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Menopause - Management
How do I manage bleeding on monthly cyclical regimens?
- Before changing treatment, visualize the cervix, check smears are up to date, and refer for transvaginal ultrasound to exclude pelvic abnormalities.
- Check compliance, drug interactions (e.g. anticonvulsants), or gastrointestinal upset.
- Altering the progestogen part of the regimen may improve bleeding problems:
- Heavy or prolonged bleeding: increase the duration or dosage of the progestogen, or change the type of progestogen. Idiopathic menorrhagia may be helped by using the levonorgestrel-releasing intrauterine system combined with an oestrogen delivered orally or transdermally.
- Bleeding early in the progestogen phase: increase dosage or change the type of progestogen.
- Irregular bleeding: change regimen or increase the dosage of progestogen.
- No bleeding whilst taking a cyclical regimen reflects an atrophic endometrium and occurs in 5% of women. Pregnancy needs to be excluded in perimenopausal women. Check compliance if the progestogen component is taken separately.
In depth
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