Let’s Talk About Unscheduled Bleeding on HRT (2024 BMS Guideline Update)

UNSCHEDULED BLEEDING ON HORMONE THERAPY: What You Need to Know

If you’re on hormone therapy (HRT) and notice spotting or unexpected bleeding, don’t panic—but don’t ignore it either. Most cases are harmless, but it’s important to make sure everything is okay.

🩸 What Is “Unscheduled Bleeding”?

This means any vaginal bleeding or spotting that happens:

• At a time you didn’t expect
• More than 6 months after starting HRT
• After you’ve had no periods for over a year

📋 What Will Your Provider Check?

We’ll review:

• The type of hormones you're using (pills, patches, IUD, etc.)
• When the bleeding started, how often it happens, and how heavy it is
• Your medical history (weight, diabetes, PCOS, family cancer history)

You may also need:

• A pelvic exam
• A pregnancy test or STI testing (if needed)
• A Pap smear (if due)

🔍 When Do We Order a Pelvic Ultrasound?

If the bleeding:

• Lasts more than 6 months
• Starts more than 6 months after starting HRT
• Is heavy, frequent, or prolonged

We’ll also order one right away if you have certain risk factors for uterine (endometrial) cancer.

📏 What Are We Looking For?

We check the thickness of the uterus lining (endometrium) with an ultrasound:

• >4 mm is a concern if you're on continuous HRT
• >7 mm if you're on a cycle (monthly) HRT plan
• If we can’t see clearly or bleeding continues, we may recommend a biopsy or hysteroscopy

💊 What Can We Adjust?

Your hormones may need a tweak. We may:

• Increase your progesterone dose
• Switch your hormone type
• Use an IUD (which can protect your uterus lining)

✅ What’s Next?

• If all tests are normal: We’ll adjust your HRT and follow up in 3–6 months.
• If there’s an abnormal result: We’ll stop hormones and refer you to a specialist.

Most bleeding is NOT cancer—but we always want to be thorough. If you're concerned, reach out so we can guide you step-by-step.

— JaeNix Team