Patient information leaflet from The Menopause Partnership (GP-led specialist care for women).
Unscheduled bleeding on HRT
Unscheduled (unexpected) bleeding is common in the first 3–6 months after starting or changing HRT. It usually settles as your body adjusts.
Bleeding may also occur if doses are missed, if the progestogen dose is too low for the oestrogen dose, or if you are still in perimenopause.
When bleeding is expected
- On sequential (cyclical) HRT, a regular monthly bleed is expected.
- On continuous combined HRT, light bleeding can happen in the first few months.
What you can do
- Take HRT exactly as prescribed, especially the progestogen part.
- Keep a record of bleeding days and any missed doses.
- If you use a patch/gel, make sure it is applied correctly.
- We may adjust the type or dose of progestogen if bleeding continues.
When to contact us promptly
- Bleeding that continues after 6 months on continuous combined HRT.
- Bleeding that starts again after being bleed-free.
- Heavy bleeding or bleeding after sex.
- Any bleeding after 12 months with no periods if you are not on sequential HRT.
How bleeding is assessed
We will review your HRT regimen, check any risk factors, and may examine you. If needed, we may arrange an ultrasound to look at the womb lining, in line with BMS guidance.
