Standard hormone replacement therapy (HRT) schedule

Hormone replacement therapy (HRT) can be taken on a continuous or cyclic schedule and in a higher or lower dose. Typical schedules include the following:

Cyclic HRT

• Take estrogen daily, and take progestin for a prescribed number of days. Menstrual-like bleeding (withdrawal bleeding) is expected during the beginning of the no-progestin period. The estrogen-only period can be as long as 2 to 3 months.

OR

Continuous HRT

• Take estrogen and progestin daily.
• Apply a transdermal patch twice a week to an area of the body not exposed directly to the sun.

Women experience different bleeding patterns with continuous HRT than with cyclic HRT. If one schedule causes unpleasant side effects, trying another schedule may improve symptoms.

• Irregular bleeding is more common with continuous HRT during the first year. One-third of women do not experience bleeding, many women stop monthly bleeding after 2 to 3 months, and most women stop monthly bleeding after 1 year of therapy.
• Continuous HRT causes fewer premenstrual-like symptoms than cyclic HRT.
• Continuous HRT causes more side effects in younger women than in women who are several years beyond menopause.
• With continuous HRT, women who are treated with higher doses of progesterone may have the fewest episodes of bleeding.
• Cyclic HRT causes most women to have predictable withdrawal bleeding, which can continue for years.
• Perimenopausal women may tolerate cyclic HRT better than continuous HRT.