CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Menopause - Management
When should I refer women who have started HRT?
- Refer if:
- Breakthrough bleeding persists for more than 4–6 months after starting HRT or tibolone.
- A bleed occurs after amenorrhoea.
- 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.
In depth
© NHS Institute for Innovation and Improvement