{"id":26254,"date":"2026-01-21T16:34:07","date_gmt":"2026-01-21T16:34:07","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=26254"},"modified":"2026-04-10T08:28:28","modified_gmt":"2026-04-10T07:28:28","slug":"unscheduled-bleeding-on-hrt","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/unscheduled-bleeding-on-hrt\/","title":{"rendered":"Unscheduled Bleeding on HRT"},"content":{"rendered":"\n<p>The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August\u00a02025.<br>We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here\u00a0 <a href=\"https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/\u00a0<\/a><\/p>\n\n\n\n<p><strong>For patients who have post-menopausal bleeding and are <u>not <\/u>on HRT, please see link to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/postmenopausalbleeding\/\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gynaecology\/postmenopausalbleeding\/\" target=\"_blank\" rel=\"noreferrer noopener\">PMB No HRT page<\/a><\/strong><\/p>\n\n\n\n<div data-wp-interactive=\"core\/file\" class=\"wp-block-file\"><object data-wp-bind--hidden=\"!state.hasPdfPreview\" hidden class=\"wp-block-file__embed\" data=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Unscheduled-Bleeding-on-HRT-2026-FINAL-Downloaded.pdf\" type=\"application\/pdf\" style=\"width:100%;height:880px\" aria-label=\"Embed of Unscheduled Bleeding on HRT 2026.\"><\/object><a id=\"wp-block-file--media-67e0deb8-b564-460d-b3d0-e95ade9c76ed\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Unscheduled-Bleeding-on-HRT-2026-FINAL-Downloaded.pdf\">Unscheduled Bleeding on HRT 2026<\/a><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Unscheduled-Bleeding-on-HRT-2026-FINAL-Downloaded.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-67e0deb8-b564-460d-b3d0-e95ade9c76ed\">Download<\/a><\/div>\n\n\n\n<p><strong>Thrombocytosis is a risk marker for malignancy. This especially applies to the \u2018LEGO-C\u2019 group \u2013 Lung, Endometrial, Gastric, Oesophageal and Colorectal cancer. See <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Thrombocytosis \u2013 RefHelp<\/a>&nbsp;for more information.<\/strong><\/p>\n\n\n\n<p><strong>MM &amp; RC 22\/1\/26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><\/h4>\n\n\n\n<p><strong>1.For patients with unscheduled bleeding on HRT:<\/strong><\/p>\n\n\n\n<p>Refer to Radiology for Unscheduled Bleeding on HRT USS <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI Unscheduled Bleeding on HRT<\/mark><\/p>\n\n\n\n<p><strong>If the USS report is reported as non-reassuring, the Primary Care Clinician to refer patient to Gynaecology<\/strong><\/p>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; RIE &gt; Gynaecology &gt; LI PMB Abnormal Ultrasound<\/mark><\/p>\n\n\n\n<p>There are 2 situations, as below, where patients who are, or have recently been, on HRT should be referred for a PMB USS (not an Unscheduled Bleeding on HRT USS):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ongoing unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions<\/li>\n\n\n\n<li>Ongoing bleeding at 6 weeks since stopping HRT<\/li>\n<\/ul>\n\n\n\n<p><strong>2.For patients with o<\/strong><strong>ngoing <\/strong><strong>unscheduled bleeding after a total of 12 months of HRT despite troubleshooting actions:<\/strong><\/p>\n\n\n\n<p>USOC Referral Gynaecology <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC)<\/mark> and simultaneous referral to Radiology for PMB USS <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/mark><\/p>\n\n\n\n<p><strong>3.For patients with ongoing bleeding at 6 weeks since stopping HRT<\/strong><strong><\/strong><\/p>\n\n\n\n<p>USOC Referral Gynaecology <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-gateway &gt; RIE &gt; Gynaecology &gt; LI Basic sign referral (select priority USOC) <\/mark>and simultaneous referral to Radiology for PMB USS <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; ELCH\/LB\/RIE\/SJH &gt; Clinical Radiology &gt; LI PMB (No HRT)<\/mark><\/p>\n\n\n\n<p><strong>4.For suspected vulval, vaginal, cervical malignancy:<\/strong><\/p>\n\n\n\n<p>USOC Referral Gynaecology <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Sci-Gateway &gt; RIE&gt; Gynaecology&gt; LI Basic sign referral (select priority USOC)<\/mark><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August&nbsp;2025.We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here&nbsp; https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/&nbsp; For patients who have post-menopausal bleeding and are not on HRT, please see link to PMB<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"class_list":["post-26254","page","type-page","status-publish","hentry"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"aparnaamanna","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/aparnaamanna\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"The Scottish Cancer Referral Guidelines have been updated and went live on Wednesday, 6th August&nbsp;2025.We are working hard to update all relevant information on the RefHelp website. If you would like to see the guidelines please click here&nbsp; https:\/\/www.gov.scot\/publications\/scottish-referral-guidelines-suspected-cancer-2025\/&nbsp; For patients who have post-menopausal bleeding and are not on HRT, please see link to PMB","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=26254"}],"version-history":[{"count":6,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26254\/revisions"}],"predecessor-version":[{"id":27602,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26254\/revisions\/27602"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=26254"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=26254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}