Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

Medeiros, Sebastião Freitas de; Yamamoto, Márcia Marly Winck; Barbosa, Jacklyne Silva

doi:10.4137/cmwh.s10483

Cited by 14 publications

(12 citation statements)

References 98 publications

(238 reference statements)

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“…In the combined continuous regimen, either via oral or transdermal routes, irregular bleeding is expected to occur in 0–77% of women in the first few months of treatment . Later on, it decreases after 6–12 months of use, and after 9 months, only 3–10% of women will still experience it.…”

Section: Unscheduled Bleeding With Hrtmentioning

confidence: 99%

“…Later on, it decreases after 6–12 months of use, and after 9 months, only 3–10% of women will still experience it. With regard to the transdermal route, irregular bleeding or spotting occurs in 10–20% of women after 12 months of use . In the sequential regimen, irregular bleeding is experienced by 8–40% of users .…”

Section: Unscheduled Bleeding With Hrtmentioning

confidence: 99%

“…Other causes of unscheduled bleeding on HRT include: poor compliance or non‐compliance with treatment; drug interactions, for example in women on liver enzyme‐inducing drugs such as antiepileptic medication; gastrointestinal symptoms or pathology including a prolonged episode of diarrhoea, undiagnosed or mild Crohn's disease, or malabsorption syndrome, which can affect the bioavailability and pharmacokinetics of these medications in the circulation; and higher endogenous oestrogen production in women with obesity …”

Section: Aetiologymentioning

confidence: 99%

“…After excluding endometrial pathology, increasing the dose or changing the type of progestogen may help, or by fitting a 52 mg levonorgestrel‐releasing intrauterine system. If all other options do not work, then changing to sequential HRT is another option …”

Section: Managementmentioning

confidence: 99%

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Unscheduled bleeding with hormone replacement therapy

Dave

Adedipe

Disu

et al. 2019

The Obstetric & Gynaecologis

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Menopause is now considered as a mid-life event. Hormone replacement therapy (HRT) is justified when menopausal symptoms adversely affect the quality of life of the individual woman. Management of unscheduled bleeding with HRT remains a clinical challenge and leads to pressure on resources. The aim should be to exclude endometrial pathology and to regulate the bleeding pattern so that the woman's concerns are addressed and compliance maintained. The mechanisms which underlie this unscheduled bleeding are poorly understood. Appropriate counselling should be offered at the outset. Learning objectivesTo gain knowledge of the most appropriate HRT regimens used in perimenopausal, postmenopausal and hysterectomised women to minimise unscheduled bleeding. To learn how to tailor the treatment regimen to the individual woman's situation. Ethical issuesThe lack of clinical evidence for managing unscheduled bleeding should be acknowledged. Should clinicians initiate expensive and invasive investigations in all women with unscheduled bleeding on HRT or only select those with significant risk factors?

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Section: Unscheduled Bleeding With Hrtmentioning

confidence: 99%

Section: Unscheduled Bleeding With Hrtmentioning

confidence: 99%

Section: Aetiologymentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

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Unscheduled bleeding with hormone replacement therapy

Dave

Adedipe

Disu

et al. 2019

The Obstetric & Gynaecologis

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“…The current approach for relieving menopausal syndrome is hormone replacement therapy (HRT), which restores the endogenous estrogen level using supplementary exogenous estrogen with or without progestin45. Estradiol and conjugated estrogens have been proven effective in the treatment of vasomotor symptoms, urogenital atrophy, and irregular menstrual bleeding678910. However, HRT can have side effects, which need to be taken into consideration.…”

mentioning

confidence: 99%

A Novel, Stable, Estradiol-Stimulating, Osteogenic Yam Protein with Potential for the Treatment of Menopausal Syndrome

Wong

Lai

Li³

et al. 2015

Sci Rep

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A novel protein, designated as DOI, isolated from the Chinese yam (Dioscorea opposita Thunb.) could be the first protein drug for the treatment of menopausal syndrome and an alternative to hormone replacement therapy (HRT), which is known to have undesirable side effects. DOI is an acid- and thermo-stable protein with a distinctive N-terminal sequence Gly-Ile-Gly-Lys-Ile-Thr-Thr-Tyr-Trp-Gly-Gln-Tyr-Ser-Asp-Glu-Pro-Ser-Leu-Thr-Glu. DOI was found to stimulate estradiol biosynthesis in rat ovarian granulosa cells; induce estradiol and progesterone secretion in 16- to 18-month-old female Sprague Dawley rats by upregulating expressions of follicle-stimulating hormone receptor and ovarian aromatase; counteract the progression of osteoporosis and augment bone mineral density; and improve cognitive functioning by upregulating protein expressions of brain-derived neurotrophic factor and TrkB receptors in the prefrontal cortex. Furthermore, DOI did not stimulate the proliferation of breast cancer and ovarian cancer cells, which suggest it could be a more efficacious and safer alternative to HRT.

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The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms

Parish¹,

Gillespie

2017

Postgraduate Medicine

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This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased the risk of invasive breast cancer after nearly 5 years of use. However, re-analyses of the WHI data suggest that some risks (eg, CHD, all-cause mortality) may be reduced when HT is initiated in women <60 years of age and <10 years since menopause, compared with later. CE/BZA is the first menopausal HT without a progestogen for nonhysterectomized women. Instead, BZA, a selective estrogen receptor modulator, in combination with CE, protects against estrogenic effects on uterine and breast tissue. Data from 5 large, randomized clinical trials show that CE/BZA reduces hot flush frequency/severity, prevents bone loss, reduces bone turnover, improves the vaginal maturation index and ease of lubrication, and improves some measures of sleep and menopause-specific quality of life. In studies of up to 2 years, there was no increase in endometrial hyperplasia, vaginal bleeding, breast density, or breast pain/tenderness compared with placebo. Venous thromboembolism and stroke are risks of all estrogen-based therapies. The choice of HT should be individualized, with consideration of the risk/benefit profile and tolerability of therapy, as well as patient preferences.

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Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

Cited by 14 publications

References 98 publications

Unscheduled bleeding with hormone replacement therapy

Unscheduled bleeding with hormone replacement therapy

A Novel, Stable, Estradiol-Stimulating, Osteogenic Yam Protein with Potential for the Treatment of Menopausal Syndrome

The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms

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