Unscheduled bleeding with hormone replacement therapy

Abstract

Key content Menopause is now considered as a mid‐life event. Hormone replacement therapy (HRT) is justified when menopausal symptoms adversely affect the quality of life of the individual woman. Management of unscheduled bleeding with HRT remains a clinical challenge and leads to pressure on resources. The aim should be to exclude endometrial pathology and to regulate the bleeding pattern so that the woman's concerns are addressed and compliance maintained. The mechanisms which underlie this unscheduled bleeding are poorly understood. Appropriate counselling should be offered at the outset. Learning objectives To gain knowledge of the most appropriate HRT regimens used in perimenopausal, postmenopausal and hysterectomised women to minimise unscheduled bleeding. To learn how to tailor the treatment regimen to the individual woman's situation. Ethical issues The lack of clinical evidence for managing unscheduled bleeding should be acknowledged. Should clinicians initiate expensive and invasive investigations in all women with unscheduled bleeding on HRT or only select those with significant risk factors?