Medically reviewed by Dr Rachel Hines, MBChB, MRCGP, DFSRH, DRCOG – Updated 10 July 2024
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 or sequential HRT.
What is hormone replacement therapy (HRT)?
Hormone levels, particularly oestrogen, fluctuate and decline during perimenopause and menopause. These hormonal changes are behind many menopause symptoms. HRT is a medication that supplements your body with hormones to treat menopause symptoms.
Oestrogen is given to treat your symptoms. If used alone, oestrogen can cause abnormal thickening and even cancer of the womb lining. Taking progesterone alongside oestrogen protects the womb lining and effectively removes this risk.
Read more about progesterone HRT.
What is cyclical HRT?
If it has been less than a year since your last period, you should probably take HRT in a cyclical, or sequential, way. Monthly cyclical HRT 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.
This variable level of hormones allows your body to have a regular, period-like bleed and keep the lining of the uterus healthy. Importantly, it reduces the chances of unpredictable, irregular bleeding when taking HRT.
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.
This is absolutely not true. If you are still having your periods you CAN take HRT.”
Are there different types of cyclical HRT?
Most people in perimenopause will be advised to take monthly cyclical HRT, but in rare cases your doctor may recommend three-monthly HRT. This is when you take oestrogen every day, and take progesterone – if needed – alongside it for 14 days every three months.
This will be recommended for people who are having irregular periods and need help with their menopause symptoms, but find progesterone very difficult to tolerate. You will need to have ultrasound monitoring at least once a year if you use this method.
Does cyclical HRT stop periods?
No, you will usually 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 they tend to be lighter and more regular, especially if you have been having heavy or irregular periods as you approach menopause.
You will likely have a bleed each month if you’re taking monthly cyclical HRT, however don’t worry if you don’t – not all women do.
How should you take progesterone while you still have periods?
There are several options for taking progesterone if needed, including tablets or patches combined with oestrogen, progesterone capsules, and hormonal IUDs.
Hormonal IUDs such as Mirena, Benilexa and Levosert are often recommended if you still have periods. They can be used to provide progesterone for 5 years as a part of HRT. They are also a contraceptive. Some women stop having bleeding with hormonal IUDs, some have regular periods and others have irregular bleeding. Bleeding is often lighter and less painful and they can be particularly helpful in perimenopause.
Read more about progesterone HRT.
How do your HRT needs change with age?
Your HRT needs will change as you go through menopause.
HRT dose
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.
HRT type
The type of HRT you need will also change with time. You’re likely to move from taking hormones cyclically to taking them continuously.
Continuous HRT involves taking oestrogen – and progesterone if you have your womb – every day without a break.
Continuous HRT is thought to reduce the risk of endometrial cancer more than cyclical HRT and can be used when you have had at least a year without periods and are thought to be postmenopausal.
The switch from cyclical to continuous HRT will generally happen after two to five years on cyclical HRT, or when you are over the age of 54, but you should speak to your doctor for personalised advice.
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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