Another way of giving hormones is “cyclic therapy.” With this regimen, the progestin component (Provera is the most commonly prescribed progestin) is only given for part of the month; the estrogen may be given daily or for only part of the month as well. More often than not, women on cyclic therapy will have bleeding — usually regular predictable bleeding just like a period.

You have a choice here, as do all women who experience bleeding on hormones. First, your doctor will determine whether the bleeding is anything to worry about. Often, if the bleeding persists for several months, we will look at the uterine lining with ultrasound or do a biopsy or D&C to make sure the bleeding is just a side effect of the hormones and not a sign of something more serious. If the bleeding is determined to be just a side effect, then you must make a decision: stop the hormones and lose all the wonderful benefits; hang in there and hope you are in the 80 percent of women whose bleeding will eventually go away; change to cyclic therapy and most likely have predictable monthy periods; or work with your doctor to adjust the dose of estrogen and progestin to try to stop the bleeding. The last option usually involves increasing the progestin component (with Prempro this would mean changing to Prempro-5), although sometimes estrogen doses are modified. It requires patience on your part and good communication with your doctor as well.

I would encourage you to talk to your doctor directly, via a face-to-face appointment, to discuss these options. In my opinion, for the vast majority of women, the benefits of hormone replacement are well worth the effort.

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