ABSTRACT
Recent evidence has shaken the status quo regarding universal prescription of opposed hormone replacement therapy (HRT – oestrogen plus progestogen). However, prescription of HRT will still be necessary for treatment of menopausal symptoms, and abnormal bleeding on HRT will still be a common complaint and indication for outpatient hysteroscopy. The prevalence of endometrial cancer in postmenopausal women with bleeding on HRT is lower (2-5 per cent) than for those not taking exogenous hormones (5-15 per cent). However, vigilance is important because endometrial disease in the form of hyperplasia, and structural anomalies in the form of endometrial polyps and submucous fibroids may be more prevalent, although data are conflicting. Interpretation of endometrial thickness by transvaginal ultrasound is more difficult when exogenous hormones are being taken, and so direct hysteroscopic visualization of the uterine cavity is often useful.
