Management of Postmenopausal Bleeding in Patients on Hormone Replacement Therapy

Initial Evaluation and Management

• The American College of Cardiology recommends adjusting the estrogen dose based on a patient's tolerance and wellbeing for women on combined continuous HRT with persistent bleeding 1

Special Considerations

• The American College of Cardiology suggests that HRT should not be given for secondary prevention of coronary events to postmenopausal women 4
• Women who experience cardiovascular events while on HRT should generally discontinue therapy unless there are compelling reasons to continue, as recommended by the American College of Cardiology 4
• The American Heart Association indicates that HRT should not be used for secondary prevention of coronary events in postmenopausal women 5
• For women with antiphospholipid antibodies or syndrome, HRT should be avoided due to increased thrombotic risk, according to the Arthritis Care & Research journal 2, 3, 6

Follow-up and Alternative Therapies

• For persistent refractory bleeding, alternative HRT formulations or routes of administration may be considered, as suggested by the Arthritis Care & Research journal 6