Hormone replacement therapy (HRT) may stop periods temporarily or permanently, depending on the prescription and desired outcome.

For example, HRT may stop periods or replace them with “withdrawal bleeding” for people taking hormones to treat symptoms of perimenopause or menopause. HRT also may stop periods for someone using hormones as a gender affirming treatment.

On the other hand, HRT may initiate periods in a person of reproductive age who has not started menstruating or who suddenly or unexpectedly stopped.

This article takes a closer look at what happens to periods on HRT, the different types of HRT and their uses, signs HRT is or is not working, and more.

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How HRT affects periods depends on several factors, including the type of HRT and the specific way a person takes it.

The most common type of HRT is a combination of estrogen and progestin. HRT can also use a single hormone, which can either be progestin-only, estrogen-only, or testosterone.

Below is some information on how different HRT types and methods affect periods.

Continuous HRT

A person may take HRT continuously, which means they do not take any breaks and take the same dose of HRT daily. This generally makes periods stop altogether, as it suppresses the hormones that help form the uterine lining.

Cyclical HRT

A person who takes HRT cyclically will have certain days of their cycle when they have a break from the medication.

Taking HRT cyclically usually means a person will likely experience a period-like withdrawal bleed from the hormones each cycle. This bleed is generally a little lighter than their period.

Sequential HRT

People can also take HRT sequentially, which means they take estrogen for a certain number of days first and then add progestin later in the cycle.

Sequential hormone therapy tries to mimic the menstrual cycle, and bleeding may occur at the end of the HRT cycle.

Gender affirming HRT

Testosterone therapy can be a form of gender affirming care, helping induce more traits that people may associate with masculinity. Testosterone therapy may make periods lighter or less frequent or stop them altogether.

Learn more

These articles explore other aspects of HRT in more detail.

A healthcare professional can provide individualized guidance on what people can expect regarding their periods after HRT.

However, generally speaking, whether a person’s period resumes after they stop HRT may depend on individual factors such as the return of their natural hormone balance and where they are in their reproductive years.

Perimenopause is the transitional time leading up to menopause, in which a person’s menstrual cycles may become irregular. They may notice variations in the length, intensity, and frequency of their periods.

Some people may experience skipped periods or changes in bleeding patterns.

Depending on the method, combined hormone therapy may help. Sequential treatment may assist in regulating periods during perimenopause, while continuous treatment may even stop them.

Learn more about perimenopause.

HRT may help manage symptoms of perimenopause and menopause, such as hot flashes, night sweats, and vaginal dryness. Some people may notice improved moods.

Side effects of HRT depend on the prescription, but people may experience:

HRT will not initiate a menstrual cycle in transgender females. Still, some may experience symptoms similar to those of premenstrual syndrome (PMS) or premenstrual dysphoric disorder when using HRT as a gender affirming treatment.

A note on identity definitions

Medical News Today uses definitions of sexual, romantic, and gender identities that come from LGBTQIA+ and ally sources.

However, it is important to note that these identities are personal, and people may define them differently. Always refer to a person’s sexual, romantic, or gender identity the same way the person describes it.

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Signs of HRT not working will depend on the desired outcome.

For example, someone treating perimenopause or menopause symptoms with HRT may expect to see results within 3 months.

Someone using HRT as a gender affirming treatment may begin seeing the development of secondary sex characteristics within 3 to 6 months, and it could take up to 5 years for some effects to completely develop.

Learn more

Learn more about HRT and bodily changes as part of gender affirming care.

People on HRT should contact their doctor if they experience severe side effects or those that last longer than expected, as these could be symptoms of a more serious condition.

Such side effects may include but are not limited to:

This section answers some common questions about HRT and periods.

Can you miss a period on HRT?

Generally, sequential combined hormone therapy regulates periods or “withdrawal bleeding,” meaning period-like bleeding occurs on a regular schedule.

Someone who misses a period on HRT may consider talking with a doctor about the possibility of pregnancy, the correct way to take the medication, and potentially adjusting the prescription.

Can you stop bleeding on HRT?

Yes, a person can stop bleeding on HRT.

For example, continuous combined hormone therapy stops periods. People may initially experience spotting or breakthrough bleeding, but this eventually stops as well.

Additionally, HRT does not prevent menopause. Despite hormones, the person’s ovaries will eventually run out of eggs. When that happens, they will stop menstruating and enter menopause and postmenopause.

Do you still ovulate on HRT?

Depending on the type of HRT and the way a doctor prescribes it, ovulation can still occur. However, most of the time, HRT will suppress ovulation and act as a contraceptive.

Becoming pregnant on HRT is still possible. The American College of Obstetricians and Gynecologists advises against HRT if a person is already pregnant or trying to become pregnant.

Menopause resources

Visit our dedicated hub for more research-backed information and in-depth resources on menopause.

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HRT may affect menstrual cycles differently depending on the treatment type, which doctors will prescribe based on an individual’s needs and treatment goals.

For some people, HRT may temporarily or permanently halt periods, while for others, it may replace periods with “withdrawal bleeding.”

Conversely, HRT may induce periods in individuals of reproductive age who have not yet menstruated or suddenly stopped having periods.