To Bleed or Not To Bleed? That's the Hormone Replacement Therapy Question
WebMD News Archive
"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
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,"
- 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