Yes, You Can Still Get Periods on HRT Patches. Here’s Why 

The transdermal hormone patch you’re using has eased the worst of your perimenopause (or early menopause) symptoms: the relentless hot flashes, mood changes, brain fog, and sleepless nights. But just as life starts to feel manageable, the unexpected happens: you begin to have periods again, or at least sudden bleeding that makes it seem that way. If your periods haven’t disappeared entirely yet, maybe it’s spotty or inconsistent. What’s going on? 

Hormone patches that contain estrogen—or a combination of estrogen and progesterone— are common forms of hormone replacement therapy (HRT) or menopause hormone therapy (MHT) that can impact your period or cause it to restart.

“MHT can make periods lighter, irregular, or stop them altogether, especially with combined estrogen and progestin therapy,” OB/GYN and menopause specialist, Sadif Lodhi, D.O., says. “It alters the balance of estrogen and progesterone in the body and supplements the hormones you already have regulating the menstrual cycle.”

About the Experts

Sadif Lodhi, D.O., FACOG, an OB-GYN and menopause specialist in private practice at Femme Vie Health in Fairview, New York.

Taniqua Miller, M.D., FACOG, an OB-GYN and menopause specialist in private practice in New York City.

Thomas Ruiz, M.D., lead OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

How HRT Patched Deliver Hormones

Unlike oral hormone therapy, MHT / HRT patches deliver hormones through the skin into the bloodstream, bypassing the liver and digestive system. Patches typically contain estrogen or a combination of estrogen and progestogen, such as estradiol and levonorgestrel. The point is to help manage menopausal symptoms like hot flashes and prevent osteoporosis, Lodhi notes.

“The addition of progestogen is necessary for women with a uterus to reduce the risk of endometrial cancer caused by unopposed estrogen,” she says.

Research suggests that patches, especially with estrogen, may pose a lower risk of blood clots compared to oral forms of HRT (1).

Cyclical hormone therapy

The most common type of HRT that may lead to irregular periods is cyclical hormone therapy, says Lodhi. The treatment mimics hormone shifts in the natural menstrual cycle, which is why it’s usually prescribed to women who are perimenopausal and still bleeding monthly—or who are in the early stages of menopause. 

The treatment involves two parts:  Typically, you wear an estrogen patch throughout your cycle, and then add a separate progesterone patch (or take a progesterone pill) for the second half of your cycle. 

Continuous combined hormone therapy

In continuous combined hormone therapy patches, both estrogen and progestogen are released and absorbed by the body, daily. The patches are changed within a week, but there is no pause in treatment. This type of hormone therapy is usually given to women who are at least one year into full menopause, according to  Thomas Ruiz, M.D., the lead OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.

How HRT Can Change Your Period

Before perimenopause, a drop in progesterone near the end of your cycle triggered your uterine lining to shed, and—viola—your period would start. Cyclical hormone therapy works similarly. You begin estrogen at the beginning of your cycle and then add the progestogen around the last 14 days. The progestogen mimics the drop in progesterone, leading to what’s called withdrawal bleeding.

Within the first three months of starting this therapy, changes in hormone levels can cause spotting or irregular or sudden bleeding. “This isn’t a true period, so it’s not your period coming back,” Ruiz says. “It’s just your body’s way of adjusting to the introduction of hormones that have been depleted as you transitioned into menopause.” Bleeding will usually stop completely within six months to a year, he adds.

Effects of HRT patches if you don’t have a uterus

If you’ve had a hysterectomy, your options are a bit different. According to the American Cancer Society, women without a uterus don’t need progestin as part of hormone therapy, because there’s no risk of endometrial cancer (2). In fact, adding progestin can slightly raise breast cancer risk, so estrogen-only patches tend to be the better option in this case.

Estrogen patches can help alleviate common menopause symptoms like vaginal dryness, night sweats, hot flashes, and mood swings.

Menopause and Bleeding

Why Your Periods Get Heavier in Perimenopause (and How to Cope)

Flash Periods: The Perimenopause Surprise You Didn’t See Coming

Other Conditions That Affect Menstruation on MHT Patches

Conditions such as fibroids, endometriosis, and thyroid disorders can affect menstruation while using MHT patches.  

“For instance, fibroids can cause heavier bleeding, while thyroid imbalances may lead to irregular cycles,” Lodhi says. “Managing these conditions alongside MHT is crucial for the best outcomes.”

When to Start MHT Patches

If you’re in perimenopause or menopause and experiencing moderate to severe symptoms like hot flashes, night sweats, or mood changes, you may want to consider hormone patches, according to Lodhi. “The best time to begin MHT is within 10 years of menopause or under the age of 60 for optimal benefits,” she says. “Each patient should consult their doctor for personalized advice based on their symptoms, age, and health risks.”

If you have reduced bone density, HRT patches can also help to improve your numbers, Lodhi noted.

Side Effects of Hormone Therapy Patches

Like all treatments, patches can cause side effects. The most common tends to be skin irritation where you place the patch, says Ruiz. The best way to avoid this is periodically to move it around. Headaches, nausea, and breast tenderness can also happen. 

Menstruation on Other Forms of HRT

Menstruation can be affected by other forms of systemic hormone replacement therapy containing estrogen and progestin, Lodhi says. That includes hormones delivered through a pill, cream, gel, or vaginal ring.

“Any type of hormone therapy may cause irregular bleeding, lighter or heavier periods, and eventually the cessation of menstruation, depending on the individual’s hormonal balance and the type of therapy,” she adds. Similar to a hormone therapy patch, breakthrough bleeding is common during the initial months due to changes in hormone levels of estrogen and progesterone and the way they act on the uterus.