Can I be on Hormone Replacement Therapy (HRT) if I'm still having periods?

Hormone Replacement Therapy During Perimenopause

Yes, you can use Hormone Replacement Therapy (HRT) while still having periods, particularly if you're experiencing perimenopausal symptoms that significantly impact your quality of life. 1

Understanding Perimenopause and HRT

Perimenopause is the transition period before menopause when hormonal fluctuations begin but menstruation hasn't completely stopped. During this time:

• Women may experience vasomotor symptoms (hot flashes), mood changes, sleep disturbances, and vaginal symptoms despite still having periods
• HRT can be appropriate for managing these symptoms even before menstruation ceases completely
• Treatment should focus on symptom management rather than prevention of chronic conditions 1

Benefits of HRT During Perimenopause

• Effective relief of vasomotor symptoms (hot flashes, night sweats)
• Improvement in sleep quality and mood disturbances
• Prevention of urogenital atrophy
• Potential stabilization of menstrual irregularities that often occur during perimenopause

Formulation Considerations

For perimenopausal women who still have periods:

• Cyclic regimens are typically recommended initially:

  • Estrogen daily (transdermal preferred for better safety profile)
  • Progestin for 10-14 days each month to prevent endometrial hyperplasia 1

• Starting doses should be low with gradual escalation:

  • Initial dose of 0.5 mg estradiol every other day
  • Can increase to 0.5 mg daily after 12-18 months as needed 1

Important Safety Considerations

1. Mandatory progestin component: Women with an intact uterus must receive progestin along with estrogen to prevent endometrial cancer 1

2. Contraceptive needs: HRT is not a contraceptive. If still having periods, you may still be fertile and need contraception 2

3. Monitoring: Regular follow-up is essential:

   • Initial follow-up at 2-4 weeks
   • Regular reassessment every 3-6 months 1
   • Monitoring hormone levels 8-10 weeks after dose adjustments

4. Risk assessment: HRT carries risks including:

   • Increased risk of venous thromboembolism
   • Potential increased risk of breast cancer with long-term use
   • Stroke risk (9 more per 10,000 woman-years) 1

Contraindications

HRT should be avoided in women with:

• History of breast cancer
• History of venous thromboembolism
• Undiagnosed vaginal bleeding
• Active liver disease
• Uncontrolled hypertension

Transitioning to Postmenopausal HRT

As you progress from perimenopause to menopause:

• Your HRT regimen may need adjustment
• Once periods have stopped for 12 consecutive months, you may transition to a continuous combined regimen (daily estrogen plus progestin) 1

Alternative Options

If HRT is contraindicated or not preferred:

• SSRIs/SNRIs (particularly venlafaxine and paroxetine) for vasomotor symptoms
• Gabapentin for hot flashes
• Non-hormonal vaginal moisturizers for vaginal symptoms
• Lifestyle modifications including regular exercise and stress reduction techniques 1

Remember that HRT should be used for symptom management at the lowest effective dose for the shortest duration needed, with regular reassessment of benefits and risks.