New guidelines can help avoid unnecessary referrals due to unexpected bleeding

New guidelines can help avoid unnecessary referrals due to unexpected bleeding
New guidelines can help avoid unnecessary referrals due to unexpected bleeding

The British Menopause Society (BMS) has issued new joint guidelines for GPs to help avoid unnecessary referrals due to unexpected bleeding. With the significant increase in prescriptions for hormone replacement therapy (HRT) in recent years, the number of women reporting unexpected bleeding has also increased. As a result, many women who are at low risk of womb cancer are subjected to unnecessary and invasive tests and procedures, making waiting lists even longer. In response to this urgent issue, a joint guideline was launched at the BMS conference. These new guidelines provide clear criteria for necessary investigations and aim to reduce waiting lists and improve patient care.

While there has always been a proportion of women reporting unplanned bleeding when taking HRT, the statistics show the extent of the increase. In 2021/2022, 1.9 million women in the UK were prescribed HRT – a 35% increase on the previous year. In parallel, there has been a 43% increase in referrals to the Urgent Suspicion of Cancer Pathway (USCP) over the past three years. Overall, this change in referral pattern does not appear to have led to an increase in cancer diagnoses.

Unexpected bleeding is a cause of concern for women, and waiting lists for these tests and procedures are long and growing, adding to the stress. Although all irregular bleeding is distressing, tests must be prioritised in women who are potentially at increased risk of womb cancer over those who are unlikely to develop womb cancer.

The new guidelines provide clarity to healthcare professionals on the appropriate assessment of risk factors and bleeding patterns, and when it may be more appropriate to review and monitor HRT prescriptions and adherence before issuing a referral for testing.”

Dr. Kristyn Manley, BMS Medical Advisory Board Member and Menopause Specialist

The BMS guidelines support the management of unplanned bleeding according to the risk of endometrial cancer, ensuring the best outcomes for all women with appropriate use of NHS resources.

Patient Karolyn Andrews says: “I had not been taking my HRT correctly and was having unexplained bleeding as a result. It was only when I read about HRT and bleeding that I realised that incorrect HRT administration could have contributed to this. With these guidelines in place, my GP would have been better able to treat this without the need for investigations. I would have saved myself the anxiety, discomfort and incapacity associated with referral treatment.”

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


The British Menopause Society (BMS)

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