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?

Thanks @over50andfab

I feel like a bit of a twat, asking on the inter web and not just going in for a check up. But. But. But…

i also thought at times it might be down to stomach upset because I get that quite often. So TMI - possible IBS meaning less progesterone absorption. Or something. I think I wanted to hear if anyone else had experienced it too, so if I get a shit GP I’ve got backup info.

I had the exact same experience, except when I stopped the HRT as requested before the scans etc, the bleeding completely stopped!

Turns out HRT had been making me bleed twice a month for 4 or 5 years. Also because I started HRT in perimenopause I was never actually sure when or if my periods had stopped.
I'm now considering mirena coil for HRT or stopping all HRT all together. I'm 57.

I doubt IBS affects it as it's absorbed very quickly- within an hour or so.

7.5mm endometrium unfortunately, so I'm fully back on the investigation pathway again ( 4th time in the last 5 years I think ). Problem is, as soon as they decide it isn't cancer, they lose interest. Nobody seems to know what to do with me! Please send some good news stories our way people!

Guidance is to increase the dose of progesterone if tests show nothing abnormal.

It infuriates me that some GPs are unable to read and follow the BMS guidance on this. It's clearly set out as a table.

My doctor let me do this for a few months over the winter. It didn't stop the bleeding but massively reduced it. She then decided I had to go back to one tablet. Surprise surprise, now I'm bleeding every other week... 🤬

Ah this thread is just what I was looking for. On HRT for 5 years - started when last Mirena removed so presumed peri not post. In last year or so getting regular dark bleeds. Usually at least twice a month. Lots of pelvic floor pain too - suspect it’s ‘guarding’ muscular pain but also have IBS-d. Have had transvaginal ultrasound. Found smallish extramural fibroid. Saw gynaecologist and she confidently said fibroid wasn’t causing bleeding. Have Hashimotos and various autoimmune conditions. Doc upped progesterone and I decreased from 3 to 2 pumps oestrogen. Doc saying Mirena not advised due to location of fibroid. Getting through boxes of sanipro every month and am so fed up. Thinking of coming off HRT completely but not sure how to do that so guess yet another trip to GP needed. It’s miserable isn’t it OP 😔

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?

this could be me! I’m 57 and take exactly the same HRT as you do. Reported the bleeding to doctor Had a scan last year and everything ok but the monthly bleeding continues. Doctor told me that some women bleed longer in life than others! Bit fed up with it now

I’m relieved it isn’t just me but sorry to hear so many are dealing with it. And that sounds awful, @Sparkletastic . So much going on, there.

I am going to have to bite the bullet and see the GP to rule things out, but given some on here are no closer to stopping the bloody bleeding, I’m not hopeful I’ll be given much of a resolution.

I don’t want to come off HRT because I certainly feel better on it, other than all these blasted periods. Really thought my tampon-buying days were over.

Can I ask anyone who might know, because the info is slightly confusing. If you’re upping progesterone how does this help with stopping bleeding? Because I thought it was the progesterone that made you bleed, given it’s taken to thin the uterine lining.

So if I go up to 200g won’t I bleed more?

I trialled 200g last night because I’ve been having terrible trouble sleeping again and know when I first started it it had a wonderfully sedating effect. I’ve now realised that it gave me headaches at the base of my skull originally (which stopped after a while). But I had one last night again. At the time I attributed the headache to melatonin.

The progesterone helps counteract the thickening of the lining which is caused by the oestrogen. So if you increase the progesterone to daily the lining will not be as thick and therefore less bleeding. less lining equals less bleeding.

I take 200mg a day because I have endometriosis.

Okay, thank you @Thesearenotthedroidsyouarelookingfor . I think I get it more now. I’ve been on continuous since I started so 100g daily. Actually I used to just take one pump of the oestrogen. I can’t recall when I switched up to two pumps but it’s possible that caused more bleeding if I didn’t also up the progesterone?

Yes it’s possible. When I took sequential HRT my period would come the day after I stopped the progesterone patch. When I moved to continuous HRT my oestrogen went up and the progesterone but my endometriosis got worse so consultant said to double progesterone. I’ve also now reduce the oestrogen a bit and stayed on 200mg progesterone. It’s all been a bit trial and error!

Yes, it is trial and error. Am a bit worried that if 200g doesn’t agree with me for whatever reason and I go back down, I’ll get loads more bleeding or withdrawal effects.

If I were you I would ask for a blood test, look at your oestrogen and progesterone levels and the range for post-menopausal women, and then adjust your doses accordingly. I'd say you are taking a lot of oestrogen, hence the bleeding and the need for a lot of progesterone, and to me it sounds like you could do with dropping both back.

I was so anxious still on just the one pump - I’d been initially prescribed ‘one to two pumps per day’ and one wasn’t cutting it, so I did follow the prescribed amount.

I probably could do with getting my levels checked again, though.

I’m whatever the opposite is to a hypochondriac. I’m a GP dodger which can be a bit reckless, I know.

It would be best to see your GP and have a scan.
That's the normal route with this.
There is no point having blood tests for your estrogen- they are not accurate (my consultant never does them and explained why.)
The dose you need is the amount to control symptoms.

You should have a scan. If your endometrium is too thick it can become abnormal, so better to find out it isn't and then you can adjust the dose of progesterone or try something else- like Nalvee or the Mirena coil.

Thanks @JinglingSpringbells Always such good advice on all matters re HRT.

I am having this issue too, am currently on 100mg utrogestan and 100 everol conti, getting a GP appt is like finding a unicorn , would anyone recommend increasing progesterone then? It does help me sleep better if I occasionally have a double dose 😃

You're on Evorel conti?
Are you using Evorel with added progesterone?
Or an estrogen only patch?+ Utrogestan?

The prescribed dose now (new guidance) is 200mgs utrogestan daily for continuous HRT with patches of 100mcg, or 4 pumps of gel.

Please don’t adjust your dose of anything without medical advice. I’m sure or at least hope, that you wouldn’t do it with medication. Just because these are hormones, doesn’t mean you treat them any differently. If you end up taking too must progesterone it can cause other more serious issues. Bleeding post menopause needs investigation. Don’t play doctor or take advice on your own health from people on the internet. Be sensible and go get it checked by someone who knows what they’re doing.

That’s interesting re occasional double dose. I might try that as I’m just super stressed and finding sleep so tough right now.

I know you’re right but as @Flapjak says getting a GP appointment these days is tough. I won’t do anything super reckless, though. For one thing, I don’t actually have enough Utrogestan stashed away to start taking loads of it, so will have to see the gp if I decide that might be the way forward.