New guidelines on when to refer women taking HRT for unexpected bleeding should help cut unnecessary tests, menopause experts have said.
The British Menopause Society (BMS) said with the recent significant rise in use of hormone replacement therapy (HRT), many women were being referred for cancer tests when they have unexpected bleeding despite them being at low risk.
Recommendations had been developed jointly with other groups including the Royal College of GPs to address this “pressing issue”, which was exacerbating already growing waiting lists, the BMS said.
HRT was prescribed to 1.9 million women in the UK in 2021/2022, which was a 35% increase on the previous year, delegates heard at the launch of the guidelines at the BMS annual scientific conference.
In parallel, there had also been a 43% increase over the past three years in urgent cancer referrals for women who had reported unscheduled bleeding.
Yet the change in referral pattern does not appear to have resulted in more cancers being diagnosed, the BMS noted.
The guidelines set out initial assessment, endometrial cancer risk factors on women taking HRT and when to investigate further.
It advises GPs that in the absence of risk factors for endometrial cancer, the first step should be to offer adjustments in the progestogen or HRT preparation, for six months in total, if unscheduled bleeding occurs either within six months of starting HRT or persists three months after a change in HRT dose or preparation.
If unscheduled bleeding continues in low-risk women after six months of adjusting their HRT, discuss the option of either an urgent ultrasound or weaning off HRT and looking at non-hormonal alternatives, it continues.
In women who chose to stop taking it, where bleeding has settled after four weeks no further investigations are needed, the recommendations state.
Major endometrial cancer risk factors set out in the guidelines include having a BMI over 40 or hereditary conditions such as Lynch syndrome. More minor risk factors include a BMI of 30-39, diabetes and polycystic ovarian syndrome.
Dr Kristyn Manley, BMS Medical Advisory Council member, said: ‘Unexpected bleeding is worrying for women and there are long and growing waiting lists for these tests and procedures, which increases the stress even further.
‘Whilst all irregular bleeding is distressing, there is a need to prioritise investigations for those with a potential increased risk of endometrial cancer, over those in whom endometrial cancer is unlikely.’
She added: ‘The new guidelines provide clarity for health professionals on the appropriate assessment of risk factors and bleeding patterns. As well as when it might be more appropriate to review and monitor HRT prescriptions and compliance, before making a referral for tests.”
Is it just me, or is this guideline utterly useless?
Absolutely no clarity, As usually we always start with low dose , so what’s point of changing preparation oral to patches/ gel? Who can wait for 3-6 months with persistent bleeding and what if risk factors are there? What to do during that time. Seems needs more clarification .