Stop bleeding shortly after starting on hormone replacement therapy.
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- เผยแพร่เมื่อ 19 มิ.ย. 2024
- What to do if you are bleeding shortly after starting on hormone replacement therapy // Bleeding shortly after starting on hormone replacement therapy is very common, and in this video, I explain why the bleeding happens, what could be causing it or making the bleeding worse, and how you can make some adjustments to your hormone therapy regimen to stop the post-menopausal bleeding on HRT.
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• Stop bleeding shortly ...
Did postmenopausal bleeding happen to you? How did you finally get it to stop?
Yes. And happy to see this video as I am afraid my Dr would look for any excuse to take me off HRT. It has helped me in so many other ways!
@heatherhirschMD, question for you. I am 10 years post menopausal and started HRT a few months ago. I had some bleeding and even had a full on period. I stopped taking the Estrogen and luckily the bleeding has stopped. My OB/GYN wants me to have a Hysteroscopy, my ultrasound suggested I might have Adenomyosis. What is your opinion? I really don't want to have the Hysteroscopy.
@@tayjay1164Hystoroscopy is very expensive, I had one two weeks ago, $55K., not painful at all. I didn't take any medication, not even Tylenol. The result comes today: "no cancer". I think it's worth it. If you have cancer, it's found early, save your life. Better than too late.
Just think…her education is very inspiring.
As a male, and being in the hormonal and menopausal business, I don’t think a lot of men could walk in a woman’s body. I think 90% of male have no clue, of course not because it’s their fault, but the education to males also is not in the pipeline.
I’m not a doctor, but I certainly praise anybody who can bring any form of education to both males and females.
I started back on the Estradot but I was getting back to normal but luckily I trusted my instincts and my Doctor suggested because of my age that I should have a pelvic ultrasound. They found an 11cm cyst on my right ovary. I had a radical hysterectomy before Christmas. Very thankful it was benign. The surgeon said it was lucky I did the ultrasound. I am glad I trusted my instincts 😅
Great advice. Thank you so much, very helpful advice.
Thanks for the video. I just started HRT so very timely for me!
I started on the Combi-Patch about nine months ago (13 months after last period), and woke up this morning to this issue. I've been a nervous wreck worrying all day, but this video helped put me at ease. TY!!! No waiting to hear back from my doc's office.
Helpful thanks do you see out of state patients ?
Thanks for the great explanation Dr. Hirsch🎉 I've recently begun with estradiol and progesterone patches recently and am looking out for any of the side effects
Hello! I was so disappointed to hear that you had moved! I didn’t have the pleasure of having my first virtual visit with you’d ! A few weeks before my appointment you move to New York I was wondering if you still do virtual visits in other states
What about premenopausal bleeding while on hormones? It’s hard to know when to worry? How do you k ow your estrogen/progesterone is balanced in this case?
She states in several of her recent videos that she is licensed to work in several states. I'm in California and I was able to see her.
are you saying synthetic hormones are safe? Or is bioidenticles better? Thanks
Omg , this video is right up my ally ! I don't tolerate progesterone well. I take 100 mg pill and 0.05 estradiol patch & still have my uterus. I asked my new GYN (i moved) If I could have an IUD. Because I'm new to her, she asked If I had any bleeding on HRT. I'm on the cyclical method and had scant bleeding once when starting back on progesterone at the beginning of the month for my 12 days. When hearing that, she immediately scheduled a transvaginal ultrasound. They found a polyp and did an immediate Hysteroscopy right there to confirm. She wont do an IUD until I go to the OR to remove the polyp and a fibroid . I'm very frustrated.
Lucky they found a pollyp and can check for cancer.
@@JN-go2yq Thanks, but I researched polyps in the uterus and it said they rarely turn to cancer just as fibroids aren't cancerous. I just wish that she had removed it via the Hysterscope she did that day that i wasn't scheduled for. That was very painful ! I don't want to be put under unless its life threatening.
My insurance doesn't cover Mirena IUD for HRT use 😢 any suggestions? Thanks😇
I jam 73 years old and got my first HRT on pellets and a progesterone pill. I’ve had minor discharge and wanted to know more about side effects of HRT so I went to TH-cam! Heather, I’m so glad I found you! Thank you for giving straightforward information. However, it never crossed my mind that I could get pregnant! I like that you give information we can process and consult our doctor.
The risk of getting pregnant is higher when you’re in peri-menopause than in post menopause. Glad you’re feeling better!
Cecilia! Do you think this far from menopause we in our 70s could get Pregnant?
I sure don’t! I’ve been on HRT pellets and will ask my doctor. 🤦♀️
Would using an Estrogen cream like Vagifem, alongside HRT, help with this bleeding issue?
The progesterone after 3 to 5 days will always trigger a period- no matter what the dosage of estrogen is. If I stop the progesterone the period stops. My concern is that we are always being told that if you use estrogen you must use progesterone do, so very confused what I am supposed to do. On a side note I feel amazing when I take estrogen and testosterone- life changing stuff! The periods btw are very punctual too and last for 3 to 5 days depending on how much estrogen - and it's been this pattern for a few years
What form of testosterone do you use? I think I need some
Such great clear concise content. Bleeding happened to me - I was on patch plus oral progesterone - had a ultrasound and removed a polyp. Switched to the Mirena IUD ever since (3 years ago) and have not had any bleeding since. I wished I would have known to get the Mirena from the beginning.
Thank you for sharing! I was bleeding so bad-! Wish I had gotten the IUD😫
I’m thinking of getting an IUD but I’m nervous about the painful procedure
@@DisneyLissy I was nervous as well. The anticipation had me pretty tense, and while it did pinch, I found that it was quick and I had zero pain right after the insertion - just the pinch upon insertion.
@@user-EinsteinSarge thank you! Did they use any form of anesthetic?
@@DisneyLissy They didn't - and I didn't even think to ask for it, but when the time comes for me to have it replaced I plan to inquire about options for anesthetic for sure. Even if they don't offer it I will still go forward with it since I know how momentary the actual pain was for me. It was truly the anticipation that made it worse.
Does this also happen with topical testosterone therapy? Or does that mean it's converting to estrogen?
I'm perimenopausal (47yo), my provider said my estrogen to progesterone ratio is high. I'm on oral progesterone and testosterone cream 2mg/gm.
Anyone else have experience with this?
So what is upping your progesterone look like. I’ve just started on hrt and have been on it for 8 days now. I’m 60 and did bleed in the first 3days but that’s subsided. My breasts are tender and swollen uterus as though I’ve got my period .. feels a little uncomfortable so when you say up my progesterone, I’m on 100ml at the moment how much would you suggest to.My Estrodial gel is at 0.75ml. ❤thank you Heather for making perfect sense.
Does this apply to localized vaginal estrogen as well?
What if you’ve been on bio identical hormones for a year then start spotting?
My bleeding didn’t start until I increased my progesterone.
You mention the endometrial lining can be up to 5 mm on HRT. Is there a source you can link to that I can show my doctor? My lining is 4 mm on HRT and my doctor wants me to do a repeat ultrasound after a few months. The procedure is quite costly in my area.
These videos are great, but if it’s up to us to educate ourselves so we can advocate for ourselves, we need references to all this information! If I tell my doctor “a doctor on TH-cam said …” she’s most likely going to role her eyes. I hope you understand what I mean.
You are right on the nose! I am at Brigham now for bleeding after beginning HRT, I had the climara pro patch and started bleeding after a few weeks. They did the pap, an ultrasound, an endo bx and topped it off with the Mirena IUD in one visit, I have been "spotting/bleeding" since. They found a polyp and nobody has contacted me because the dr is in vacation. My gyn does not think a woman should be on HRT long term. I already disagree thanks to Menopause Barbie's education series. I am ready to fight for it, My brain fog is gone! I feel like I am getting the cohesion back in body and it is significant, I am not giving up HRT. Both my primary and my gyn do not believe in long term HRT, they are fearful of the cancers they learned about and not fearful of the heart arteries hardening, the Alzheimer's or osteoporosis (my gyn said that there is no evidence showing estrogen reduces osteoporosis). Will need a new doc eventually, aside of the bleeding, I cannot wait to see what I can do again :)
Is it normal to get periods with testosterone hormone replacement therapy for a transman ? After 2 years later ?
Dr Hirsch, I wonder if you might be willing to do a video at some point on taking HRT vaginally. I've seen other menopause specialists especially in Britain talking about the pros and cons of using prometrium vaginally. I've also read quite a few research papers on vaginal administration of drugs including estradiol. It sounds like drugs are absorbed very quickly through the vaginal tissues, which is why the femring is a slow release device. I'm assuming from what I've read that taking oral estradiol vaginally would be unhelpful because you'd get a huge spike but it would not be sustained? I wish the femring was not so expensive! Patches and gels don't work for everyone, and I want to avoid oral.
Vaginal estradiol can be sustained up to 12 hours. I guess you can apply 2x a day
I take 100 mg of oral micronized progesterone capsule every night VAGINALLY inserted at bedtime. I also use Estradiol patch & this combination & the way I take it has been extremely successful for me! I'm in America but also follow menopause news in the UK & the UK really promotes oral micronized progesterone capsules to be inserted VAGINALLY for patients who have intolerant side effects from swallowing the capsule.
I had a D & C a short time ago. It seems to have helped as I was bleeding monthly.
I’m bleeding heavily monthly on the Combipatch. I wonder if a D&C would help
@@DisneyLissy it may, my doctor suggested it and it worked for me.
@@maryellen33714 thank you! I’ll ask my dr
@@DisneyLissy I recently started the Combipatch. How soon before you started to feel relief of your symptoms? And did the bleeding start right away after you began treatment?
@@benitadurgan8390 the symptoms started getting better about a week into it. The bleeding occurs right when I put on my second to last patch. It’s almost like a menstrual cycle. It’s so weird. The bleeding doesn’t even bother me as much as the cramps though. 😭
I have been using HRT Estradot patches x 2 a week and progesterone pill for about 3 years and have been very happy. Recently in Australia it has been impossible to get my usual patches. I have started using Clamara which is one patch a week, it is the only thing available 2 weeks in and I started having bleeding like a period. Is this common?It’s frustrating because I was a happy symptom free lady before the shortage 😢
Sometimes they will have you increase the prometrium dose, sometimes they will suggest taking it vaginally. Could also try a hormonal IUD. I'm just guessing, but maybe the once a week patch releases higher amounts of estrogen so you need more progesterone to keep your uterine lining thin
I started a bleed every 10 days or so when I had to start the Climara-50 patch, due to shortages with the Estradot-50. I was THRIVING on Estradot-50 & 100mg progesterone. Since Climara and bleeding all the time, I've been chopping & changing to try and sort out this bleeding because I'm at my wits END!!! I just recently started Divigel-25 and will work back up to 50 if this stops the bleeding. I've been off-and-on 100mg to 200mg oral progesterone. Has your bleeding resolved yet, and if so, what did you do or take to resolve it??
Started combi patch & had just stopped periods for 4months at 54yrs 🤦♀️ When I started combi patch I felt great but began to bleed soon after. Gyno did an ultrasound said I had a thickened uterus. Then a biopsy. Said I had a fibroid. Then some type of hydro ultrasound type test & said I had a big uterus but didn't explain what that means?? Said to just continue on. So I did a virtual call with MIDI changed to an estrogen patch & progesterone 200mg. Bleeding stopped yay!! But now it's back again. Prob from the new patch? They said double the dose of progesterone for 5days.
@helenhernandez2197 - Are you still dealing with bleeding? I’m having this issue. 2.3 years post-menopause and 4 months post op uterine lining clean up and negative biopsy. Have only used estrogen patch and oral micronized progesterone and just finished up my 12th week on it. I’ve been having a week of breakthrough bleeding every 3-4 weeks. I see the gynecologist in a few days to touch bases on the HRT and don’t know what she’ll do.
Can you do a video on starting estrogen without progesterone if you still have a period. My doctor did that and I am worried I should be on progesterone but she said since I still have periods I should still be protected because I should still have progesterone considering I have fairly regular periods.
If you have a uterus you can not take estrogen without progesterone it will cause uterine cancer unless it’s a vaginal cream
Your doctor should not be guessing. She can test your progesterone levels.
Dr Hirsch has a video about this.
Can a post menopausal woman have light spotting after starting progesterone only (no estrogen)?
Progesterone only was a nightmare for me pushing me into a spiral of deep depression and anxiety. Estrogen is super important. Your body NEEDS estrogen so why would you not do estrogen too?
It happened to me. I had an iud and patch. I bled everyday for months. I liked the iud, no pills to take. Had iud removed, now taking prometrium with patch.Bleeding stopped. Don’t like taking pills, but no more bleeding
Can you share what your dose of estrogen is?
Interesting… sounds like there are different ways for different women.
What happens if u still have symptoms and that’s the reason your doctor increased the estrogen.
I have bleeding after three years in menopause and my doctor increased progesterone to 225 mg
Does it help you?
But bleeding with huge cramps??? 😮
Same, since I was "forced" to change to Climara patch due to shortages with Estradot.
Me too 😢
Im only on progesterone for 10 days every 3 months. I've never heard of this dosing before. I bleed and am not happy.
It sounds like you're not getting enough progesterone to balance the estrogen. Most menopausal women are given a continuous dose of progesterone. Or if they don't tolerate it well sometimes they can try it cyclically. I would definitely go see a doctor about this
What if your estrogen level is 168
For postmenopausal women, I’ve never heard that using HRT can cause ovulation to start again. I’d always heard that the triggering factor for menopause is when the ovaries have no more eggs to ovulate. If no more eggs after menopause, how could HRT stimulate ovulation to start again? Confusing. Thx
I completely agree with you antkristi9086
You got it wrong. HRT can't make ovulation happen after menopause.
@@lisianemiotti1403I didn’t say that, the doctor did. I was saying I’d never heard that before.
I have the patch and more a IUD and still getting a monthly period. (53 year old, started hurt while in perimenopause about 5 months ago). Why could I still be having a regular period?
@@susiedbc did your periods stop before you began hrt?
The frustration is also Heather does not answer comments
That's because she can't give you medical advice without doing a personal workup, and she has to be licensed to practice medicine in your state. It's partly a legal thing. She is just trying to provide free education. If you want her to treat you as your medical doctor you're going to have to make an appointment with her. I know it feels like a lot of money, but even one thorough consultation with her can be so helpful, and she can prescribe for you. She is not in my medical network so I privately paid for a consultation, but the prescriptions went through my insurance. Also, she spent an entire hour with me as compared to a rushed 10 minute appointment with a regular doctor who wouldn't have been willing to help me.
The alternative is gleaning everything you can from her and other TH-cam menopause specialists, taking notes, and going to your doctor armed with the information and ready to debate. Sometimes it works.
@@athenachloewoodrow6356 yes, you are right. Thank you for pointing that out.
Other doctors on youtube have answered questions 😮
How I consult with you?
Through the links added below the video.
Oops! They are on the right side now.