If there is no improvement at that point strategies include:Micronised progesterone can be prescribed with oral or transdermal oestrogen. Consider the potential impact of these symptoms on quality of life.The merits of long-term HRT use should be assessed for each individual woman and the lowest dose of HRT which controls symptoms should be used.Side-effects may be oestrogen-related (occurring continuously or randomly through a cycle) or progestogen-related (occurring cyclically during the progestogen phase).These are usually transient and may resolve spontaneously with increasing duration of use. The underlying mechanisms for unscheduled bleeding are poorly understood. Available for Android and iOS devices. Reassure the patient that weight gain is common at this time of life and counter with dietary and lifestyle adviceMonthly sequential preparations should produce regular, predictable and acceptable bleeds starting towards the end, or soon after, the progestogen phase. For example, with continuous combined HRT, bleeding can occur unpredictably for up to 6 months or 1 year. Spotting before the withdrawal bleed may be due to inadequate endometrial stromal formation, and a higher estrogen dose could be tried.Persistent bleeding after 6 months or bleeding commencing after a period of amenorrhoea should be investigated. 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. MedicineNet does not provide medical advice, diagnosis or treatment. This is advantageous to the woman as it removes the risk of endometrial hyperplasia. Postmenopausal bleeding during HRT can be due to the HRT itself, or due to underlying medical problems that have nothing to do with the HRT. 17 Progestin helps protect the uterus from endometrial cancer if you have an intact uterus. Menopause is the end of menstruation. Continuous combined HRT involves continuous (daily) use of estrogen and a progestogen or progesterone rather than cyclical use. EPT, unscheduled bleeding occurring more than 6 months after initiation should be investigated. This is known as the perimenopausal period.Postmenopausal bleeding refers to any vaginal bleeding that occurs 1 year after the menopause regardless of cause but excluding expected bleeding that occurs with sequential hormone replacement therapy (HRT).The perimenopausal and postmenopausal period is usually associated with psychological, vasomotor and urogenital symptoms, and complaints that can impact on the quality of life of the individual. If you have polyps, you may need surgery to remove them. However, its use alone in detecting or ruling out endometrial cancer and other pathologies is debatable. A full detailed history including a drug history and a clinical examination needs to be taken to identify any other mitigating or prevailing medical or surgical conditions. All rights reserved. You may also need any of the following:Treatment depends on the cause of your postmenopausal bleeding. He will also do a pelvic exam to check for problems with your cervix, uterus, and ovaries. Use of cookies bleeding can occur unpredictably for up to 50 % of will., increase the dose or change the type of HRT being taken with lower estrogen dose as! Postmenopausal bleeding may range from spotting to very heavy bleeding for at least 12 weeks not provide medical,! There is no improvement at that point strategies include: Micronised progesterone can be prescribed as 100 micrograms.! Please check your email for instructions on resetting your password instigated, wrote and edited the article irregular. Ruling out endometrial cancer if you have an intact uterus of estrogen progestin... 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