Women's expectations and acceptance of cyclic induced HRT bleeds

To assess women's expectations and acceptance of cyclic induced HRT bleeds before and after their participation in a 1-year study and to compare the impact of these cyclic bleeds with that of previous menstrual bleeds.

A structured bleeding questionnaire was used to gather information: at baseline (before screening) on previous menstrual cycle patterns and accompanying discomfort, oral contraceptive use, current smoking habits, parity and the acceptance, preferences and expectations regarding HRT-induced bleeds. Women with amenorrhoea of 6 months or more and FSH levels (35 IU/l then received a daily oral dose of 1 mg 17 beta-oestradiol on days 1-28, combined with either 5 or 10 mg dydrogesterone on days 15-28, for 12 months (13 cycles of 28 days). At the end of their participation, women were again interviewed about their actual experiences with HRT-induced bleeds.

One hundred and fifty-four women completed the questionnaire at baseline and 141 (including 131 completers) responded at the end. At baseline, 82% indicated to be pleased that menstruation had ceased, but nevertheless 94% stated that return of periods would be acceptable. At the end, 91% still found the occurrence of cyclic bleeds acceptable; this mostly depended on the perceived benefits outweighing the discomfort. Of the women who actually experienced bleeds (101) 60% regarded discomfort and blood loss less than during their previous menstrual cycles. A regular cycle pattern was considered more important than modest flow and short duration.

In contrast to other studies, the acceptance of renewed vaginal bleeds in our study was high.