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Menopause - Management
When should I refer women who have started HRT?
- Refer women who are taking cyclical hormone replacement therapy if:
- There is a change in pattern of withdrawal bleeds or break through bleeding.
- There is multiple treatment failure e.g. three or more regimens have been tried.
- Refer to a team specializing in the management of gynaecological cancer (depending on local arrangements) any persistent or unexplained bleeding after cessation of hormone therapy for 6 weeks.
Basis for recommendation
- These recommendations are based on published expert opinion [Monga, 2006; Rees and Purdie, 2006b].
- Abnormal bleeding requires investigation if:
- The pattern of withdrawal bleeding or breakthrough bleeding changes while taking monthly cyclical therapy.
- There is breakthrough bleeding that persists for more than 4–6 months or does not lessen while taking a 3-monthly regimen.
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