Bleeding on HRT - I need more guidance

[temporaryname99]

Started on HRT just over a month ago. Gel and progesterone pill - its an oral pill but Im taking it vaginally.
I know that some bleeding is expected when youre starting HRT. But the guidance on the Internet is vague. Basically it seems to say any bleeding in the first 6 months is normal and no need to do anything unless its very heavy.

Its not very very heavy - but its more than just spotting. More like a period than spotting. And been going on for 5 days. Im not worried that there's anything wrong; it's just that it's gross (hadn't had periods for 2 years before this and not loving going back to it!) and I dont like the idea of not knowing how long its going to go on.

I feel that the bleeding might be due to too much progesterone. But I'm only guessing.

I was about to switch from the gel and the vaginal progesterone to the combined patch - have already picked up the prescription. But feel like I shouldn't switch while I'm bleeding.

So, any reassurance about how long the bleeding might go on?

Thanks

Go to the GP.

They might order a scan to be sure there’s nothing else untoward going on

You don't need to see your GP.
The medical guidance is that bleeding for up to 6 months on continuous hrt is normal.
It takes that long for the low daily dose of progesterone to ensure the womb lining stays thin.
There is no point or need to have a scan after 1 month on continuous hrt.

I'm sure it's not nice but it is normal and will stop.

It's definitely not to much progesterone. It's the opposite.
Progesterone keeps the lining thin but not immediately.

If you carry on bleeding after 6 months the guidance is to use 200mgs a day not 100mgs.

ps The patch- if it's a combined patch with a different progesterone in it (Norethisterone), it is stronger. So you may bleed less.

If you carry on with heavier bleeding see your GP. My guess is the change to Norethisterone in the patch will stop it. The other option is to reduce the estrogen dose which will mean the lining is thinner.

Thanks so much for this. Thats interesting re too much oestrogen. And I also thought the patch might alleviate the bleeding. But I guess I should check with the GP before switching....

I had light spotting about days 7-10 from the 3rd month. Went to GP at 6 months and she immediately took me off hrt and ordered a scan. Any bleeding should be suspected womb cancer until proven otherwise. Was only 2 week wait for the scan, no cancer.

@temporaryname99 @BreezyClouds

The guidance from the British Menopause Society suggests adjusting HRT or referring for a scan within 6 weeks when on HRT (not 2 weeks which is the timeline for women post menopause and not on HRT.)
The guidance does not usually apply to women on combined continuous HRT until the 6 months has passed, as some bleeding is expected.

This advice is online.

Obviously if the bleeding is heavy, or really troubling, see your GP.

There is medical guidance saying to expect bleeding in the first 6 months.

https://www.menopausematters.co.uk/postmeno.php The writer of this is Dr Heather Currie, NHS consultant gynaecologist and menopause specialist.

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control.

Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.