Light bleeding on continuous HRT after a year without periods

[bowiemaestro]

Am 50. Went on sequential HRT about 3 years ago…all fine though periods a bit all over the place on it at the start.

Around a year ago I had a number of cycles with no breakthrough bleeding and also found I was struggling with sleep on non progesterone days. GP’s view was that it was fine to swap to continuous HRT - so I’ve been on it since.

No periods whatsoever until today when I’ve had some light bleeding. I also did a tough Pilates class so it could have something to do with it 🤦🏼‍♀️

Anyone experience similar?

Going through something similar albeit with cyclical hrt. I think it’s pretty common with hrt. I went to GP who referred me for a scan and I’ve also had a blood test. I’ve been advised to stop hrt for 6 weeks and see what happens. I’m finding it all quite unsettling but I’m telling myself that (I think) my chance of uterine cancer is about 1% which I’m finding comforting in the meantime. Wishing you all the best, probably best to speak to your GP.

@lampshade95 - thank you. It does feel quite unsettling and I will get it checked.

anyone else? X

If it's been a year without periods the advice is to get it checked out.
I'm in a very similar situation (am also 50) and was swapped to continuous HRT last summer, after missing some bleeds on the sequential.
I had a period in February this year and some spotting the last couple of months. I did see the GP who said I didn't meet the criteria for a scan as I wasn't post menopausal. But she suggested that they'd put me on combined HRT too early and if the bleeding continues they could put me back on sequential.

@Punxsutawney - thanks. Think I read online that the ‘any bleeding after a year of no periods needs investigation’ guidance doesn’t apply to those on HRT, as it can make things erratic (and the risks of uterine and ovarian cancer are significantly lower on HRT).

Not sure that’s correct though, but reassuring if so!

Interesting you have had a similar experience. How are things for you now?

Things seem okay thanks. It's probably a month or so since I've had any spotting. But I might return to the GP if it happens again.
Interestingly I was seen very quickly by the GP. I filled in the online triage form at 8am and was called about 20 mins later for an appointment at 9.30am. They seemed to take it seriously, although were less concerned, once they knew I was not post menopausal.
It does feel unsettling to have irregular bleeding, it's good that you're getting it checked.

Think I read online that the ‘any bleeding after a year of no periods needs investigation’ guidance doesn’t apply to those on HRT, as it can make things erratic (and the risks of uterine and ovarian cancer are significantly lower on HRT).

That's not quite right @bowiemaestro

It does apply to women on HRT but when starting continuous HRT, bleeding is expected for up to 6 months as the womb lining settles into a no-bleed pattern. It can take that long. (The risks of ovarian cancer are not reduced on HRT.)

Any bleeding after that needs a review or investigation.
The likelihood of it being endo cancer or hyperplasia are tiny because you are taking daily progesterone. The most likely explanation is you are not yet post menopausal.

Yo didn't fulfil the criteria for continuous HRT.
1- You were only 49
2 -You'd not gone 12 months without a natural period.

The guidance is
1- Aged 54+
OR
2- No natural period for at least 12 months

Also, not sure what you mean here..
Around a year ago I had a number of cycles with no breakthrough bleeding

On sequential you should have a regular withdrawal bleed every 4th week, on a cycle. Did this not happen or do you mean you had been bleeding in between the withdrawal bleeds for 3 years?

See your GP and you will most likely be referred for a scan but it might be worth going back onto sequential unless you're happy to have these blips as you're possibly not post meno.

@JinglingSpringbells - thank you for your reply, really helpful.

I will get it checked - but to answer your questions, for the first several months on sequential HRT I had a regular withdrawal bleed. They gradually petered out and then stopped altogether - which I gather is fairly normal.

When I spoke to the GP about it, he said it my own oestrogen levels had probably declined to the degree that the HRT dose probably wasn't quite 'topping up' enough to cause a withdrawal bleed. Given I hadn't had other symptoms return, but did struggle with insomnia on the progesterone free weeks, it was agreed that continuous HRT would be fine. I started this last October, and therefore hadn't had any bleeding at all for over a year...until now. It's actually exactly like a normal period since I posted yesterday - not heavy, but more than light spotting.

Weirdly I did have some ovulation symptoms a couple of weeks ago, so maybe this is just fluctuation.

They gradually petered out and then stopped altogether - which I gather is fairly normal.

It happens but it's not 'normal'. For various reasons I've used sequential for over 15 years (many years post meno) and I bleed every cycle. I know women in their 70s where they have the same.

It's true you need a certain level of estrogen to build up the womb lining, but you don't need your own as well to create a thicker lining- enough to shed.

I started this last October, and therefore hadn't had any bleeding at all for over a year

There is a difference here though. The no-bleed could be because you're one of the 25% of women who don't bleed at all on sequential - not because you were post menospausal.

Not bleeding on sequential (in your case) was because your womb lining was not stimulated enough by HRT estrogen and kept bleed-free by the 2 weeks each cycle of progesterone. Even if you'd have your own cycle in the background, it's quite possible that 2 weeks of progesterone were keeping the lining too thin to bleed.

So it's only just over 6 months since you started continuous (October to mid April.)

It's your choice over what too do next, but it's unlikely anything is amiss. More likely you're not post menopausal.

Thanks again @JinglingSpringbells for your expertise! I think you are right. Curious about this though - Not bleeding on sequential (in your case) was because your womb lining was not stimulated enough by HRT estrogen and kept bleed-free by the 2 weeks each cycle of progesterone - so if this is the case, what do you think is likely to be happening now? That my body is absorbing more estrogen, or that my own levels are fluctuating (if I am indeed not actually post-menopausal)?

I think it's more likely to be the latter.
It does appear your womb lining doesn't respond very much to estrogen on HRT. Or that you absorb progesterone well.

I have heavier withdrawal bleeds on HRT than I ever did ( before menopause) and that's on a medium dose of estrogen. But I also know other women on the same dose as me who barely bleed at all.

The only way for you to know what's going on would be to have a scan (with a consultant) to look at your ovaries and see if there are any follicles that are still active, if you've ovulated lately, or may do in the future.
This isn't likely to be offered on the NHS as your GP will probably just say leave all of this alone for the moment or maybe refer you for a simple scan of your womb lining.

Thanks again.

This is one of the things that worries me about HRT. I don’t have many symptoms (insomnia, anxiety and brain fog) and haven’t had a period for over 12 months.

Every now and then I consider HRT (usually due to the insomnia and early morning anxiety!) but would HRT likely cause bleeding?