Tips for Managing Bleeding on Hormone Replacement Therapy

The British Menopause Society ( BMS ) has released new guidelines in collaboration with other organizations to assist General Practitioners ( GPs ) in managing unexpected bleeding in women using Hormone Replacement Therapy ( HRT ) . The increase in HRT prescriptions has led to a rise in women experiencing unscheduled bleeding , resulting in unnecessary referrals for cancer tests . This surge in referrals has caused longer waiting lists and unnecessary stress for women , with no significant increase in cancer diagnoses.

According to statistics , 1.9 million women in the UK were prescribed HRT in 2021/2022 , marking a 35 % increase from the previous year . Additionally , there has been a 43 % rise in referrals to the Urgent Suspicion of Cancer Pathway ( USCP ) over the past three years . Despite this increase in referrals , there has not been a corresponding increase in cancer diagnoses . The new guidelines aim to provide clear criteria for GPs to determine when further investigations are necessary , helping to reduce waiting lists and improve patient care.

The guidelines outline the initial assessment and risk factors for endometrial cancer in women on HRT and suggest adjustments to HRT preparations if unscheduled bleeding occurs . For low - risk women , the guidelines recommend offering adjustments in progestogen or HRT preparation for a period of six months . If bleeding persists after this adjustment period , further discussions about ultrasound or alternative non - hormonal treatments are suggested . Women who choose to stop HRT and experience settled bleeding do not require further investigations.

Key factors outlined in the guidelines that increase the risk of endometrial cancer include a BMI over 40 and hereditary conditions like Lynch syndrome . Minor risk factors include a BMI of 30 - 39 , diabetes , and polycystic ovarian syndrome . Dr. Kristyn Manley , a member of the BMS Medical Advisory Council , emphasizes the importance of prioritizing investigations for women at higher risk of endometrial cancer to ensure appropriate care and resource allocation.

The guidelines were developed in collaboration with various organizations , including the Royal College of Obstetricians & Gynaecologists , British Gynaecological Cancer Society , and Royal College of General Practitioners . By providing clarity on risk assessment and bleeding patterns , the guidelines aim to streamline the management of unscheduled bleeding in women on HRT and improve outcomes while utilizing healthcare resources efficiently . The new guidelines are a step towards addressing the challenges posed by the increasing use of HRT and reducing unnecessary referrals and testing for women experiencing unexpected bleeding.