Menopause Hormone Therapy: Why Am I Still Experiencing Menstrual Bleeding?

Menopausal hormone therapy can still result in menstrual-like symptoms?

Hello, Director Cao: I am 44 years old and have experienced irregular menstrual cycles over the past two years.
I went to a gynecology clinic for follicle hormone testing, and my level was 118.
Following my doctor's advice, I started hormone therapy, taking one tablet of Estromon (0.625 mg of estrogen) and one tablet of Utrogestan (progesterone) every night before bed.
I have been taking them consistently, and the hot flashes have ceased, while my sleep quality has improved.
I regularly take vitamins C, E, D, folic acid, and fish oil, but I have not taken any traditional Chinese medicine supplements (like Si Wu Tang).

About 15 days after starting hormone therapy, I got my period on March 16, with blood flow and clots similar to my normal menstrual cycle.
On the second day of my period, I returned to the doctor, who performed a pelvic exam and an ultrasound, both of which were normal.
He prescribed a three-day course of hemostatic medication and changed my estrogen dosage from once daily to three times daily, while keeping the Utrogestan at once daily.
This menstrual cycle ended on March 20, but I experienced another period starting on March 28.

I learned online that estrogen can cause endometrial hyperplasia, leading to menstruation, while progesterone stabilizes the endometrium.
However, excessive estrogen intake may increase the risk of endometrial cancer.
I would like to know if patients with situations like mine are common.
My doctor told me that hormone therapy involving both estrogen and progesterone should prevent menstruation, which makes me anxious and concerned about the possibility of it being a precursor to gynecological cancer.
I feel very confused and scared.

TINA, 40~49 year old female. Ask Date: 2022/03/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it may be due to just starting the medication and still adjusting.
Please continue to follow up with your original obstetrics and gynecology provider.
Wishing you good health.

Reply Date: 2022/03/29

More Info

Menopause Hormone Therapy (MHT) is a common treatment for women experiencing symptoms of menopause, such as hot flashes, mood swings, and sleep disturbances. However, it can sometimes lead to unexpected outcomes, such as menstrual bleeding, which can understandably cause concern.

In your case, you are 44 years old and have been undergoing hormone therapy with Estromon (an estrogen) and Utrogestan (a progesterone) for about 15 days. You initially experienced a return of your menstrual cycle, which included normal blood flow and clots, and after a follow-up with your doctor, you were prescribed a hemostatic agent and an adjustment in your estrogen dosage. Despite these changes, you experienced another episode of bleeding shortly after.

It is important to understand that hormone therapy can affect each individual differently. The primary role of estrogen in MHT is to alleviate menopausal symptoms by replacing the hormones that the body is no longer producing. However, estrogen can also stimulate the growth of the endometrium (the lining of the uterus), which can lead to bleeding if the endometrial lining becomes too thick. This is where progesterone comes into play; it helps to stabilize the endometrial lining and counteracts the effects of estrogen.
The occurrence of menstrual-like bleeding while on hormone therapy is not uncommon, especially in the initial stages of treatment. This can be due to several factors, including the dosage of estrogen, the balance between estrogen and progesterone, and individual variations in how your body responds to these hormones. In some cases, the bleeding may be a result of the body adjusting to the new hormone levels, while in others, it may indicate that the dosage needs to be adjusted.

Your concern about the risk of endometrial cancer is valid, especially since prolonged exposure to unopposed estrogen (estrogen without progesterone) can increase this risk. However, when estrogen is combined with progesterone, as in your case, the risk is generally mitigated. It is essential to have regular follow-ups with your healthcare provider to monitor your response to therapy and to ensure that your hormone levels are balanced.

If you continue to experience irregular bleeding, it may be necessary to reassess your treatment plan. This could involve adjusting the dosages of your medications, switching to a different formulation, or exploring alternative therapies. Additionally, your healthcare provider may recommend further investigations, such as an endometrial biopsy, to rule out any underlying issues if the bleeding persists or if there are any concerning symptoms.

In summary, while experiencing menstrual bleeding during hormone therapy can be alarming, it is not uncommon and can often be managed with appropriate adjustments to your treatment. It is crucial to maintain open communication with your healthcare provider, express your concerns, and work together to find the most suitable approach for your individual needs. Regular monitoring and adjustments can help ensure that you achieve the desired relief from menopausal symptoms while minimizing any risks associated with hormone therapy.

Similar Q&A

Understanding Menopause: Irregular Bleeding Concerns at 54

Hello, my mother is 54 years old and she stopped menstruating about a year and a half ago. During her menopause, she was taking hormone medication, but in the past two months, she has experienced menstrual bleeding again, which lasts about two weeks. Should we be concerned about ...

Dr. Wei Fumao reply Obstetrics and Gynecology
Bleeding may be caused by hormonal factors (poor drug absorption can lead to bleeding). Please consult the physician who prescribed the hormones. Additionally, if the cervix is severely eroded, bleeding may occur during sexual intercourse. Furthermore, excessive endometrial hyper...

Managing Menopause Symptoms: Hormone Therapy and Its Effects

Hello Doctor: I have been menopausal for 7 years, but due to significant menopausal symptoms such as facial flushing, palpitations, and insomnia, I followed my doctor's advice and started hormone therapy 2 years ago to alleviate these symptoms. Now, I have been experiencing ...

Dr. Wei Fumao reply Obstetrics and Gynecology
If there are no contraindications, please continue taking the hormone.

Understanding Secondary Bleeding: Causes and When to Seek Medical Advice

Hello Doctor, I received a menopause injection in 2020 due to having an ovarian chocolate cyst and a small uterine adenomyosis. Because of the medication, I was expected to have my period this year. I experienced light bleeding from January 27 to January 31, which was very minima...

Dr. Chen Zhiyu reply Obstetrics and Gynecology
In response to your concerns, based on your description, it is indeed advisable to return to your original treating physician to confirm the status of the bleeding. Thank you for your inquiry, and I wish you good health and happiness.

Is Low Menstrual Flow a Sign of Menopause at 43?

Dear Dr. Chen, For the past three years, my menstrual cycle has been very regular, occurring every 24 days. However, the flow has been extremely light, requiring only panty liners, and it lasts just one day. Initially, the color is often dark red, almost black, but there are no ...

Dr. Chen Changfu reply Obstetrics and Gynecology
At 43 years old, there has been a decrease in menstrual flow and a shortening of the menstrual cycle in recent years, which are early signs of declining ovarian hormone secretion, consistent with the earliest symptoms of female menopause. Currently, the concept of hormone replace...