 52 years old. I started my continuous combined HRT on 04/06/2024 with 1 pump of Oestrogel and 100mg of Utrogestan. On 25/10/2024, I increased to 2 pumps of Oestrogel, while maintaining 100mg of Utrogestan. On 11/10/2024, I started to have bleeding. I did an ultrasound on 19/10/2024 and they diagnosed an endometrium thickness of 1.6cm (it was with normal thickness1 year before ) On 23/11/2024 I decreased to 1 pump of Oestrogel and 100mg de Utrogestan On 01/12/2024, I am still experiencing bleeding (21 days). I have two questions: Will the thickness of my endometrium be able to return to acceptable levels even without stopping HRT, that is, just by adjusting the doses of estradiol and progesterone? Would the following dosage be a safe possibility for continuous combined HRT to try to stop the bleeding and return to an adequate thickness of the endometrium in my case? Estradiol Dose: 0.5mg Sandrena Progesterone Dose: 200mg Gynpro (continuous)

[@ApostleAliciaKee]

Your progesterone was too low to oppose the estrogen. It also takes a few months to reset proper hormone levels that your body was used to working with before perimenopause or menopause. Progesterone levels are the first to drop in perimenopause; therefore it is most likely you had too low progesterone. If you are cyclic, withdrawal bleeding is expected. You may find that 300mg of micronized progesterone alleviates premature withdrawal bleeding (fake period). Another option may be continuous progesterone to oppose the estrogen throughout the month. This can be done orally or with an IUD. Unless you understood what levels were optimized for you in your twenties or thirties, you will need a few months to play around with dosing to get it right. What we took for granted in that our bodies did naturally, we think we can get it right on the first few tries in replacement. That is very rarely true in any given scenario (whether HRT, thyroid, or any other medication). Medicine is trial and error; it is different for everyone. Don’t be afraid to relearn your body and experiment with guided research and not by misguided fears.

[@DeborahAdams-d1l]

Bleeding on hrt tablets and gel,can I use tampons

[@barbaratankersley7117]

Hi i have had a D C because of bleeding on HRT Still after DC I'm still bleeding on HRT What is the answer to bleeding after surgery? Is it to much of one of the the HRT ?

[@beatricefrask5230]

I have the same problem.

[@magellagoldstein]

@@beatricefrask5230 me too

[@jackicrew5849]

Prescriptions of hormone therapy have really gotten out of hand. Someone needs to look into regulation and oversight of this long term usage. I had to watch my mother deteriorate for years thanks to incorrect dosing. She still can't eat right and her teeth are falling out. This stuff can cause osteoporosis in females and basically turns men into angry robots who eat like there is no tomorrow and can only think about sex. This is unnatural and I hope to God some regulatory agency steps in and manages these doctors.

[@ApostleAliciaKee]

Bahahaha What are you talking about? Proper hormone replacement at the correct dosage DOES NOT cause osteoporosis. It is very likely your mother was not given the correct dosage to prevent bone loss. There is a minimum dosage uptake depending on the route (oral, transdermal or vaginal). Dosage is also dependent on whether bioidentical is selected versus synthetic. Secondly, it most countries, HRT IS regulated. Please women do your research and find a menopausal expert. Listen to your body and find what works for you. There is NO RESEARCH suggesting HRT Causes bone loss; conversely, the research supports it prevents bone loss.