Regular bleeding on continuous HRT.

[ConstantlyFuriosa]

I’ve been taking continuous HRT - daily oestrogen (2 pumps) and 100mg tablet of progesterone since 2023. In the early days I had some spotting and irregular bleeds and knew that might be the case. Three years on and I have what seems to be a ‘period’ at least once a month; sometimes every fortnight? It’s not heavy but can be heavy enough to use tampons for a couple of days.

the blood is regular colour; not too dark and it’s not massively heavy, but as I say, enough to use tampons.

Is this normal on continuous HRT?

How old are you? I think it depends- if you are still perimenopausal your own cycle could still be going on also. If you are post menopause you need to get it checked.

Post. Last proper period in 2022.

The most obvious reason is if this is regular bleeding, you were not post meno when you thought you were.

How old were you in 2022 when you had your last period? That means nothing- no spotting etc for a whole year at least.

Did you go straight onto continuous hrt after 12 months with no period?

If you were under 50 when you had your last period it's possible they can restart even after a 12 month gap and if you were on hrt you might not know.

In any case you need to have a scan- see your GP.

Last period about a day before my birthday in 2022. Nothing for a full year. Started HRT in 2023 when my hair started falling out. A bit of spotting, with the odd ‘sort of period’ which I know was my body adjusting. Then a bit of spotting here and ther3 and suddenly this year, a ‘period’ almost twice a month.

I hate seeing the gp. I suppose I must.

Youve not said how old you are.

In younger women their periods can sometimes come back after 2 years- (this is especially relevant to young women with premature menopause.)

Ok so the early menopause doesn't apply.

No, I’m definitely post. Or in menopause? I think it’s post when your periods have stopped? This bleeding is so annoying. I was so happy to not have them any more.

I experienced something similar. Bleeding can be common in the first few months after starting, increasing or changing systemic HRT, however beyond that it would be best to see your doctor about it.
Options might be to either increase the Utrogestan dose i.e. doubling it (or switch to a Mirena coil which can be more effective and controlling bleeding) or referring you for investigation to see if there are any causes of the bleeding, for example polyps or fibroids.

I thought it was the progesterone that provoked the bleeding? So wouldn’t increasing that make it worse?

I think bleeding is prompted by a drop in progesterone after a peak. The body detects falling levels and that’s what stimulates the uterus to shed. Having a too-low progesterone component in HRT can have the same effect. So increasing the dose and keeping it high should stave off the bleeding.
I had a similar problem on continuous HRT. Two periods a month on average. Had the scans, hysteroscopy etc…all normal. Gyno said my progesterone dose was probably too low. I’m back on a cyclic regimen now and waiting to see how it settles down.

Thank you, @HearMeSnore thats really helpful and reassuring.

I'm in exactly the same boat. I've had 2 light, week long bleeds in the last 3 weeks. I'm having an ultrasound tomorrow to investigate. The doctors don't seem to know what is causing it & don't seem to want to try to solve it. They just keep sending me for repeated ultrasounds & hysteroscopies.

Hope you get a better resolution - but definitely see your doctor. They're hopefully better than mine!

I had bleeding. Saw GP - referred to hospital for ultrasound to check thickness of lining. Then to gynae clinic for further investigation - in my case all was fine. Definitely get it checked up for reassurance. I was told to stop taking hrt while undergoing investigation which was about 6-8 weeks for me.

Sorry to hear you’re going through it, @LurkyLarry . Please keep us updated as to your results.

@Duchessofmuchness i know this makes me sound like a pillock, but i just hate the whole investigation thing. Glad you had a good outcome. Why do some of us bleed like this, though?

I’m sure if we were blokes we wouldn’t even need to ask. #medicalmisogyny

I think the worst bit is getting the appointment set up with GP. Receptionist made appointment for same day so and you are in the process it’s worrying but just got to go along with it. I actually can’t remember what was causing mine … but the key thing was nothing sinister. Gynae gave me additional oestrogen pessary and sent me on my way. And then you feel great cos it’s sorted! Like a personal MOT

No, oestrogen thickens the womb lining which can lead to bleeding, progesterone thins it. You may need more or a mirena

Some women need more or stronger progesterone (or synthetic progesterone) to keep the womb lining thin. Hence why increased progesterone is the first thing to try. So 2 Utrogestan instead of one per day.

Some women have fibroids, or polyps or a 'bulky womb' which causes bleeding. Obesity can also cause it, according to my menopause specialist.

I had bleeding every two weeks like you. I had a hysteroscopy under GA and they discovered I had a bulky womb and a large fibroid. They put a Mirena Coil in which stopped the bleeding. Before that I had tried increasing Utrogestan and taking Provera which is synthetic.

You could try increasing your progesterone - this is the BMA advice. If that doesn't work they would refer you for a scan. As it's been going on for so long they might refer you for a scan first.

Progesterone , when it's withdrawn, causes the womb lining to shed.
Same as in a normal cycle ( without HRT) when no conception occurs.
Progesterone is produced for around 14 days (2nd half of a month.)

Utrogestan is part of fertility treatment in larger doses. It stop the womb lining breaking down and loss of the embryo.

Progesterone controls the womb lining. If not enough is used to oppose the estrogen, or for example if it were stopped then bleeding can occur.
100 is usually enough for 2 pumps estrogen, however some women need more.
Or the case of the OP, the bleeding might be caused by something else

I think I may try increasing the Utrogestan and if that doesn’t work, go see the gp. It’s not just laziness. I have social anxiety that stops me doing lots of things I should.

Thank you for the replies.

I’ve attached the guidelines which you can use to refer to when you see your doctor
https://www.womens-health-concern.org/wp-content/uploads/2026/06/33-NEW-WHC-FACTSHEET-Management-of-unscheduled-bleeding-on-HRT-MAY2026-B.pdf

Note that any changes should be given three months and then reviewed