Changes in bleeds: your FAQ

It’s common (but can be confusing) to experience changes to your periods or have bleeding during perimenopause and menopause. We answer some of your most-asked questions

Q I’m perimenopausal, not on HRT and am having irregular periods. How long can I expect this to last?

All women are different and factors such as your age, ethnicity and body size can influence your cycle during perimenopause. Periods can change in frequency and duration during perimenopause. Many women find their periods become heavier and closer together, whereas others experience lighter and less frequent periods. Your periods may be regular but last longer or less time. The early changes in menstrual cycle occur on average six to eight years before the final menstrual period [1]. Perimenopause can last for around 10 years but this varies between women.

Q I went a whole year without bleeding but now I’ve just had a bleed! What’s going on?

If bleeding occurs more than a year since your last period then you should be checked by a doctor. Your doctor is likely to examine you and may arrange for you to have a scan of your womb. There are many causes of bleeding, including thickening of your womb lining, a polyp or fibroid. Occasionally there are more serious causes so it important to have bleeding checked [2].

Q I’m perimenopausal and fed up with erratic, heavy periods. Can I go straight to continuous HRT or do I have to try sequential first? I don’t want any more bleeds!

Cyclical (sequential) HRT can often help regulate your cycle. Many women find their periods become lighter too when they take HRT. However, some women prefer to take continuous HRT so the progesterone is taken every day. Periods can become more erratic initially but then often stop completely.  

Another option to consider is the Mirena coil, which can make periods lighter and shorter, and usually causes them to stop altogether.

RELATED:  heavy periods during the perimenopause: what you need to know

Q Is it beneficial to bleed every month? I’m considering switching from sequential to continuous HRT but have heard it’s healthy to have a monthly bleed.

There are no health benefits or risks to a monthly withdrawal bleed. It is a bleed due to taking cyclical hormones rather than a natural period. There is no build-up of blood if you do not have a bleed each month and many women prefer not having bleeding. The decision to move from sequential to continuous HRT can be made with your healthcare professional.

Q I’ve had persistent bleeding since starting HRT six months ago – what should I do?

It can be quite common to experience bleeding in the first 3-6 months after starting HRT or changing dose (or type) of HRT. However any bleeding that persists or occurs after six months should be investigated by your doctor. If you have bleeding at any time which is heavy, troublesome, painful or you are worried then you should see your doctor.

RELATED: what to expect when you start HRT

Q I’ve been using combined HRT patches for some time but my bleeding has increased. How long is this bleeding considered normal and when should I see someone?

Irregular bleeding is common in the first few months after starting combined HRT but you should speak to your doctor if you have been taking HRT for more than six months and are having unexpected bleeding. For some women, changing dose or type of HRT improves any bleeding.

Q I am perimenopausal, taking sequential HRT and still having periods. Will they eventually stop when I’m menopausal or will I keep on bleeding unless I switch to continuous HRT? If so, how do I know when to switch over?

Menopause is defined as one year after your last period. However, bleeding will usually keep occurring when you are taking sequential HRT. Usually women change to continuous HRT after 6-12 months and then bleeding stops.

RELATED: sequential and continuous HRT: what’s the difference?

Q I have the Mirena coil and am getting random bleeds, sometimes light and sometimes heavy – why?

The Mirena coil can cause some irregular, longer or more frequent bleeding, which may continue for up to six months. You may also have some light bleeding between your periods. After this time, it usually settles down but if it persists, see your healthcare professional for a check-up.

RELATED: the Mirena coil or Intrauterine System (IUS)

Q I was having a regular withdrawal bleed after the 12 days of Utrogestan but now it’s completely random and can be 8-10 weeks apart – what does this mean?

It may mean that you own hormones are reducing and many women decide to change to continuous HRT and their bleeding then stops all together.

RELATED: micronised progesterone or Utrogestan factsheet

Q I’ve moved from sequential to continuous HRT and am having erratic bleeds – how long will it take for them to stop?

Irregular bleeding is common in the first 3-6 months after starting combined HRT. If it is heavy or painful within this time, consult with your healthcare professional. Also see your doctor if it has not settled after six months.

References

1. Harlow S.D., Paramsothy P. (2011), ‘Menstruation and the menopausal transition’, Obstet Gynecol Clin North Am. 38(3):595-607. doi: 10.1016/j.ogc.2011.05.010.
2. NHS: postmenopausal bleeding
3. Harlow S.D., Paramsothy P. (2011), ‘Menstruation and the menopausal transition’, Obstet Gynecol Clin North Am. 38(3):595-607. doi: 10.1016/j.ogc.2011.05.010.