Take 2: Abnormal bleeding

When should abnormal bleeding during perimenopause or on HRT be investigated?

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It’s very common for women to experience abnormal bleeding in the first six months of continuous HRT.

But if breakthrough bleeding continues beyond six months, it should be investigated, says Professor Bronwyn Stuckey, a clinical endocrinologist and the medical director at the Keogh Institute for Medical Research in WA.

“Abnormal bleeding patterns on hormone replacement therapy are quite common especially if people use combined continuous HRT very close to the menopause,” she says.

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“So I think the recommendation should be that we use cyclical hormone replacement therapy, cyclical treatment in the perimenopause until well after the last natural menstrual period and then go onto continuous.

“That will eliminate a lot of the abnormal bleeding patterns. If you try to give continuous combined HRT too close to the last menstrual period you get breakthrough bleeding.”

If abnormal bleeding occurs after six months of continuous HRT an endometrial ultrasound is necessary.

The sort of things that could cause abnormal bleeding are an imbalance between the oestrogen and progestogen, and a fibroid.

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