By: 11 July 2024
Women experiencing unnecessary invasive tests and procedures due to HRT prescriptions

The British Menopause Society (BMS) has launched new, joint guidelines for GPs to help alleviate unnecessary referrals related to unexpected bleeding.

With the significant rise in Hormone Replacement Therapy (HRT) prescriptions in recent years, there has been a corresponding increase in women reporting unexpected bleeding. Consequently, many women who are at low risk of uterine cancer are being subjected to unnecessary and invasive tests and procedures, exacerbating growing waiting lists. Addressing this pressing issue, a joint guideline was unveiled at the BMS Conference. These new guidelines offer clear criteria for necessary investigations, aiming to reduce waiting lists and improve patient care.

While there has always been a proportion of women reporting unscheduled bleeding on HRT, the statistics demonstrate the extent of the increase. HRT was prescribed to 1.9 million women in the UK in 2021/2022 – a 35% increase from the preceding year. In parallel, there has been a 43% increase over the past three years in referrals to the Urgent Suspicion of Cancer Pathway (USCP). Overall, this change in referral pattern does not appear to have resulted in more cancers being diagnosed.

Dr Kristyn Manley, BMS Medical Advisory Council member and Menopause Specialist, says, “Unexpected bleeding is worrying for women and there are long and growing waiting lists for these tests and procedures, which increases the stress even further. Whilst all irregular bleeding is distressing, there is a need to prioritise investigations for those with a potential increased risk of endometrial cancer, over those in whom endometrial cancer is unlikely.

“The new guidelines provide clarity for health professionals on the appropriate assessment of risk factors and bleeding patterns. As well as when it might be more appropriate to review and monitor HRT prescriptions and compliance, before making a referral for tests.”The BMS guidelines support management of unscheduled bleeding according to risk of endometrial cancer, ensuring best outcomes for all women whilst using NHS resources appropriately.

Karolyn Andrews, patient, says: “I had not taken my HRT correctly, and as a result, I had unexplained bleeding. It wasn’t until I read about HRT and bleeding that I realised that not taking my HRT correctly could have contributed. With these guidelines my GP would have been better equipped to manage this without the need for investigations. I would have avoided the anxiety, discomfort, and time off work associated with referral treatment.”

The guidelines were drawn up by a panel including representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time).