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[Dotty]

https://thebms.org.uk/wp-content/uploads/2024/04/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-APRIL2024-D.pdf

This document has just been produced giving details on steps to be taken when unscheduled bleeding occurs on hrt .

[sheila99]

Thanks for posting.
Great. Instead of the 2 week pathway it's now many months. Do nothing for 6 months, wait a month for a gp appointment then an "urgent" appointment which now takes 6 weeks (which in reality might be twice as long). Time to put on weight, the more unhealthy you are the better treatment you get.

• If unscheduled bleeding continues in low-risk women, after six months of
adjustments, discuss the options of an urgent ultrasound (within six weeks)
versus weaning off HRT and consideration of non-hormonal alternatives (to avoid
invasive investigations).

I wonder how many curable cancers will become terminal as a result.
 And nice to know they're just thinking of us suggesting we stop hrt. Anyone cynical might think they were just trying to avoid investigating it.

[Penguin]

I wonder whether this will become part of a wider change where they move away from the 2 week pathway unless you meet more criteria. A way of getting their numbers to look better in terms of actually seeing people on time!

[Dotty]

I think it’s saying that you don’t have to stop hrt. It can be suggested but you don’t have to stop whilst waiting for investigations.

[Penguin]

Except if you do have something really wrong and you have to wait so much longer for investigations because you dont meet their risk threshold, then continuing hrt is even more risky.

[shrosphirelass]

If these are the clinical guidelines that doctors follow I am very concerned about them suggesting that women should consider weaning off HRT to see how that affects the bleeding. This could lead to undue pressure.

I am sure my view is controversial but I am personally glad that they are no longer going to pressurise women every time they have unscheduled bleeding whilst on HRT to having hysteroscopies. From what I have read on here the incidence of endometrial cancer for women who are on HRT with PMB is very low. I would hope that these new guidelines would result in doctors changing their language so they do not raise women's anxiety level by suggesting they have cancer, when they are generally low risk.

[CarolineM]

Thanks for posting this Dotty - I think the flow chart on page 6 is really clear.

I saw a different HRT nurse this morning due to irregular bleeding after almost 9 months of Evorel 50 patches and Utrogestan, and she followed this pathway. She said it was likely I'd get a scan in about 2 weeks. Got the impression the scan may be in a general unit rather than specifically in a gynae unit, then if my known fibroids are bigger or there's something there that shouldn't be that would bring on the gynae referral. Just have to wait and see.

[Dotty]

Shropshirelass….i agree with you about unnecessary hysteroscopies and procedures etc ( having had this happen to me many times.)

I think the document is actually saying that you done have to try and wean off hrt. It’s saying that that is only one suggestion but the first suggestion should be to try ways of stopping the bleeding. The Menopause Doctors that I follow on other platforms are actually seeing this document as a positive move.

[Cassie]

Does anyone know why they recommend continuous hrt after the age of 54, I really do not want to take utrogestan daily. Is it riskier to be getting bleeds when you are in your 60s and to be on utrogestan for 12 days a month only?

[Dotty]

Hi Cassie it’s thought to be less risky to be on continuous progesterone. However, quality of life is important and your personal preference should be taken into consideration.

[sheila99]

Does anyone know why they recommend continuous hrt after the age of 54, I really do not want to take utrogestan daily. Is it riskier to be getting bleeds when you are in your 60s and to be on utrogestan for 12 days a month only?

Didn't you know? This is because everyone is meno by 54 (sound of hollow laughter  ) . I have been told there's a slightly higher risk of endometrial cancer with sequi but they weren't able to direct me to any research. I wonder how big the sample size was? They finally agreed I can stay on sequi but perhaps they'd worked out I wasn't going to take utro daily anyway ( lm not gping to be permanently doped).

 The guidelines may be OK for those who are clued up and will express their opinion but I'll lay a bet that some of the 'suggestions' will turn into orders for others.

[Scottish lass]

Current guidelines are good to be aware of and available for 1000s of conditions for everyone to access via the internet. But it is important to remember that these are guidelines for medical personnel . Before someone jumps down my throat I'm sure everyone on here who has ever been employed will have had guidance to work too and there isn't one policy that has ever been written that someone can't find some fault or disagree with. I'm not saying I disagree with people's comments just that we have to realise there will always be restrictions and limitations to any system even those involving people's health.

[Alex 2024]

The Menopause Doctors that I follow on other platforms are actually seeing this document as a positive move.

Hi Dotty,
Can I ask which menopause doctors you follow and which one in particular you think is the best....?
Thanks

[Dotty]

Hi Alex 2024….i mainly follow Diane Danzebrink.  She’s the leader of The Menopause Support Group and has campaigned tirelessly to help menopausal women.  On Instagram she can be found at Diane Danzebrink.  She has a public Facebook group and a private facebook group and a website too.

Dr Louise Newson…..Menopause Doctor.

Dr Juliet Balfour …. Menopause Health on Instagram.

Dr Naomi Potter….instagram

[buffy26]

Thank you for posting this. The thing that really struck me is how lacking we are in studies and evidence, lets hope something gets done soon on this! I hope the prominent voices in this arena are banging the drum and monitoring this so that studies are set up and not just expressed as a need to do