Unscheduled bleeding with hormone replacement therapy

2019 ◽  
Vol 21 (2) ◽  
pp. 95-101 ◽  
Author(s):  
Fulva Gajjar Dave ◽  
Tolu Adedipe ◽  
Stewart Disu ◽  
Raphael Laiyemo
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Unscheduled Bleeding

Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy

2019 ◽  
Vol 25 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Salwa Abdullahi Idle ◽  
Haitham Hamoda
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Transvaginal Ultrasound ◽  
Hormone Replacement ◽  
Atypical Hyperplasia ◽  
Pelvic Ultrasound ◽  
Normal Appearance ◽  
Endometrial Polyps ◽  
Ultrasound Findings ◽  
Unscheduled Bleeding

Objective This study correlates the transvaginal ultrasound findings with histopathology results in women who present with unscheduled bleeding on hormone replacement therapy. Study design Retrospective analysis of 469 consecutive cases with unscheduled bleeding on hormone replacement therapy (203 patients on sequential hormone replacement therapy (seq-HRT) and 266 patients on continuous combined hormone replacement therapy (con-HRT)). Main outcome measures Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy. Results Normal appearance of the endometrium on pelvic ultrasound was seen in 62% patients on seq-HRT and 43% of women on con-HRT. These women required no further assessment and were discharged. Histological assessment showed normal endometrial tissue in 22% of women on seq-HRT and 22% of con-HRT group. Benign endometrial polyps were noted in 8% of women on seq-HRT versus 18% of women on con-HRT. Hyperplasia without atypia was noted in 0.5% of woman on seq-HRT versus 0.4% of women on con-HRT while atypical hyperplasia/endometrial cancer was noted in 2% of women on seq-HRT versus 1% of women on con-HRT. Conclusion Women who present with unscheduled bleeding on hormone replacement therapy both on sequential and continuous combined regimens can be reassured that the risk of pathology is low.

A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy

2021 ◽  
pp. 205336912110244
Author(s):  
Salwa Abdullahi Idle ◽  
Nick Panay ◽  
Haitham Hamoda
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Outcome Measures ◽  
Study Design ◽  
Questionnaire Survey ◽  
Hormone Replacement ◽  
Treatment Options ◽  
Cross Sectional ◽  
Unscheduled Bleeding

Objective To explore the views of members of the British Menopause Society on the management of women with unscheduled bleeding on hormone replacement therapy. Study design An electronic cross-sectional questionnaire survey. Main outcome measures Investigations, treatment options and preferences for the management of women with unscheduled bleeding on hormone replacement therapy. Results A total of 91/178 (51%) clinicians investigate patients with unscheduled bleeding within three to six months of starting sequential hormone replacement therapy (seq-HRT) versus 83/178 (47%) for continuous combined hormone replacement therapy (con-HRT). A total of 52/178 (29%) versus 54/178 (30%) would investigate unscheduled bleeding continuing beyond six months while 18/178 (10%) versus 26/178 (15%) would investigate within three months. Assessment is requested as urgent by 88/176 (50%) clinicians, routine by 47/176 (27%) and a two-week-wait-suspected cancer referral by 41/176 (23%). A total of 97/178 (55%) clinicians would continue seq-HRT and refer versus 117/178 (66%) for con-HRT. A total of 46/178 (26%) clinicians would change the progestogen preparation in women with unscheduled bleeding on seq-HRT. For women on con-HRT, 12/178 (7%) clinicians would change to seq-HRT and 8/178 (5%) to the Mirena IUS. The Mirena IUS is the preferred progestogen for 81/178 (45%) of clinicians when prescribing hormone replacement therapy. Conclusions There is a varied approach in the practise amongst British Menopause Society members to managing women with unscheduled bleeding on hormone replacement therapy. Further research is needed to determine the optimal assessment pathways for women with unscheduled bleeding on hormone replacement therapy.

Postmenopausal bleeding

2013 ◽  
Vol 6 (11) ◽  
pp. 709-716
Author(s):  
Rebecca Pugh ◽  
Anna Humphries
Keyword(s):  
Endometrial Cancer ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Secondary Care ◽  
Hormone Replacement ◽  
Postmenopausal Bleeding ◽  
Urgent Referral ◽  
Underlying Malignancy ◽  
Unscheduled Bleeding ◽  
Careful History

Postmenopausal bleeding (PMB) is one of the most common reasons for referral to gynaecology services. This is due to the concern of possible underlying malignancy, as approximately 10% of women with PMB will have endometrial cancer. With growing use of hormone replacement therapy there is increased uncertainty as to what constitutes unscheduled bleeding and careful history and examination is required. Although benign conditions represent the most frequent cause of PMB, all women will require urgent referral and investigation in secondary care.

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