Hormone replacement therapy (HRT) and abnormal vaginal bleeding

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Hormone replacement therapy (HRT) and abnormal vaginal bleeding

Hormone replacement therapy (HRT) can cause abnormal vaginal bleeding. Depending on the type of hormone replacement therapy you are using, you may have normal periods, bleeding between periods, or no periods at all. In most cases, some abnormal bleeding can be expected when HRT is first started.

• Estrogen plus cyclic progestin. When you first begin using estrogen plus cyclic progestin (minimum of 25 days of estrogen plus 10 to 14 days of progestin at the end of the cycle), you can expect vaginal bleeding to start a few days before your last progestin dose up to 5 days after the last progestin dose. This type of vaginal bleeding is called withdrawal bleeding.
• Estrogen with continuous progestin. If you are using estrogen with continuous progestin (daily estrogen and progestin), you may have irregular vaginal bleeding for 6 to 12 months and then bleeding usually stops.
• Estrogen only. Most women who use estrogen have had a hysterectomy. No bleeding should occur in this situation.

Call your health professional if you think that hormone replacement therapy is causing your abnormal vaginal bleeding. An appointment may not be needed.

Credits

Last updated:	July 11, 2007
Author:	Jan Nissl, RN, BS
Reviewed By:	Kathleen Romito, MD - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Susan Van Houten, RN, BSN, MBA, Tracy Landauer