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Human Reproduction, Vol. 15, No. suppl_3, pp. 7-17, 2000
© 2000 European Society of Human Reproduction and Embryology

Disturbances of endometrial bleeding with hormone replacement therapy

Anna M. Thomas1, Martha Hickey2 and Ian S. Fraser1,3

1 Department of Obstetrics and Gynaecology, University of Sydney, Sydney Centre for Reproductive Health Research, Family Planning NSW Australia 2 Department of Obstetrics and Gynaecology, St Mary's Hospital London, UK

Correspondence: 3To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia. E-mail: helena{at}med.usyd.edu.au

Breakthrough bleeding is a common problem in postmenopausal women taking hormone replacement therapy (HRT) and is often the single most important factor deterring women from continuing to use HRT, or from starting it in the first place. The mechanisms which underlie this unscheduled bleeding are poorly understood. The benefits of HRT in terms of longevity and quality of life are becoming increasingly apparent, and a greater understanding of why this bleeding occurs and how we can prevent or treat it, will undoubtedly enable more women to reap the potential considerable benefits of long-term oestrogen and progestogen replacement. What sets postmenopausal women apart from their counterparts in the mid-reproductive years is the increased likelihood of endometrial adenocarcinoma in which unscheduled bleeding is the presenting symptom. Therefore, spontaneous postmenopausal bleeding must always be appropriately evaluated. Hence, the occurrence of unscheduled bleedingwith HRT may provide a dilemma with diagnosis as well as a challenge to acceptability. Combined HRT regimens tend to be predominantly progestogenic, and there is increasing evidence to suggest that some of the vascular changes seen in women taking longterm, low-dose progestogen-only contraceptives may also occur in women taking HRT.

Key words: bleeding/blood vessels/endometrium/hormone replacement therapy


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