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Menopause Health Center

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

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"Menopausal symptoms decreased to a comparable degree on either therapy," says Hill. "What differentiated the two therapies was that there was less monthly bleeding with the [daily estrogen and progestin therapy], and, therefore, women were more likely to continue to take it."

After a year, nearly 60% of the women taking estrogen daily plus two weeks of progestin each month reported vaginal bleeding. Less than 10% of women taking both medications daily had bleeding. Irregular bleeding was similar for the two groups.

Both groups of women had a rather high rate of quitting treatment altogether, however. The most frequently cited reason for quitting was beginning a monthly period again or irregular bleeding, although nervousness, anxiety, irritability, water retention, and weight gain were other reasons.

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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