Erratic Bleeding after HRT

I have started hormone replacement therapy (HRT) recently, but I am having irregular bleeding- What can I do? This is a question commonly asked by women who were started on HRT.

It is not unusual to have some irregular (unexpected) bleeding in the first 3 to 6 months after starting HRT, even if the last natural period was many years ago. Within the first 3-6 months of taking HRT, you can expect to have vaginal bleeding as your body gets used to the change in hormone levels in your blood. We believe every woman should be reviewed after their first 3 months on HRT and if the bleeding shows no signs of improving, the HRT can be adjusted to try to settle it.

However, any abnormal vaginal bleeding after 6 months of HRT needs to be investigated. This is very important if you have heavy or painful bleeding, post-coital bleeding (bleeding after sex) or bleeding associated with any other worrying symptoms.

At Rockingham Women’s Health Centre, our specialist takes a detailed history to check:

1. Whether you are taking the HRT correctly e.g. do the patches stick on properly or are you taking the right amount of progesterone to protect the lining of the womb.
2. Duration of HRT and any changes in the treatment?
3. Are you using unregulated bioidentical HRT eg. transdermal progesterone cream etc.?
4. Checking the last pap smear?
5. We need to do a vulval, vaginal and cervical examination with swabs.
6. Any risk factors for endometrial cancer?

Although most erratic bleeding settles down by adjusting the dose of HRT, it is important to exclude vulval, vaginal or cervical pathology, endometrial polyps, endometrial hyperplasia, endometrial cancer, fibroids and ovarian cancer.

Investigating abnormal bleeding

The bleeding on HRT that requires investigation is:

• Break-through bleeding on sequential HRT
• A change in pattern of withdrawal bleeds
• Bleeding that occurs on continuous combined HRT after the first 6 months of initiating therapy.

When to see the Gynaecologist?

We may wish to further investigate the cause of your vaginal bleeding by referring you for an ultrasound scan if not done already to measure the thickness of the lining of your womb (uterus) and any ovarian issues. Depending on the result of this, a hysteroscopy may be undertaken, which involves a small camera being inserted into the womb and a biopsy can be taken if necessary.

Please contact Rockingham Women’s Health Centre on 0895918943 to book an appointment or www.rockinghamwomenshealth.com.au