Bleeding on hormone replacement therapy (HRT) can sometimes be concerning, but is usually not serious. There are a few key points to understand:
- Irregular bleeding is common when starting HRT. The uterus and ovaries are very sensitive to changes in hormone levels. It takes time for the body to adjust.
- Breakthrough bleeding - light unexpected bleeding between cycles - often resolves on its own within 6 months as the body adapts.
- Heavy, prolonged bleeding past 6 months is not normal and should be evaluated.
Causes of abnormal bleeding on HRT:
- Hormone imbalance - Estrogen and progesterone levels may need adjustment
- Infection - Endometritis, cervicitis
- Polyps or fibroids - Benign growths in uterus or cervix
- Hyperplasia - Thickening of the uterus lining
- Cancer - Very rare. Uterine or cervical cancer.
When to see a doctor:
See your doctor if you have any of the following:
- Prolonged heavy bleeding
- Bleeding after 6 months on the same HRT regimen
- Bleeding after menopause
- Bleeding accompanied by pain or fever
- Foul-smelling discharge
To evaluate bleeding, the doctor may order:
- Pelvic exam
- Endometrial biopsy - takes a sample of the uterine lining
- Ultrasound
- Hormone level blood tests
Treatment depends on the cause but may include:
- Changing HRT dosing or formulation
- Antibiotics for infection
- Surgery - D&C, polypectomy, hysterectomy (rarely needed)
The good news is
most cases of HRT-related bleeding are not serious. Breakthrough bleeding often settles with some patience as your body adjusts. However, it's important to monitor and report troublesome bleeding to your doctor. Working together, you can find the right hormonal balance for your body.
I aimed to provide an overview of the key issues related to bleeding on HRT without use of advertisements or restricted formatting. Please let me know if you need any clarification or have additional requests!
