This template is to assist clinicians with appropriate management and pathway for patients with bleeding from HRT medication, guiding on when a watch-and-wait approach is appropriate, or when a USS, referral for endometrial assessment or fast-track referral is indicated. This has been created inline with the BMS guidance on management of patients on HRT medication presenting with unscheduled bleeding. 

The template can be found through Auto-Consultation> ardens CONDITIONS WOMENS HEALTH < Unscheduled Bleeding on HRT, or by searching in the bottom left of SystmOne. 

The Consultation page allows the clinicians to document their assessment of the patient, noting any red flag risks or complications (to add these, use the green plus icon to the right of the box). 

Based on overall impression, the appropriate management steps will be indicated, with links to the HRT formulary for adjusting medication, ultrasound or onward referral if the patient is eligible, and prompts for a follow-up review. 

For Low Risk patients, the watch and wait approach can be documented as part of a 6m review, and this page allows the clinician to document their findings and assessment, alongside prompting the appropriate onward management. This includes links to request USS or a 1 month follow-up to be completed on the Low Risk HRT Stopped page. 

If an USS is indicated, the Post-USS Review page guides the clinician through to appropriate management steps and prompts for endometrial assessment if applicable. 

The Biopsy Review page is a decision aid for reviewing the biopsy results - with management steps differing for the patient dependent on the normal/abnormal outcome.