If you’re still having periods but have started experiencing bothersome symptoms like hot flushes, mood swings, or poor sleep, you might be wondering where you stand with menopause, and whether hormone replacement therapy (HRT) is an option for you.

The good news is that you don't have to wait until your periods stop completely to start HRT. Many women begin treatment during perimenopause, the transitional stage before menopause where periods may be irregular, to help manage symptoms, improve their quality of life and support overall well-being.

In this article, we’ll answer common questions about periods and HRT, including whether you’ll still have bleeds, what changes to expect, and how different types of HRT affect periods.

Does HRT stop periods?

HRT may stop periods temporarily or permanently. However, this depends on the type of HRT and where you are in the menopausal transition (1).

If you’re still having periods, even if they are irregular, you can still take HRT – you just have to take it in a slightly different way than if you were postmenopausal and hadn’t had a period for at least 12 months.

Types of HRT

Many types of HRT exist, including patches, gels, creams, sprays and tablets. However, the way that HRT is taken determines whether it will stop periods.

Continuous combined HRT

Continuous combined HRT is typically recommended if you’re postmenopausal, meaning you haven’t had a period for at least a year. This type of HRT contains both oestrogen and progesterone, taken daily without a break, to help manage menopause symptoms (2).

With this HRT regimen, there should be no menstrual bleeding as it suppresses the hormones that help form the uterine lining (1).

Continuous combined HRT isn’t generally prescribed if you’re still having periods or are within 12 months of your last one, as starting it too early can lead to irregular bleeding. However there are some situations when continuous HRT is prescribed, for example if you have endometriosis, so as not to flare up the endometrial deposits. In most situations if you're in perimenopause, a sequential (cyclical) HRT regimen is usually prescribed instead (2).

The Mirena coil can be used as the progesterone part of HRT and gives continuous progesterone. This can be used either if you are perimenopausal (ie. still having periods) or post menopausal and have stopped your periods. It is likely to either stop periods or make them much lighter.

Find out more about taking contraception during menopause.

Sequential combined HRT

If you are perimenopausal and still having periods, or your last period was less than a year ago, you’ll usually be prescribed sequential combined HRT (3) unless you have or would like the Mirena

It still contains both oestrogen and progesterone, but the hormones are taken in a way that mimics your natural cycle, leading to a monthly withdrawal bleed. This is similar to what happens when taking some forms of contraceptive pill.

Sequential combined HRT is usually taken in 28-day cycles. You take oestrogen every day and take progesterone in addition to the oestrogen for 10 to 14 days of the cycle. You then repeat the cycle without a break. The withdrawal bleed usually occurs at the end of each course of progesterone (4). There are other regimes which can be used (for example using progesterone for 25 days and having a 3 day break), which your doctor can discuss with you to get the correct individualised treatment.

If you’d like to understand HRT in more depth, from how it works and what is in it, to the different types and who it is and isn’t suitable for, check out our guide to HRT.

Can HRT cause periods?

HRT can cause bleeding, including period-like bleeding. It’s common to have some spotting or irregular vaginal bleeding in the first few months of starting HRT as your body acclimatises to the increased levels of hormones (5). Occasionally HRT can make periods heavier and then alternative regimes may be needed.

Continuous combined HRT

With continuous HRT, it’s common to experience irregular vaginal bleeding within the first 4-6 months of starting it6. Up to 80% of women may experience breakthrough bleeding within the first month and although this decreases over time, up to half of women on continuous combined HRT still have irregular bleeding after six months (7).

If after six months you are still bleeding, get heavy bleeding or have unexpected bleeding, you should talk to your doctor as your dosage or type of HRT may need to be changed (8). If the dose of regime is changed in any way, it again can cause bleeding for up to 3 months which is normal. If it persists longer than 3 months after a change then it should be investigated.

Sequential combined HRT

When taking sequential combined HRT, it’s normal to have a withdrawal bleed at the end of each course of progesterone. It should be like a period, lasting between 3 and 7 days. About 85% of women will have a regular withdrawal bleed but if you don’t, it’s not usually cause for concern (9).

It’s also common to have unscheduled bleeding or spotting within the first few months of starting. Up to 38% of women using sequential hormone replacement therapy experience bleeding in addition to the regular withdrawal bleed (10).

Bleeding on HRT can be a worry and it’s one of the main reasons why women ultimately stop taking it (10). However, it’s always best to consult with your prescriber to discuss side effects as they may be able to amend your regimen. They can also arrange testing to rule out any other underlying causes of irregular vaginal bleeding, including a cervical smear test to check for any abnormalities, as well as scans or blood tests if needed.

Learn more about bleeding on HRT.

When do you change from sequential to continuous HRT?

It can be difficult to know when to change from sequential to continuous HRT. In some cases periods stop even on sequential HRT and therefore you can be changed to the continuous regime. If bleeding returns then it may be too soon and you would go back to sequential. In other situations you can continue to get a withdrawal bleed on sequential HRT even when your periods have naturally stopped. This can make it harder to know when to change and it can be trial and error.

General advice is to not be on sequential HRT for more than 5 years as it can increase the risk of endometrial (womb) cancer so you would be switched to continuous HRT even if you are still getting periods within 5 years.

Can HRT regulate periods?

HRT isn’t designed to regulate periods in the same way as hormonal contraception, but sequential HRT can create a more predictable bleeding pattern if you’re in perimenopause.

There are some regimes which can help with heavy menstrual bleeding in perimenopause, but this should be discussed with your doctor to find the best option.

Since this type of HRT follows a set cycle of oestrogen and progesterone, it can lead to regular monthly withdrawal bleeds, even if your natural periods have become irregular. Conversely as it is normally given in a 28 day cycle it can lead to periods changing or becoming erratic as it is not always synced with the body’s natural cycle.

However, HRT won’t restore or extend natural fertility, and it won’t necessarily bring back a regular cycle if your periods have already stopped. It also does not act as a contraceptive (even if it stops your periods - unless you have the Mirena).

If your goal is to regulate periods in perimenopause rather than manage menopause symptoms, other hormonal treatments, like the combined contraceptive pill or the mirena, may be more suitable.

You can find out more in our guide to the risks and benefits of HRT.

Do you have to wait for periods to stop to start HRT?

Due to the drastic fluctuations in hormones during perimenopause, many women find the symptoms more challenging than once menopause has occurred.

The average length of perimenopause is four years (12), and this is a long time to navigate symptoms without support.

Fortunately, you don’t need to wait until your periods have stopped altogether before beginning HRT; sequential combined HRT is suitable for women who are still having menstrual periods, even if they have become irregular in frequency, length or flow.

In summary:

HRT can help manage symptoms in perimenopause.
You do not have to wait until your periods have stopped to ask your doctor about starting HRT.
If you are still having periods, even if they are irregular, sequential combined HRT is usually recommended.
If it’s been more than 12 months since your last period, then continuous combined HRT may be prescribed.
Spotting and irregular bleeding can occur within the first few months of starting HRT, but you should speak to your doctor if it lasts longer than six months.
Sequential combined HRT produces a regular period-like withdrawal in most women, which can help create a predictable bleeding pattern in perimenopause.

If your periods have become inconsistent and you are experiencing symptoms such as hot flushes, mood changes, low libido and night sweats, then you are likely in perimenopause. At Menopause Care, we have a team of specialists who are here to help you navigate this life stage fully informed and empowered to make the best decisions for yourself.

If you’d like to book a consultation to find out whether starting HRT is right for you, browse through our menopause doctors or be matched with a specialist when you take our symptoms quiz.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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