When I started HRT, I was still having periods. My doctor prescribed progesterone first — not what I’d choose now, but I didn’t know any better at the time. I took it 14 days on, 14 days off, and the bleeding was relentless. Heavy, disruptive, exhausting. Eventually, it eased a little, but I was still bleeding every couple of weeks. Later, when I increased my estrogen, the bleeding flared again.
Like many women, I barely thought twice about it. Bleeding had been part of life since my teens. It didn’t occur to me that starting HRT meant I also needed to think differently about what bleeding meant — and how to manage it.
I saw two specialists, one in Singapore and another in the UK. Neither mentioned that increasing my estrogen also meant I should have adjusted my progesterone. That omission matters — because progesterone’s role is not optional. It’s essential.
Why Progesterone Matters
Progesterone’s most important job in HRT is to protect the uterine lining. Estrogen stimulates the endometrium to grow, and if it doesn’t shed, the build-up of cells can increase the risk of endometrial cancer. Progesterone ensures the lining sheds safely.
Yes, it can also help with sleep when taken at night. But that’s just a bonus. Its real role is protection.
I’ve even heard doctors debate this on podcasts. On one of Lauren Streicher’s episodes, a guest suggested that endometrial cancer rates are rising because women aren’t taking enough progesterone alongside estrogen. Whether or not that’s the whole story, one thing is clear: women must be told — clearly and upfront — that progesterone is there to protect them.
And then there’s this: on a Louise Newson podcast, she recalled a doctor saying that some women “wouldn’t be responsible enough” to take their progesterone. Really? That attitude feels incredibly patronising. If women were actually told what could happen if they skipped it — the risks of unchecked estrogen and the protective role of progesterone — how many do you honestly think would choose not to take it?
The Message Women Deserve
The point isn’t to scare women off HRT. Quite the opposite. It’s about trust and transparency.
- Bleeding can happen when you start HRT, especially in perimenopause.
- It often settles, but it still needs to be monitored.
- If you increase estrogen, your progesterone also needs to be reviewed.
That’s how balance — and safety — is maintained.
So let’s stop treating women like they can’t handle the truth. Give us the facts. Explain the risks. Explain the protections. And then trust us to make informed choices.
Because HRT isn’t about making doctors’ lives easier. It’s about making women’s lives better.
My Reflection
I had to learn this the long way round — through months of bleeding, confusion, and unanswered questions. I didn’t know then what I know now: that progesterone isn’t optional if you have a uterus, and that changes in estrogen need to be matched with changes in progesterone. If someone had explained that clearly from the start, I could have avoided a lot of frustration.
That’s why I share this — so other women don’t have to find out the hard way.
Resources & Further Reading
📄 Websites & Guidelines
- NHS – HRT: Types, Benefits, and Risks
- British Menopause Society – HRT Guidance
- North American Menopause Society (NAMS) – Hormone Therapy Statement
🎧 Podcasts & Multimedia
- The Dr Louise Newson Podcast — expert conversations on HRT and progesterone
- Dr. Lauren Streicher: Inside Information — discussions on endometrial cancer and hormone therapy
📝 Related Blog Posts
- [HRT Before Periods Stop: Why Perimenopause Matters (Part 1)] — on why starting HRT earlier makes sense
- [Does Breast Density Really Matter?] — exploring breast density, risk, and why women aren’t routinely told
- [Vaginal Estrogen: The Simple Fix We’re Not Talking About] — shining a light on GSM and the treatment too few women hear about
OMG: The Women's Health Brief 
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