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Hormone Replacement Therapy whilst you still have periods

Women who still have periods have to take replacement hormones in cycles - some time on, some breaks. This article what cyclical HRT is and why it matters.

Recap - what is hormone replacment therapy (HRT)?

HRT is when you take a form of medication to replace your body's natural hormones. This is because female hormones - most importantly oestrogen and progesterone - drop during perimenopause and menopause.

All forms of HRT contain a type of oestrogen. If you've had a hysterectomy in the past, you'll be given estrogens alone - Oestrogen Hormone Therpay. If you haven't had a hysterectomy, estrogen will be combined with a progestogen. The type of HRT recommended for you will also depend on your risk factors, preferences, symptoms and if you are still having periods. For a better recap, have a look at our Hormone Replacement Therapy - explained article.

What is cyclical (HRT)?

It's a common misconception that you can't take HRT if you're still having periods. That is not true. If you are still having your periods you CAN take HRT. The perimenopause is the time before your periods stop and your hormones are swinging from high to low. Often women experience their worst symptoms during this time and so might really benefit from taking HRT.

If you have not had a year without periods, you should take HRT in a cyclical (or sequential) way. This means you spend some time taking both oestrogen and progesterone hormones, and some time on oestrogen only.

Are there different types of cyclical HRT?

Yes, broadly there are two types of cyclical HRT:

  1. Monthly cyclical HRT. This is when you take oestrogen every day, and take progesterone for the last 14 days of your cycle. This is for women who are still having fairly regular periods, but need HRT to help with their menopause symptoms.
  2. Three monthly cyclical HRT. This is when you take oestrogen every day, and take progestogen (if needed) alongside it for about 14 days every 3 months. This is for women who are having irregular periods.

Will I have periods when using cyclical HRT?

Yes. If you are taking monthly cyclical HRT you should roughly have a bleed each month. If you are taking three monthly cyclical HRT you should have a bleed every 3 months.

How do HRT needs change with age?

As your hormones drop and you progress through menopause (one year without periods), your HRT needs will change. You'll move from taking hormones cyclically, to taking them continuously. Continuous HRT involves taking oestrogen (and progestogen if you have a uterus) every day without a break.

This switch will generally happen after 2-5 years on cyclical HRT, or when you are above the age of 54.

References:

1.nhs.uk. n.d. Hormone Replacement Therapy (HRT). [online]
Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/. [Accessed 16 March 2020]

  1. Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society.

  2. British Menopause Society. n.d. Bioidentical HRT | British Menopause Society. [online]
    Available at: https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/ [Accessed 16 March 2020].