The Truth About Bleeding On Hormone Replacement Therapy

Dr. Helen Hirsch talks us through what’s normal and what’s not:

In the blood

We’ve all been there for one reason or another: it seems we are past any threat of bleeding, and then by surprise, lo and behold, we find we’ve got the flag of Japan in our underwear.

There are many reason why this can be. For example, irregular bleeding is a normal hallmark of perimenopause, so periods may become unpredictable in timing, frequency, and heaviness.

As for where that line is drawn: bleeding after 12 consecutive months without a period is considered postmenopausal bleeding and should be distinguished from the irregular bleeding that commonly occurs during perimenopause.

After that, causes can include:

• Ovulation after starting hormone therapy (HRT): some people may unexpectedly ovulate after beginning hormone therapy, even if they have gone one or more years without a period. Bleeding that feels like a normal menstrual period, especially if accompanied by familiar symptoms such as breast tenderness, may result from ovulation.
• Fibroids and uterine polyps: benign fibroids and polyps can cause bleeding, because HRT stimulates the tissue within the uterus. Polyps are especially likely to bleed because they contain many blood vessels.
• Bleeding after vaginal penetration: bleeding can result from cervical polyps, vaginal or uterine atrophy, or small tears caused by physical trauma. Vaginal atrophy is mentioned as being the most common cause of postmenopausal bleeding.
• Hormonal bleeding: hormone therapy itself can cause the uterine lining to build up and shed, producing benign bleeding that does not necessarily indicate a problem or require stopping treatment.
• Uterine cancer risk: although cancer is an important cause that should not be overlooked, it is considered the least likely explanation for bleeding if you are using appropriate HRT including adequate progesterone (which is protective).

For more on all of this for once absolutely no visual demonstrations, enjoy:

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Take care!