Breakthrough bleeding is common for those on hormone replacement therapy (HRT). Up to 60% of women experience irregular bleeding in the first 6 months of starting HRT. There are several potential causes for this:
- Your body adjusting to the new hormone levels. It takes time for your system to adapt to the estrogen and/or progesterone you're taking. Fluctuations and irregularities are normal during this adjustment period.
- An imbalance between estrogen and progesterone. Too much or too little of either hormone can lead to changes in the uterine lining that spur bleeding between periods. Your doctor may adjust your dosages over several months to find the right balance for you.
- Forgetting doses or running out of medication. HRT regimens often require taking tablets regularly at the same time each day. Forgetting even a single daily dose can be enough to trigger unexpected bleeding.
- The type of HRT you're using. Synthetic progestins, as found in most HRT regimens, may be more likely to cause breakthrough bleeding than bioidentical progesterone. Talk to your doctor about switching formulations if bleeding persists.
What You Can Do
- Track your bleeding on a calendar. Note how long and heavy the bleeding is along with any medication changes. This helps identify patterns for your doctor.
- Contact your doctor if bleeding lasts over a week or contains large blood clots, which may indicate other uterine issues need evaluation. Lighter bleeding can usually be managed with medication adjustments.
- Ask about adding the hormone norethindrone for several months. This can help stabilize the uterine lining and halt erratic bleeding.
- Try a different progestin, route of administration, or dosage. Your body may respond better to oral tablets vs. creams, gels, patches, or vaginal rings for example.
- Get your hormone levels tested, especially if symptoms get worse instead of better over 3-6 months of HRT. Dosage tweaks guided by lab testing helps get your regimen right.
When to Worry
Breakthrough bleeding is often just an annoyance to be endured when starting HRT. But contact your doctor promptly for:
- Heavy, prolonged bleeding lasting over a week
- Bleeding that contains blood clots
- Bleeding accompanied by severe cramping or pain
- Bleeding that worsens over time instead of improving
These may indicate complications requiring further evaluation like infection, polyps, fibroids, or endometrial hyperplasia. Don't hesitate to get checked out for peace of mind.
Expert Hormone Care is Here for You
The hormone specialists at
Vitality Hormone Center understand the frustrations of HRT side effects like breakthrough bleeding.
We take the time to listen and find solutions tailored to your unique needs. With
over 30 years of experience optimizing hormone levels, we have the knowledge to make HRT work for YOU.
Contact us today to ask questions, review treatment options, and take charge of any HRT issues with breakthrough bleeding or other bothersome symptoms.
