Hormonal Cycles with POI and HRT
Yes, you do have hormonal cycles if you are using cyclical (sequential) HRT, but these are artificially created cycles from the medication, not natural ovarian cycles. 1, 2
Understanding Your Hormonal Patterns with POI
If You're on Cyclical/Sequential HRT:
- You experience medication-induced cycles where estrogen is given continuously and progesterone is added for 12-14 days each month, creating withdrawal bleeding similar to a menstrual period 3, 2
- These are NOT natural ovarian cycles - they are pharmacologically created patterns that mimic normal menstrual cycles 1
- The cyclical regimen is actually preferred for women with POI because it allows earlier recognition of spontaneous pregnancy, which can occur in 20-25% of women with POI who may unexpectedly ovulate 3, 2
If You're on Continuous Combined HRT:
- You have NO cyclical pattern - both estrogen and progesterone are given daily without interruption 4
- This prevents withdrawal bleeding entirely and creates a steady hormonal state 4
- There are no hormonal fluctuations or "cycles" with this regimen 4
Natural Ovarian Activity with POI
Spontaneous Ovulation Possibility:
- Approximately 20-25% of women with POI may spontaneously ovulate even while on HRT, though this is unpredictable and infrequent 3
- 5-10% may achieve spontaneous pregnancy despite the diagnosis 3
- However, these spontaneous ovulations are rare, temporary, and cannot be reliably predicted or timed 5
Important Caveat:
- The HRT you're taking suppresses any residual ovarian function that might exist, similar to how birth control pills work 3
- If you're on cyclical HRT and miss a withdrawal bleed, you should test for pregnancy promptly as this could indicate spontaneous ovulation occurred 3
Key Clinical Distinction:
The "cycles" you experience on HRT are medication-withdrawal bleeding, not true menstrual cycles driven by your ovaries. 2 Your ovaries are not producing the cyclical hormonal changes that characterize normal ovarian function - the medication is creating this pattern artificially to provide endometrial protection and allow pregnancy detection 1, 2