You can take hormone replacement therapy (HRT) if you are still having periods – you just have to take it in a slightly different way. This way of taking HRT is called cyclical HRT. Read on to learn more about why you might be prescribed cyclical HRT.
What is hormone replacement 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.
Read here for more about the risks and benefits of HRT.
What is cyclical HRT?
If it has been less than a year since your last period, 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.
This variable level of hormones allows your body to have a regular, period-like bleed and keep the lining of the womb healthy.
It’s a common misconception that you can’t take HRT if you’re still having periods.
This is absolutely not true. If you are still having your periods you CAN take HRT.”
Perimenopause is the phase of menopause that happens before your periods stop. During this time, you will be experiencing hormonal changes and this is often the point at which menopause symptoms are at their worst. HRT can be really beneficial at this time.
Read more about the stages of menopause.
Are there different types of cyclical HRT?
Yes. Broadly, there are two types of cyclical HRT:
Monthly cyclical HRT
What is it? This is when you take oestrogen every day, and also take progesterone for the last 10 to 14 days of your cycle, depending on the type of hormone prescribed.
Who is it for? People who are still having fairly regular periods, but need HRT to help with their menopause symptoms.
Three-monthly cyclical HRT
What is it? This is when you take oestrogen every day, and take progesterone – if needed – alongside it for 14 days every three months.
Who is it for? People who are having irregular periods and need help with their menopause symptoms.
Does cyclical HRT stop periods?
No, you will still have bleeds on cyclical HRT. These are caused by the hormones in your HRT and they are often referred to as ‘withdrawal bleeds’ rather than periods. They will seem very similar to normal periods although tend to be lighter and more regular, especially if you have been having heavy or irregular periods as you approach menopause.
You should have a bleed each month if you’re taking monthly cyclical HRT. You should have a bleed every three months if you’re taking three monthly cyclical HRT.
How do your HRT needs change with age?
Your HRT needs will change as you go through menopause.
It’s common to need to adjust your dose of HRT. As time passes, you may find that you need more or less oestrogen to control your symptoms. This is normal and reflects the continued change in your body’s own oestrogen levels as you progress through menopause.
When you reach menopause itself, meaning that you have gone a year or more without a period, your HRT needs will change. You’ll move from taking hormones cyclically, to taking them continuously. Continuous HRT involves taking oestrogen – and progesterone if you have a uterus – every day without a break.
This switch will generally happen after two to five years on cyclical HRT, or when you are over the age of 54. It can be tricky to decide when you have reached menopause if you don’t have regular periods. Your doctor will be able to advise you when it is time to switch.
Final word
Cyclical HRT is an option for you if you’re still having periods but struggling with menopause symptoms.
HRT is very effective at treating menopause symptoms but it’s not suitable for everyone.
Find out more about menopause on our blog or in our symptoms library.
- NHS,Hormone Replacement Therapy (HRT).
- 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.
- British Menopause Society, Bioidentical HRT | British Menopause Society.
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