Q.I’m 59 and haven’t had a period since I was 48. Recently my family doctor decided I should be on hormone therapy and put me on Prempro (.625/2.5mg). After taking it for three months, I started bleeding. I’ve now had three five-day periods, spaced two weeks apart. I called my doctor’s office and was told that this is normal and the only alternative was to discontinue the Prempro. Isn’t there another hormone regimen I could try that won’t cause bleeding? I’d really like to get the heart benefits of hormone therapy. I’m overweight, and I recently had to see a cardiologist when my long-term high blood pressure treatment (15 years) appeared to have caused some thickened heart muscle and pulmonary hypertension.

– Verna

A. First, let’s talk about why your doctor suggested hormone replacement therapy (HRT) in the first place. The most likely cause of death in women after menopause is cardiovascular disease. Use of estrogen in these women may reduce this risk by 50 percent — and if that is not amazingly significant, then I don’t know what is! Estrogen also reduces the risk of osteoporosis (brittle, easily broken bones) and Alzheimer’s. Hormones also help with menopausal symptoms such as hot flashes, night sweats and vaginal dryness.

Now, for the annoying little side effect you have noticed: some women who start hormone replacement will have bleeding. Medications like Prempro (a combination of the estrogen Premarin and the progestin Provera) are called “continuous combined” therapy because they deliver both the estrogen and the progestin component every day. With continuous combined therapy, 80 percent of women who stick with the hormones for a year will NOT bleed — however, in the initial several months of use, irregular nuisance bleeding is fairly common. Twenty percent of women on continuous combined therapy like Prempro will continue to bleed indefinitely.

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