It is a common primary care presentation and a possible SCA scenario. It tests your ability to apply up-to-date guidance, assess cancer risk, and communicate sensitively and safely.
In our practice, a woman on sequential HRT for more than five years presented with unscheduled bleeding. According to the updated BMS guidance this is now considered a major risk factor for endometrial cancer and requires a fast track referral, not a pelvic ultrasound first.
We are updating our HRT review templates and processes. Although we already had an annual review system, there wasn’t a specific prompt to check the type and duration of HRT, particularly for women on long-term sequential regimens. We are also identifying and contacting others who may be on sequential HRT for more than 5 years to offer to swap to continuous combined HRT.
How would you explain the need for a fast track referral to a patient who feels well?
What language might you use to balance clarity and reassurance?
How would you safety-net and offer follow-up?
Are you confident in identifying different HRT regimens?
✔ Check type and duration of HRT
✔ Refer via fast track if indicated based on BMS guidance
✔ Communicate clearly and safety-net appropriately
British Menopause Society – Management of unscheduled vaginal bleeding on HRT
Author
N. Turner
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