What should you know about HRT bleeding between periods?

HRT-related bleeding may look like light spotting or a period arriving outside its expected time. The pattern can be influenced by the type of HRT, the dose, how regularly it is taken and whether the womb lining is being exposed to progestogen. Bleeding can also have a cause unrelated to HRT.

Spotting is more likely during the adjustment period after starting or changing HRT, and missed or late doses can also disturb the bleeding pattern. Do not change the dose or stop treatment without advice, because this can make symptoms and bleeding harder to interpret.

Other explanations include changes in the cervix or womb lining, vaginal dryness or infection. Chlamydia can cause bleeding between periods, especially when it occurs with unusual discharge, pelvic discomfort or bleeding after sex. Uterine fibroids, endometrial polyps, cervical dysplasia and, less commonly, cervical cancer or womb cancer can also present with abnormal bleeding. A symptom does not identify its cause by itself.

Record when the bleeding starts, how long it lasts, whether it is spotting or a flow, and whether it follows sex, a missed dose or a change in treatment. Note pain, discharge, dizziness and any chance of pregnancy. Take HRT exactly as prescribed and arrange a review if the bleeding continues, returns after settling, or begins after a period without bleeding.

A clinician may review your HRT schedule and other medicines, ask about your menstrual and menopause history, and examine the vagina and cervix. Depending on your symptoms and stage of menopause, assessment may include a pregnancy test, infection testing, cervical screening if due, or imaging of the womb. The aim is to match the investigation to the bleeding pattern rather than assume HRT is the only explanation.

Seek urgent medical help if bleeding is heavy or rapidly increasing, you feel faint or unusually weak, or you have severe or worsening pelvic pain. Get prompt assessment for bleeding during pregnancy or after sex when it is accompanied by pain, fever or feeling unwell.

Arrange a non-urgent appointment for any unexplained bleeding after menopause, bleeding that keeps recurring, or bleeding that does not settle after an HRT change has been reviewed. Bring the HRT name, dose, schedule and a record of the bleeding pattern to the appointment.

Ask whether your bleeding pattern fits the HRT regimen you use, whether a missed dose or another medicine could contribute, and how long you should monitor it. You can also ask which examinations or tests are appropriate, what symptoms should prompt earlier contact, and whether your treatment needs review.