April 24, 2025 • 14 mins
Postmenopausal bleeding can be an alarming experience, especially when you've gone years without a period. What causes this unexpected bleeding? When should you be concerned?
Dr Ceri Cashell joins me to demystify this common but often distressing symptom.
We dive into the definition of postmenopausal bleeding - any bleeding that occurs after 12 months without periods - and explore the various causes, from hormone imbalances to more serious conditions that require immediate attention. Dr Ceri uses a brilliant analogy, comparing the uterus to a jumbo jet where multiple hormone "switches" need perfect alignment for smooth operation.
For women recently started HRT, bleeding can be a side effect, particularly in the first three to six months or after dosage adjustments. However, Dr Ceri emphasises that certain risk factors like obesity, family history, tamoxifen use, and smoking warrant prompt investigation.
We walk through exactly what happens during medical assessment - from initial GP visits to ultrasounds that measure endometrial thickness and potentially hysteroscopy procedures.
My own experience with unexpected bleeding after eight years without periods highlights how confronting this symptom can be.
Dr. Ceri reminds us that while HRT offers tremendous benefits, it's not a perfect solution and may require personalised adjustments to find your hormone sweet spot. Most importantly, she urges women not to dismiss or normalise symptoms that could indicate something serious - "Women are far too good at sucking things up," she notes, encouraging listeners to prioritise their health concerns.
Have you experienced unexpected bleeding after menopause? Don't wait - speak with your healthcare provider today and get the answers and reassurance you deserve.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Sonya (00:01):
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:25):
needs to hear them.
This way, more people can findthese amazing conversations.
Hi everybody, welcome to thisweek's episode of Dear Menopause
.
Now, this is a little bit of ashorter episode this week
because I am joined by my verygood friend, Dr Ceri Cashell.
Ceri and I have jumped on tohave a conversation about a
topic that I personally havenoticed is being spoken about a
little bit more, and Ceri isabsolutely the person to get to
(00:48):
the bottom of this for us.
Ceri, welcome to the podcast.
Dr Ceri (00:51):
Hi Sonya, Thanks for having me again.
Sonya (00:53):
Always a pleasure, Ceri.
Today we're going to talk aboutpostmenopausal bleeding, the
reasons why, the reasons when,to get it checked out and to
alleviate any concerns when itstarts happening and it does
happen, yeah.
Dr Ceri (01:06):
So I think postmenopausal bleeding is
something that is really quitecommon, especially for women who
are on hormone replacementtherapy, but can absolutely
occur for women who are not onhormone replacement therapy, and
I suppose it's always importantto go back to those basic
definitions.
So menopause is 12 months afteryour last menstrual period, so
you've had 12 months where youhaven't had any bleeding, and
(01:29):
then postmenopause is everythingafter that.
So, technically, postmenopausalbleeding is bleeding that
occurs after a year of noperiods at this time in a
woman's life, which is differentto somebody that maybe hasn't
had periods for differentreasons when they're younger.
And postmenopausal bleeding can, on occasion, be a sign of
something serious going onwithin the uterus or the cervix,
(01:51):
rarely in the vulva and vagina,but the big thing we're trying
not to miss is a cancer, ofcourse, and that's why it is
very important for women to getchecked when this happens.
So there's lots of differentreasons for postmenopausal
bleeding.
A common cause would be just animbalance in the hormones in
your hormone replacement therapy.
(02:11):
So there's a very good analogyof looking at the uterus like a
jumbo jet where you want all theswitches to be aligned for it
to fly safely cruise control andthe sex hormones the oestrogen,
the progesterone, thetestosterone are probably just
three of those switches.
There's lots of other thingsthat will impact the lining of
the womb things like insulin,probably other hormones like
(02:32):
vitamin D.
We know there's lots of theseother hormones that are playing
a role in all of our pathwaysthroughout the body, so
including the uterus.
So we are really looking attrying to get a Goldilocks sweet
spot with each of our differenthormones for women that are on
HRT, and it's really importantthat women do appreciate when
they start HRT in the not hadperiods for a year or five years
or 10 years, it can be reallyquite frightening to suddenly
(03:09):
have a period if you haven'tbeen aware of it.
For most women it's not heavyand I have had some patients
who've had some very heavybleeding and that has been
really very traumatic for themand again, that's something that
they really do need to getchecked out with their doctor.
Sonya (03:24):
So it's really any type of bleeding, whether it's as
simple as some spotting throughto more heavy, almost kind of
flooding, unexpectedly bleedingonce you're postmenopausal.
Obviously your first port ofcall with any time that happens
is straight to your GP to asksome questions and do a bit of
an investigation.
Dr Ceri (03:44):
Yeah, absolutely.
The thing that we really don'twant is for women one to be
sitting at home getting veryanxious, but two also that
you're not sitting at home withheavy bleeding, putting yourself
at risk of losing blood.
That would make you amount ofblood that would make you anemic
or iron deficient, or also thatwe could be missing something.
That is much more serious.
So when I see a woman withpostmenopausal bleeding,
(04:04):
irrespective of whether she ison hormone replacement therapy
or not, the first thing we lookat is different risk factors and
what else is going on with her.
So, depending on how heavy thebleeding is, it is important to
examine a woman in the surgery.
So we're wanting to look andsee if there's another source of
bleeding.
Sometimes women get littlevaricose veins in their vulva
(04:24):
and vagina that can bleed.
That's not so common, but it issomething that can happen.
If you're able to see thecervix, sometimes you'll see a
pull-up.
That's bleeding.
Sometimes you'll see anabnormality there that might be
more serious.
But we can't look into the wombinside the uterus in a GP
surgery.
So that's really where we needthe expertise of our gynecology
colleagues.
So first thing is to come andsee the doctor.
(04:46):
They can check your bloodpressure, check you're not
bleeding so much that you'vedropped your blood pressure.
That's very important.
We can obviously check yourbloods and make sure that you're
not anemic.
But then usually we are sendingyou off to get an ultrasound.
Ideally we use somebody that isused to doing what we call
gynecology ultrasound, so that'sa gynecologist that's been
trained both as a gynecologistbut also as a radiographer or
(05:07):
sonographer, very used to doingthese transvaginal ultrasounds,
looking at the womb.
So off to see them.
They will have a look and thenthey can grade whether the womb
lining looks like it is ofconcern or not.
And there are differentguidelines in different
countries that give you a cutoffthickness of the womb as to
(05:27):
when we think we should beconcerned.
So at the minute the guidancewould be around about four
millimetres.
So the person who does the scanwill give an endometrial
thickness.
Dependent on that willdetermine how aggressive or how
concerned we would be about thenext stage.
So four millimetres would beconsidered a cut off where
you're very unlikely.
If it's less than fourmillimetres, it's very unlikely
(05:49):
that you've got anything seriousgoing on within your womb.
It's actually probably closerto nine millimetres where the
risk of cancer really goes up.
But we have to always put thatin the context of the woman
herself.
So there are other factors thatmean a woman might be more
likely to have a serious processlike a cancer going on the womb
.
And unfortunately, women whoare overweight, who are carrying
a lot of extra weight, do havean increased risk of endometrial
(06:12):
cancer.
Women who have a family historyare at an increased risk.
Women who have been ontamoxifen or who are on
tamoxifen are also at anincreased risk, and smoking, of
course.
So looking at those as riskfactors, hrt probably isn't
considered a risk factor forendometrial cancer, but
postmenopausal bleeding isdefinitely increased in women
(06:33):
who are on HRT.
So I would see somebody examinethem, send them for an
ultrasound, and I would tend tohave quite a low threshold for
getting a gynaecologist toconsider whether they would then
have a direct look into thewomb.
They can take a biopsy.
They can actually see what thetissue looks like under a
microscope, and that can be veryreassuring for everybody
involved.
Sonya (06:52):
Yeah.
So my gynaecologist I love thisanalogy.
She describes it in thisbeautiful way where she's like
imagine it's a garden and youhave your lawn and you want your
lawn length to be, as you said,that endometrial thickness, to
be at a particular level, and ifyour lawn is a bit overgrown
and maybe you've got some weedsin there.
So she was referring in myspecific instance to some
(07:15):
fibroids and some polyps.
She goes, you know, and thiswas a procedure that I had done
recently through a hysteroscopywhere they go in and they mow
the lawns as she described, andshe pulled out some weeds.
But it was a really goodanalogy for me to understand
that endometrial lining.
I guess that it can kind of geta little bit out of control and
there are other things that cangrow in there the fibroids, the
(07:38):
polyps and obviously, wantingto eliminate any concerns around
there being a cancer growing inthere as well, yeah, absolutely
.
Dr Ceri (07:49):
And for a lot of women finding something like a polyp
and removing the polyp in thathysteroscopy is perfect, because
then the bleeding source isoften removed.
They're the women that willbleed because their womb lining
has got so the grass has got alittle bit long.
But you also know when yourgrass gets a bit short and a bit
dry that it can also bleed, andwe know that is.
Another cause ofpost-menopausal bleeding is
actually the womb lining is toothin.
(08:10):
It can sometimes be that thelittle superficial veins in the
uterus become a bit dilated.
That sometimes is related totoo much progestogen and they
actually bleed because we'rekind of thinning the womb lining
too much and that can require aslightly different approach.
It's not serious, but it is acause of that persistent
bleeding which certainly can bea nuisance for women.
(08:32):
So the approach really is onevery important that we rule out
that there's not anythingsinister going on.
And then two then what we do tomanage your bleeding can be
very different depending on whatwe find in that ultrasound or
that hysteroscopy.
Sonya (08:46):
Yeah, fantastic.
So just a little bit of a recap, going back to what you
mentioned at the start about forsomebody that is perhaps
starting HRT for the first timebut they are postmenopausal that
there is a chance that they mayexperience some bleeding.
When is that most likely tooccur?
From when they start their HRT.
Dr Ceri (09:06):
So it's most likely to occur within the first three to
six months of starting HRT or ifyou change the dose and
obviously if you've beensomebody that hasn't really been
on medication, you can forgetto take a couple of days of
maybe your progesterone or yourprogestogen.
Usually people are quite goodat taking their oestrogen but
definitely stopping and startingprogesterone or the progestogen
(09:26):
can trigger a bit of bleeding.
So light bleeding within thefirst three to six months we
wouldn't be so concerned aboutAnytime that it's heavier, like
a period, and certainly if it'sheavier than a period you should
really be getting seen by yourdoctor like I would say really
within a few days if it'sheavier than a period.
But it is a common side effect.
(09:47):
So, being aware of that, solight bleeding within the first
three to six months, you shouldstill tell your doctor about it,
but I wouldn't consider it anemergency.
Heavy bleeding or bleeding thatis beyond that three to six
month of starting or changingdose definitely needs a
consultation reasonably quicklyto progress to other
investigations.
Sonya (10:06):
Yeah, great.
And, as you said, those otherfactors to take into
consideration.
So if you were someone likemyself, for example, who has
taken tamoxifen, then you wouldwant to make sure that you were
having that conversation withyour GP straight away, as soon
as there was any bleeding, justto make sure that everything is
as it should be.
Dr Ceri (10:24):
But there are some women who do have persistent
bleeding.
So you've done a scan andyou've done a hysteroscopy and
everything is fine and theycontinue to have bleeding and
that certainly can be a nuisance.
So it can be a process oftrying to find out what is your
Goldilocks for your oestrogen,progesterone and even
testosterone has a role inbleeding.
(10:44):
So trying to find out what'sright for each woman can be a
bit different, like everythingelse, between individuals.
The Mirena IUD is a greatoption for women that tolerate
it and you can use it in thepostmenopause environment
possible years.
It does seem to really controlbleeding.
Progesterone the naturalprogesterone is not as effective
(11:04):
as the synthetic progestins atkeeping womb lining thin.
So, you know, while it's greatin the brain, it can take higher
doses to keep the womb liningthin for women.
So there is a lot ofpersonalized, individualized
titrating and tweaking of themedications to get it right, and
that can certainly be quitefrustrating for women who have
(11:26):
loved the no period part ofpostmenopause that's the bit
they're delighted about.
And then you've put them backto having a period every two to
three months, which is it'sinteresting, but some women that
certainly does happen.
Sonya (11:39):
And that was certainly my experience and my situation.
I found it really confronting.
I hadn't had a period for eightyears and then all of a sudden
I went to the bathroom and therewas blood.
And it is confronting, it'sscary, and I was straight on the
phone to you, who happens to bemy GP, because it is something
that kind of really does comeout of left field that you
weren't expecting, and for me itwasn't within those first few
(12:02):
months of starting my HRT aswell.
So I guess this is also just areally good reminder that
hormone therapy is very nuanced.
It takes some tweaking for somewomen to get those levels of
all three factors, if you'retaking all three of the hormones
, to get that interplay betweenthem all right.
And I loved your analogy at thebeginning of the jumbo jet and
(12:24):
making sure that all thoselittle levers are sitting at the
right levels to make sure yourengine just hums along.
Dr Ceri (12:31):
And I think it is also like HRT although it is body
identical hormones and it isextremely safe, it does still
carry these side effects.
So it is something that peoplehave said we don't talk enough
about that it's not a perfectmagic wand.
There are these side effects,and bleeding and irregular
bleeding on HRT is certainly oneof the biggest, most common and
(12:53):
most troubling side effects ofHRT for a proportion of women,
as is breast tenderness andheadaches, but certainly the
bleeding is the thing thatcauses distress, causes concern
and requires investigation.
You know HRT is a wonderfultreatment but it is not perfect.
Sonya (13:11):
I think that's a really great reminder, and thank you
for bringing it back to thatreally overarching theme of you.
Know it must be investigated,because we always, always want
to ensure that we've eliminatedanything that could be a little
bit more sinister than justgetting your hormone levels
right.
Awesome, Kerry.
Thank you so much for thisquick chat.
Was there anything else thatyou wanted to leave the
(13:32):
listeners with today?
Dr Ceri (13:33):
No, I think that's perfect.
So, always leaning into yourbody If something is concerning
you.
Your doctor is there to listento your concerns, so never feel
that you are bothering yourdoctor.
Women are far too good atsucking things up.
We are here to deal with yourconcerns, address your worries,
make it's our job to make surethere's nothing serious going on
.
But we can only do that if youcome and speak to us about it.
Sonya (13:56):
Yeah, great point and a really good reminder for us to
finish up on.
Thank you, Ceri.
I will point in the show notesto the amazing Healthy Hormones
platform, which does provide anonline community with access to
amazing GPs like yourself, sothere's a great opportunity for
women to jump into thatcommunity, be able to ask any
questions that do crop up,obviously working alongside
(14:18):
their GPs as well at the sametime.
Thank you, thank you, Thank you.
Welcome to the Dear Menopause podcast.
I'm Sonya Lovell, your host Now.
I've been bringing youconversations with amazing
menopause experts for over twoyears now.
If you have missed any of thoseconversations, now's the time
to go back and listen, and youcan always share them with
anyone you think needs to hearthem.
This way, more people can findthese amazing conversations,
(00:25):
needs to hear them.
This way, more people can findthese amazing conversations.
Hi everybody, welcome to thisweek's episode of Dear Menopause
.
Now, this is a little bit of ashorter episode this week
because I am joined by my verygood friend, Dr Ceri Cashell.
Ceri and I have jumped on tohave a conversation about a
topic that I personally havenoticed is being spoken about a
little bit more, and Ceri isabsolutely the person to get to
(00:48):
the bottom of this for us.
Ceri, welcome to the podcast.
Dr Ceri (00:51):
Hi Sonya, Thanks for having me again.
Sonya (00:53):
Always a pleasure, Ceri.
Today we're going to talk aboutpostmenopausal bleeding, the
reasons why, the reasons when,to get it checked out and to
alleviate any concerns when itstarts happening and it does
happen, yeah.
Dr Ceri (01:06):
So I think postmenopausal bleeding is
something that is really quitecommon, especially for women who
are on hormone replacementtherapy, but can absolutely
occur for women who are not onhormone replacement therapy, and
I suppose it's always importantto go back to those basic
definitions.
So menopause is 12 months afteryour last menstrual period, so
you've had 12 months where youhaven't had any bleeding, and
(01:29):
then postmenopause is everythingafter that.
So, technically, postmenopausalbleeding is bleeding that
occurs after a year of noperiods at this time in a
woman's life, which is differentto somebody that maybe hasn't
had periods for differentreasons when they're younger.
And postmenopausal bleeding can, on occasion, be a sign of
something serious going onwithin the uterus or the cervix,
(01:51):
rarely in the vulva and vagina,but the big thing we're trying
not to miss is a cancer, ofcourse, and that's why it is
very important for women to getchecked when this happens.
So there's lots of differentreasons for postmenopausal
bleeding.
A common cause would be just animbalance in the hormones in
your hormone replacement therapy.
(02:11):
So there's a very good analogyof looking at the uterus like a
jumbo jet where you want all theswitches to be aligned for it
to fly safely cruise control andthe sex hormones the oestrogen,
the progesterone, thetestosterone are probably just
three of those switches.
There's lots of other thingsthat will impact the lining of
the womb things like insulin,probably other hormones like
(02:32):
vitamin D.
We know there's lots of theseother hormones that are playing
a role in all of our pathwaysthroughout the body, so
including the uterus.
So we are really looking attrying to get a Goldilocks sweet
spot with each of our differenthormones for women that are on
HRT, and it's really importantthat women do appreciate when
they start HRT in the not hadperiods for a year or five years
or 10 years, it can be reallyquite frightening to suddenly
(03:09):
have a period if you haven'tbeen aware of it.
For most women it's not heavyand I have had some patients
who've had some very heavybleeding and that has been
really very traumatic for themand again, that's something that
they really do need to getchecked out with their doctor.
Sonya (03:24):
So it's really any type of bleeding, whether it's as
simple as some spotting throughto more heavy, almost kind of
flooding, unexpectedly bleedingonce you're postmenopausal.
Obviously your first port ofcall with any time that happens
is straight to your GP to asksome questions and do a bit of
an investigation.
Dr Ceri (03:44):
Yeah, absolutely.
The thing that we really don'twant is for women one to be
sitting at home getting veryanxious, but two also that
you're not sitting at home withheavy bleeding, putting yourself
at risk of losing blood.
That would make you amount ofblood that would make you anemic
or iron deficient, or also thatwe could be missing something.
That is much more serious.
So when I see a woman withpostmenopausal bleeding,
(04:04):
irrespective of whether she ison hormone replacement therapy
or not, the first thing we lookat is different risk factors and
what else is going on with her.
So, depending on how heavy thebleeding is, it is important to
examine a woman in the surgery.
So we're wanting to look andsee if there's another source of
bleeding.
Sometimes women get littlevaricose veins in their vulva
(04:24):
and vagina that can bleed.
That's not so common, but it issomething that can happen.
If you're able to see thecervix, sometimes you'll see a
pull-up.
That's bleeding.
Sometimes you'll see anabnormality there that might be
more serious.
But we can't look into the wombinside the uterus in a GP
surgery.
So that's really where we needthe expertise of our gynecology
colleagues.
So first thing is to come andsee the doctor.
(04:46):
They can check your bloodpressure, check you're not
bleeding so much that you'vedropped your blood pressure.
That's very important.
We can obviously check yourbloods and make sure that you're
not anemic.
But then usually we are sendingyou off to get an ultrasound.
Ideally we use somebody that isused to doing what we call
gynecology ultrasound, so that'sa gynecologist that's been
trained both as a gynecologistbut also as a radiographer or
(05:07):
sonographer, very used to doingthese transvaginal ultrasounds,
looking at the womb.
So off to see them.
They will have a look and thenthey can grade whether the womb
lining looks like it is ofconcern or not.
And there are differentguidelines in different
countries that give you a cutoffthickness of the womb as to
(05:27):
when we think we should beconcerned.
So at the minute the guidancewould be around about four
millimetres.
So the person who does the scanwill give an endometrial
thickness.
Dependent on that willdetermine how aggressive or how
concerned we would be about thenext stage.
So four millimetres would beconsidered a cut off where
you're very unlikely.
If it's less than fourmillimetres, it's very unlikely
(05:49):
that you've got anything seriousgoing on within your womb.
It's actually probably closerto nine millimetres where the
risk of cancer really goes up.
But we have to always put thatin the context of the woman
herself.
So there are other factors thatmean a woman might be more
likely to have a serious processlike a cancer going on the womb
.
And unfortunately, women whoare overweight, who are carrying
a lot of extra weight, do havean increased risk of endometrial
(06:12):
cancer.
Women who have a family historyare at an increased risk.
Women who have been ontamoxifen or who are on
tamoxifen are also at anincreased risk, and smoking, of
course.
So looking at those as riskfactors, hrt probably isn't
considered a risk factor forendometrial cancer, but
postmenopausal bleeding isdefinitely increased in women
(06:33):
who are on HRT.
So I would see somebody examinethem, send them for an
ultrasound, and I would tend tohave quite a low threshold for
getting a gynaecologist toconsider whether they would then
have a direct look into thewomb.
They can take a biopsy.
They can actually see what thetissue looks like under a
microscope, and that can be veryreassuring for everybody
involved.
Sonya (06:52):
Yeah.
So my gynaecologist I love thisanalogy.
She describes it in thisbeautiful way where she's like
imagine it's a garden and youhave your lawn and you want your
lawn length to be, as you said,that endometrial thickness, to
be at a particular level, and ifyour lawn is a bit overgrown
and maybe you've got some weedsin there.
So she was referring in myspecific instance to some
(07:15):
fibroids and some polyps.
She goes, you know, and thiswas a procedure that I had done
recently through a hysteroscopywhere they go in and they mow
the lawns as she described, andshe pulled out some weeds.
But it was a really goodanalogy for me to understand
that endometrial lining.
I guess that it can kind of geta little bit out of control and
there are other things that cangrow in there the fibroids, the
(07:38):
polyps and obviously, wantingto eliminate any concerns around
there being a cancer growing inthere as well, yeah, absolutely
.
Dr Ceri (07:49):
And for a lot of women finding something like a polyp
and removing the polyp in thathysteroscopy is perfect, because
then the bleeding source isoften removed.
They're the women that willbleed because their womb lining
has got so the grass has got alittle bit long.
But you also know when yourgrass gets a bit short and a bit
dry that it can also bleed, andwe know that is.
Another cause ofpost-menopausal bleeding is
actually the womb lining is toothin.
(08:10):
It can sometimes be that thelittle superficial veins in the
uterus become a bit dilated.
That sometimes is related totoo much progestogen and they
actually bleed because we'rekind of thinning the womb lining
too much and that can require aslightly different approach.
It's not serious, but it is acause of that persistent
bleeding which certainly can bea nuisance for women.
(08:32):
So the approach really is onevery important that we rule out
that there's not anythingsinister going on.
And then two then what we do tomanage your bleeding can be
very different depending on whatwe find in that ultrasound or
that hysteroscopy.
Sonya (08:46):
Yeah, fantastic.
So just a little bit of a recap, going back to what you
mentioned at the start about forsomebody that is perhaps
starting HRT for the first timebut they are postmenopausal that
there is a chance that they mayexperience some bleeding.
When is that most likely tooccur?
From when they start their HRT.
Dr Ceri (09:06):
So it's most likely to occur within the first three to
six months of starting HRT or ifyou change the dose and
obviously if you've beensomebody that hasn't really been
on medication, you can forgetto take a couple of days of
maybe your progesterone or yourprogestogen.
Usually people are quite goodat taking their oestrogen but
definitely stopping and startingprogesterone or the progestogen
(09:26):
can trigger a bit of bleeding.
So light bleeding within thefirst three to six months we
wouldn't be so concerned aboutAnytime that it's heavier, like
a period, and certainly if it'sheavier than a period you should
really be getting seen by yourdoctor like I would say really
within a few days if it'sheavier than a period.
But it is a common side effect.
(09:47):
So, being aware of that, solight bleeding within the first
three to six months, you shouldstill tell your doctor about it,
but I wouldn't consider it anemergency.
Heavy bleeding or bleeding thatis beyond that three to six
month of starting or changingdose definitely needs a
consultation reasonably quicklyto progress to other
investigations.
Sonya (10:06):
Yeah, great.
And, as you said, those otherfactors to take into
consideration.
So if you were someone likemyself, for example, who has
taken tamoxifen, then you wouldwant to make sure that you were
having that conversation withyour GP straight away, as soon
as there was any bleeding, justto make sure that everything is
as it should be.
Dr Ceri (10:24):
But there are some women who do have persistent
bleeding.
So you've done a scan andyou've done a hysteroscopy and
everything is fine and theycontinue to have bleeding and
that certainly can be a nuisance.
So it can be a process oftrying to find out what is your
Goldilocks for your oestrogen,progesterone and even
testosterone has a role inbleeding.
(10:44):
So trying to find out what'sright for each woman can be a
bit different, like everythingelse, between individuals.
The Mirena IUD is a greatoption for women that tolerate
it and you can use it in thepostmenopause environment
possible years.
It does seem to really controlbleeding.
Progesterone the naturalprogesterone is not as effective
(11:04):
as the synthetic progestins atkeeping womb lining thin.
So, you know, while it's greatin the brain, it can take higher
doses to keep the womb liningthin for women.
So there is a lot ofpersonalized, individualized
titrating and tweaking of themedications to get it right, and
that can certainly be quitefrustrating for women who have
(11:26):
loved the no period part ofpostmenopause that's the bit
they're delighted about.
And then you've put them backto having a period every two to
three months, which is it'sinteresting, but some women that
certainly does happen.
Sonya (11:39):
And that was certainly my experience and my situation.
I found it really confronting.
I hadn't had a period for eightyears and then all of a sudden
I went to the bathroom and therewas blood.
And it is confronting, it'sscary, and I was straight on the
phone to you, who happens to bemy GP, because it is something
that kind of really does comeout of left field that you
weren't expecting, and for me itwasn't within those first few
(12:02):
months of starting my HRT aswell.
So I guess this is also just areally good reminder that
hormone therapy is very nuanced.
It takes some tweaking for somewomen to get those levels of
all three factors, if you'retaking all three of the hormones
, to get that interplay betweenthem all right.
And I loved your analogy at thebeginning of the jumbo jet and
(12:24):
making sure that all thoselittle levers are sitting at the
right levels to make sure yourengine just hums along.
Dr Ceri (12:31):
And I think it is also like HRT although it is body
identical hormones and it isextremely safe, it does still
carry these side effects.
So it is something that peoplehave said we don't talk enough
about that it's not a perfectmagic wand.
There are these side effects,and bleeding and irregular
bleeding on HRT is certainly oneof the biggest, most common and
(12:53):
most troubling side effects ofHRT for a proportion of women,
as is breast tenderness andheadaches, but certainly the
bleeding is the thing thatcauses distress, causes concern
and requires investigation.
You know HRT is a wonderfultreatment but it is not perfect.
Sonya (13:11):
I think that's a really great reminder, and thank you
for bringing it back to thatreally overarching theme of you.
Know it must be investigated,because we always, always want
to ensure that we've eliminatedanything that could be a little
bit more sinister than justgetting your hormone levels
right.
Awesome, Kerry.
Thank you so much for thisquick chat.
Was there anything else thatyou wanted to leave the
(13:32):
listeners with today?
Dr Ceri (13:33):
No, I think that's perfect.
So, always leaning into yourbody If something is concerning
you.
Your doctor is there to listento your concerns, so never feel
that you are bothering yourdoctor.
Women are far too good atsucking things up.
We are here to deal with yourconcerns, address your worries,
make it's our job to make surethere's nothing serious going on
.
But we can only do that if youcome and speak to us about it.
Sonya (13:56):
Yeah, great point and a really good reminder for us to
finish up on.
Thank you, Ceri.
I will point in the show notesto the amazing Healthy Hormones
platform, which does provide anonline community with access to
amazing GPs like yourself, sothere's a great opportunity for
women to jump into thatcommunity, be able to ask any
questions that do crop up,obviously working alongside
(14:18):
their GPs as well at the sametime.
Thank you, thank you, Thank you.
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