Fortnightly review: Management of abnormal bleeding in women receiving hormone replacement therapy

Classification of benign endometrial glandular cells in cervical smears from postmenopausal women

“…In addition to many beneficial effects, HRT stimulates the endometrium, and cyclic withdrawal of hormonal treatment may result in pseudomenstrual endometrial shedding, especially when sequential combinations of estrogen and progesterone derivatives are used. [7][8][9][10][11][12] Vaginal bleeding/spotting is one of the most common complaints among PMP women on HRT, and, not infrequently, it may lead to discontinuation of HRT. [7][8][9][10][11][12] This symptom is most common among PMP women who are starting HRT right after the onset of menopause, probably secondary to the additive effect of HRT and endogenous reproductive hormones that still are released at paraphysiologic levels right after the onset of menopause.…”

“…[7][8][9][10][11][12] Vaginal bleeding/spotting is one of the most common complaints among PMP women on HRT, and, not infrequently, it may lead to discontinuation of HRT. [7][8][9][10][11][12] This symptom is most common among PMP women who are starting HRT right after the onset of menopause, probably secondary to the additive effect of HRT and endogenous reproductive hormones that still are released at paraphysiologic levels right after the onset of menopause. [7][8][9][10][11][12] The Bethesda System guidelines do not provide specific recommendations on this issue, although it may be assumed that benign endometrial cells in PMP women on HRT also will be diagnosed as a glandular cell abnormality.…”

“…[7][8][9][10][11][12] This symptom is most common among PMP women who are starting HRT right after the onset of menopause, probably secondary to the additive effect of HRT and endogenous reproductive hormones that still are released at paraphysiologic levels right after the onset of menopause. [7][8][9][10][11][12] The Bethesda System guidelines do not provide specific recommendations on this issue, although it may be assumed that benign endometrial cells in PMP women on HRT also will be diagnosed as a glandular cell abnormality. 6 The lack of specific guidelines accounts for wide variability in the diagnostic interpretation of this finding, and we even found variability among cytopathologists in our own department.…”

Is Naturopathy as Effective as Conventional Therapy for Treatment of Menopausal Symptoms?

“…However, postmenopausal bleeding related to HRT has been reported to result in discontinuation of use in as many as 70% of women who initiate therapy (Ravnikar, 1987). Contraindications to usage (e.g., such as uterine or vaginal bleeding [Spencer et al, 1997], coagulation defects, histories of endometrial cancer, or deep venous thrombosis [Loose-Mitchell and Stancel, 2001]), and epidemiologic evidence suggesting an association between estrogen therapy and breast cancer (Colditz et al, 1990(Colditz et al, , 1995Steinberg et al, 1991;Stevenson, 1996), are among the reasons that women pursue alternative therapies for symptomatic relief (Follingstad, 1978).…”

Comparison of Transvaginal Ultrasonography with Hysteroscopy taking Endometrial Biopsy as Gold Standard in Perimenopausal Patients with Abnormal Uterine Bleeding

“…1,2 Of the women attending gynecological outpatient department, those with AUB constitute 30 to 70%. 3,4 In postmenopausal women, any vaginal bleeding 6 months after cessation of menses is considered abnormal and requires evaluation.…”