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Human Reproduction, Vol. 11, No. 3, pp. 503-508, 1996
© 1996 European Society of Human Reproduction and Embryology

Endometrial responses to hormone replacement therapy: the bleeding pattern

M.A. Habiba1,2, S.C. Bell1,2, K. Abrams3 and F. Al-Azzawi1,2,4

1 Menopause Research Unit, University of Leicester, School of Medicine Leicester LE2 7LX, UK 2 Department of Obstetrics and Gynaecology, University of Leicester, School of Medicine Leicester LE2 7LX, UK 3 Department of Epidemiology and Public Health, University of Leicester, School of Medicine Leicester LE2 7LX, UK

Correspondence: 4To whom correspondence should be addressed at: Menopause Research Unit, Department of Obstetrics and Gynaecology, Robert Kilpatrick Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, UK

Little information is available concerning the response of the endometrium to exogenous sex steroid therapy, particularly in the post-menopausal state. In this study we examined the variability of the bleeding pattern in 103 post-menopausal women receiving cyclical sequential combined hormone replacement therapy (HRT) over 6 months. All patients kept menstrual diary cards to record the onset, duration and subjective assessment of the severity of bleeding. We defined a cycle as starting from the commencement of treatment till the day of onset of bleeding. Two groups were identified amongst 99 women who experienced bleeding: those with a mean cycle length of 29 or more days (late bleeders, n = 50) and those with shorter mean cycle length (early bleeders, n = 49). The former were characterized by less variability in cycle length and bleeding that was of shorter duration. Four women experienced no bleeding. There were no significant differences between the two groups in age, year since the menopause, weight, height, body mass index (BMI), parity, or in the previous use of HRT. The only significant difference was in their smoking habits. This suggests a possible link of a hypo-oestrogenic state to poor cycle control.

Key words: cycle variability/hormone replacement/menopause/menstrual bleeding pattern

Submitted on October 10, 1995; accepted on December 12, 1995.


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