Breakthrough Bleeds on Menopause Hormone Treatment (MHT)

An image that reflects the complications of breakthrough bleeds


Menopause can be a challenging phase of life for many women due to the myriad of physical and emotional changes that occur. For some, Menopause Hormone Treatment (MHT) becomes a crucial component of managing these symptoms. However, one common concern that may arise when beginning MHT is the occurrence of breakthrough bleeds. In this blog post, we will explore why breakthrough bleeds are considered normal when starting menopause hormone treatment and explain how and why they occur. We will also delve into the use of the Mirena Coil and other progestogens like Utrogestan in managing breakthrough bleeds during the perimenopausal and postmenopausal stages. It is important to note that progestogens must always be prescribed as part of MHT when there is a uterus.

Breakthrough Bleeds: A Common Occurrence

When women first start menopause hormone treatment, they may experience what is known as “breakthrough bleeds.” These episodes are often disconcerting but are considered a normal part of the adjustment phase when beginning MHT. It is essential to understand that this does not indicate that something is wrong with the treatment or the patient.

The British Menopause Society, in collaboration with experts like Dr. Joanne Hobson, recognizes that the body takes some time to adapt to the new hormonal balance introduced by MHT. As a result, breakthrough bleeds may occur as the body attempts to find its equilibrium. It is important to note that these bleeds are not the same as menstrual periods and should decrease in frequency and intensity as the treatment continues.

Why Breakthrough Bleeds Occur

The occurrence of breakthrough bleeds can be attributed to several factors:

  1. Hormonal Fluctuations: When beginning MHT, there can be fluctuations in hormone levels as the body adapts to the treatment. This adjustment phase may lead to spotting or light bleeding.
  2. Uterine Changes: The uterine lining may become more sensitive to hormonal changes during menopause. These changes can result in occasional bleeding, especially when oestrogen and progestogen levels are being optimised.
  3. Individual Variations: Each woman’s response to MHT is unique. Factors such as the specific formulation of MHT, the woman’s medical history, and her individual physiology can all influence the likelihood and severity of breakthrough bleeds.

Managing Breakthrough Bleeds: The Role of the Progestogens

Breakthrough bleeds can be managed effectively, especially during the perimenopausal and postmenopausal stages, by using specific strategies:

  1. Mirena Coil: The Mirena Coil is a hormonal intrauterine device that releases a low dose of a progestogen hormone called levonorgestrel. This coil is a versatile option for women, as it can be used by both perimenopausal and postmenopausal individuals. It works by thickening the cervical mucus and making the uterine lining less receptive to bleeding, thus reducing the occurrence of breakthrough bleeds. In addition, the Mirena Coil can provide contraceptive cover during the peri menopausal phase.
  2. Utrogestan: Utrogestan (a body identical MHT) is another progestogen option, often used in a sequential manner during perimenopause and continuously post-menopause. Sequential use means taking Utrogestan for a certain number of days each month, while continuous use involves taking it every day. Utrogestan helps maintain uterine health and minimize breakthrough bleeding by balancing the effects of oestrogen in the body.
  3. Synthetic progestogens: These are found in a variety of MHT preparations. They maybe in combination with oestradiol or some of them can be prescribed separately.

Your Healthcare professional can talk through these options with you.


Breakthrough bleeds during menopause hormone treatment are a common occurrence and should not be a cause for alarm. It is essential to understand that these bleeds are part of the body’s adjustment to the new hormonal balance introduced by MHT. Utilizing options like the Mirena Coil, Utrogestan or Synthetic Progestogens can effectively manage and reduce the frequency and severity of breakthrough bleeds, making the journey through menopause more comfortable and manageable.

While it’s important to consult with a healthcare provider to tailor treatment to individual needs, these strategies can help women navigate this transformative phase of life with confidence and peace of mind.

Women’s Health Concern Factsheets – Menopause:

British Menopause Society:

Dr. Joanne Hobson – British Menopause Society Menopause Specialist:

Patient Information Leaflet for Mirena Coil: Consult with your healthcare provider for specific information.

Utrogestan Patient Information Leaflet: Consult with your healthcare provider for specific information.

Synthetic Progestogen: Patient Information Leaflet: Consult with your healthcare provider for specific information.