Even before the era of hormone replacement therapy, postmenopausal vaginal
bleeding was a common problem. But now, increasing use of hormone replacement
therapy (HRT) has made abnormal bleeding an even more frequent reason for
office visits. Current guidelines from the American College of Obstetricians
and Gynecologists recommend endometrial biopsy for women who are taking continuous
combined HRT and have bleeding for more than 6 months after starting treatment,
and for any prolonged or irregular bleeding in women taking cyclic HRT. About
20% of postmenopausal women taking continuous combined HRT still have bleeding
at 12 months; variations in bleeding patterns in women taking cyclic HRT are
common.1 Thus, a substantial number of postmenopausal
women will face the prospect of diagnostic testing to evaluate abnormal vaginal
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