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link between cortisone and breakthrough bleeding on HRT
I'm a 56 year old post menopausal woman. I started HRT orally in Dec 2024 and would have slight spotting if I forgot a dose. I changed to the HRT patch with both estrogen and progesterone in December 2025 and would only spot if I forgot to change the patch on time. Fast forward to two weeks ago I received a cortisone injection in my foot and a few days ago started to have breakthrough bleeding which hasn't stopped yet. My naturopath booked for a vaginal ultrasound which is tomorrow, but it has set my anxiety into overdrive! I have been researching and today just found a few studies that show some women experience breakthrough bleeding after a cortisone injection. Has anyone here experience this? If so how long did the bleeding last? I have read it could last for a few days to a month or more. I am due to have another cortisone injection in two weeks and am seriously considering going off the HRT as I need the cortisone more and am sick of bleeding after not having a period for a few years.
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You, I believe have experienced the hypothalamic-pituitary-ovarian axis reaction.
"Breakthrough bleeding after a cortisone injection is a recognized, though often unexpected, side effect caused by synthetic steroids interfering with the hypothalamic-pituitary-ovarian axis. This systemic absorption causes hormonal imbalances—typically a drop in estrogen/progesterone—leading to irregular periods, spotting, or postmenopausal bleeding, which usually resolves within 1–2 weeks." https://joint-injections.co.uk/can-epidural-steroid-injections-affect-your-menstrual-cycle/.
The bleeding happened because it messed with your hormones and you experienced bleeding, probably because it increased testosterone which converted to estradiol.
I had something similar with a knee injection, cortisone. My testosterone shot up, according to my hormone doctor, higher than most of his male patients.
I actually enjoyed the effect and it lasted for about 4 months.
Seems the shot tanked my cortisol and my testosterone shot up in a see-saw effect.
No bleeding, but my already contralto blues singing voice went into the baritone range, acne appeared, hair grew, muscles appeared and my sex life was great.
I have had a couple of cortisone shots since then but not the same reaction.
My friend who gets cortisone shots regularly says she has a different reaction every time.
My doctor shook my husband's hand and told him, congratulations, when I reported my reaction to that first shot. Doctor also told me not to tell people or they would be lining up for the shot; I have anyway. ha
https://pubmed.ncbi.nlm.nih.gov/7573091/.
Hi, @blueyes70, and welcome. I was just checking in to see how you're doing now. Unexpected bleeding is always stressful, especially when you've finished having periods!
You might be interested in this conversation about spotting following cortisone injections: https://connect.mayoclinic.org/discussion/spotting-following-cortisone-injection/
Are you still experiencing bleeding?
@klp thanks for responding. I had my transvaginal ultrasound last Wednesday and my bleeding stopped on Thursday thank goodness. My uterine lining looks good, However according to the report, there was some fluid noted in my pelvic region so now I have to go for a CT scan which is causing more anxiety. I’m wondering if the fluid was the blood since on that day I still had active breakthrough bleeding. Wondering if anyone has had this same thing happen and everything turned out ok?
I experienced a similar reaction from a cortisone shot. The cortisone shot knocked my cortisol level down and the body reacted by raising my testosterone which then converted to estradiol. I did not have the reaction in my uterus, but I did have symptoms of too much testosterone. Most of which I thoroughly enjoyed. 🙂
There is research showing hypothalamic-pituitary-ovarian axis reaction.
"Breakthrough bleeding after a cortisone injection is a recognized, though often unexpected, side effect caused by synthetic steroids interfering with the hypothalamic-pituitary-ovarian axis. This systemic absorption causes hormonal imbalances—typically a drop in estrogen/progesterone—leading to irregular periods, spotting, or postmenopausal bleeding, which usually resolves within 1–2 weeks."
https://joint-injections.co.uk/can-epidural-steroid-injections-affect-your-menstrual-cycle/.
In many women, some blood from the uterus flows backward through the fallopian tubes and collects in the pelvic cavity. This might be what you are seeing on the ultrasound.
You may continue to have some symptoms. My symptoms continued for about 4 months as my body converted the testosterone to estradiol and then as the hormones dissipated.