Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time

Kristyn Manley; Timothy Hillard; Justin Clark; Geeta Kumar; Jo Morrison; Haitham Hamoda; Katie Barber; Debra Holloway; Bronwyn Middleton; Maria Oyston; Mark Pickering; Jenifer Sassarini; Nicola Williams

doi:10.1177/20533691241254413

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time

Post Reprod Health. 2024 May 14:20533691241254413. doi: 10.1177/20533691241254413. Online ahead of print.

Authors

Kristyn Manley¹, Timothy Hillard^{2

3}, Justin Clark^{4

5}, Geeta Kumar^{6

7}, Jo Morrison^{8

9}, Haitham Hamoda^{3

10}, Katie Barber^{3

11}, Debra Holloway¹², Bronwyn Middleton¹³, Maria Oyston¹⁴, Mark Pickering², Jenifer Sassarini^{15

16}, Nicola Williams¹⁷

Affiliations

¹ Department of Gynaecology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK.
² Department of Gynaecology, University Hospitals Dorset NHS Trust, Poole, UK.
³ British Menopause Society, Marlow, UK.
⁴ Department of Gynaecology, Birmingham Women's Hospital, Birmingham, UK.
⁵ British Gynaecological Endoscopy Society, London, UK.
⁶ Department of Gynaecology, Betsi Cadwaladr University Health Board, Wales, UK.
⁷ Royal College of Obstetricians and Gynaecologists, London, UK.
⁸ Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton, UK.
⁹ British Gynaecological Cancer Society, Bangor, UK.
¹⁰ Department of Gynaecology, King's College Hospital, London, UK.
¹¹ Primary Care Physician, Oxford, UK.
¹² Department of Gynaecology, Guys and St Thomas' Hospital, London, UK.
¹³ Department of Gynaecology, University Hospitals Sussex NHS Trust, Worthing, UK.
¹⁴ NHS England Elective Recovery and Transformation Team, London, UK.
¹⁵ Department of Gynaecology, NHS Greater Glasgow and Clyde, Glasgow, UK.
¹⁶ Scottish Menopause Network, Glasgow, UK.
¹⁷ Primary Care Physician, London, UK.

PMID: 38743767
DOI: 10.1177/20533691241254413

Abstract

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.

Keywords: Unscheduled bleeding; guideline; hormone replacement therapy; postmenopausal bleeding; urgent suspicion cancer pathway.