Bleeding Patterns during Cyclic Hormonal Replacement Therapy (HRT) in Postmenopausal Thai Women

Abstract

Objective To report the initial demographic data of the patients receiving HRT at Ramathibodi Hospital, to determine the incidence and patterns of uterine bleeding after sequential or cyclic HRT in postmenopausal women and to investigate the factors associated with uterine bleeding such as body mass index (BMI), duration of menopause before starting HRT, endometrial thickness, and hormonal level of estradiol (E.), luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Subjects and methods Eighty-four postmenopausal women without contraindication to hormone replacement therapy were recruited. A daily oral cyclic estrogen and progestogen was administered to all subjects for 12 months. Patients were scheduled to come back for follow up at 1, 3, 6, 9, 12 months after the treatment.

Results Four out of eighty-four patients dropped out from the study because of withdrawal bleeding. The average age of patients was 52.75 † 6.53 years (range 37-65 years) with the mean age at menopause of 48.43 5.66 years. Of the 80 postmenopausal women treated with cyclic HRT, 59 (73.75%) had uterine bleeding. 48 out of 59 (81.3%) had normal withdrawal uterine bleeding while the other 11 (18.7%) had metrorrhagia or irregular uterine bleeding. The first episode of uterine bleeding occurred variably between the first and the seventh month after treatment. Most of the patients (52 or 88.1%) had the first episode of uterine bleeding during the first four months after treatment. There were no significant differences between the two groups of patients with and without uterine bleeding during cyclic HRT in body mass index (BMI), duration of menopause before starting HRT, endometrial thickness, and hormonal level of estradiol (E.), luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Conclusion This preliminary results demonstrate the incidence of uterine bleeding after cyclic HRT of 73.75%. Most of the patients had good cycle control and had the first episode of uterine bleeding during the first four months after treatment. No case of endometrial hyperplasia occurred among the patients with irregular bleeding. This information will assist clinicians to encourage women who are considering hormone replacement therapy and help physicians to counsel the patients and improve patients' compliance while taking HRT especially cyclic estrogen progestin regimen.