<prompt> 28 year old female presents with irregular slight bleeding after taking combined OCPs 3 months for heavy menstrual bleeding. What is your adviceEndometrial sampling to rule out neoplasia.Change over to progestin only preparations.Reassure the patient as it is break through bleeding.Discontinue OCPs.  <response>: With hormone replacement therapy, irregular spotting or bleeding is side effect. There is no need to sample endometrium, as this is seen only in early months of use. 