A review of the role of progestogens in hormonal replacement therapy: influence on bleeding patterns

Most post-menopausal hormone replacement regimens lead to endometrial bleeding in some women. However, the response to any one regimen varies greatly from individual to individual. With most regimens, some women will experience amenorrhoea, some will experience scheduled withdrawal bleeding and some will experience unscheduled breakthrough bleeding. The proportions of women in each case will depend on the oestrogen and progestogen dosages, the regimen and route by which these are administered and their respective 'potencies'. With appropriate counseling, many women will tolerate continued menstrual bleeding after the menopause, but most would still prefer not to have it if given the option. Much additional research needs to be done to determine which hormonal regimens are the most effective, safe and acceptable for different groups of women.