HORMONE THERAPY: COMPLICATIONS OF TREATMENT
Bleeding
Bleeding is the most common side-effect of hormone therapy and it is vital that it be clearly distinguished from any other cause of bleeding such as cancer of the genital tract. On continuous oestrogen, with progestogen at regular intervals, you will almost certainly bleed after the progestogen. However, if you bleed at any time other than after the progestogen, you must tell your doctor who will almost certainly suggest dilatation and curettage, or suction curettage-an outpatient procedure. (Your doctor will also almost certainly suggest this if the bleeding is heavy or prolonged, even if it is at the expected time.)
Do not panic if abnormal bleeding occurs. This is almost always due to the oestrogens that you are taking. These bleeds while on oestrogen do not necessarily mean there is any serious cause, and in fact they may be beneficial, as investigation may show up something small, like a polyp, which is easily corrected, or they may alert your doctor to some trouble that might, if no oestrogen had been taken, have remained undetected until much later.
Could oestrogen stimulate a cancer already present? Cancer of the endometrium is stimulated by oestrogens. A full history and medical examination will always be done by your doctor before oestrogens are given. If a history of irregular or excessive bleeding is present the doctor would investigate it by dilatation and curettage or suction curettage.
Does a Pap smear diagnose cancer of the endometrium? A Pap smear is a test only for the cells of the cervix, not for the lining of the uterus. However, cells shed from the lining of the uterus may be present in the smear and may give useful information that an abnormality is present in the endometrium. This would be reported with your smear test and investigated by your doctor.
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