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To Bleed or Not To Bleed? That's the Hormone Replacement Therapy Question


Robert Rathauser, MD, an Ob-Gyn affiliated with the UMDNJ-Robert Wood Johnson School of Medicine in New Brunswick, N.J., reviewed the study for WebMD. He emphasizes that the selection of an HRT regimen depends on what stage of menopause a woman is in.

For women in early menopause, he recommends daily estrogen and two weeks of progestin a month. "It's more acceptable to them because they've been having periods and, therefore, to continue having periods is not a problem for most," Rathauser tells WebMD. "If you try [daily estrogen combined with daily progestin] early in menopause, the irregular bleeding would be typically intolerable, or a warning sign of other problems, such that patients would be more likely to discontinue it."

Conversely, "older women don't want to start bleeding again when they haven't bled for years," he says. "They are more likely to have a good response to combined [estrogen and progestin daily] continuous therapy," says Rathauser.

Vital Information:

  • Postmenopausal women who begin taking estrogen and progestin each day are more likely to still be on their medication one year later, compared to those who take estrogen daily but progestin only two weeks of each month.
  • It is important to find therapies that women will continue taking, because the benefits of hormone replacement therapy on cardiovascular and bone health don't kick in until after a number of years.
  • The biggest difference between women taking the two types of HRT is that those who take progestin only two weeks of each month are more likely to experience monthly bleeding, which leads to a discontinuation of the therapy.

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