Bleeding Abnormalities During Menopause Hormone Therapy

Women experiencing menopausal symptoms usually undergo estrogen plus progestogen therapy. Most of them experience bleeding abnormalities, one of the most common side effects during hormonal therapy, requiring primary-care settings to exclude severe pathologies. This chapter aims to quantify the incidence of abnormal bleeding in women receiving menopause hormone therapy (MHT) while delineating a good clinical practice to exclude endometrial pathologies. The incidence of postmenopausal bleeding depends on many parameters, including the woman’s reproductive age, doses, routes of administration, and duration of MHT. Regarding the compounds’ composition, studies reported a lesser rate of bleeding abnormalities with the lower estrogen plus progestogen therapy dose. Moreover, norethisterone acetate (NETA) offers better control of abnormal bleeding than medroxyprogesterone acetate (MPA). In addition, due to the absence of a consensus on the general assessment of those women, this dissertation discusses the overall evaluation of abnormal bleeding, particularly the role of transvaginal ultrasound as an initial diagnostic tool while also investigating when an endometrial biopsy is required, considering ACOG Practice Bulletin recommendations. In conclusion, the goal should be to take preventive action to reduce the percentage of abnormal bleeding by administering the proper compound compositions while also distinguishing women with anatomic causes from dysfunctional problems as timely as possible following an accurate diagnostic assessment.