RCOG World Congress 2023

Are guidelines for managing bleeding on HRT clear?

Anastasia Martin1, Leila Frodsham2

Doctors menopause cafe (DMC) is a Facebook group of 5200 female doctors

Current practices and perceptions of general practitioners across the UK regarding management of PMB in patients on HRT

Introduction

Doctors menopause cafe (DMC) is a Facebook group of 5200 female doctors - 84% are GP’s. Members often ask how to manage bleeding on HRT, with uncertainty about when to refer and if to scan first, stop HRT or amend regimens prior to referral. Many describe different protocols regionally, are uncertain when to refer and how to find local/national guidance.

Methods

A survey was disseminated in November 2022-February 2023 to DMC members. Responses were anonymised and consent was gained for survey responses to be used for research purposes.

Results

We received 220 responses, 92% GPs, from all regions of England, Scotland, Wales and Northern Ireland.

•44.5% of rapid access clinics recommend stopping HRT before referral, most commonly for 6 weeks.

• In those women whose HRT has stopped, 72% of respondents stated that over half will return to see their GP with menopausal symptoms.

•The majority of respondents also stated that over 40% of these women will represent with bleeding once HRT is restarted.

Conclusion

•There is a lack of accessible local guidance for PMB in women using HRT across the UK.

•This has led to pressure on rapid access clinics with very little gain to cancer diagnosis.

•Some GPs are being encouraged to stop HRT which our data shows increases distress to women, with return of bleeding once restarted and workload for GPs.

We have created a flowchart visualising the consequences of these issues (pink), and the recommendations that (blue)

RCOG World Congress 2023

Are guidelines for managing bleeding on HRT clear?

Poster Presenter

Authors

Affiliations

Part of Topic