118: Postmenopausal Bleeding: Causes, Concerns, and When to Seek Help
04/24/25 • 14 min
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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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.
Links
Thank you for listening to my show!
Join the conversation on Instagram
Previous Episode
117: Weight Loss, Hormones and Metabolic Health with Dr Lucy Burns
Have you ever wondered why weight creeps on during menopause, despite your best efforts?
Dr Lucy Burns pulls back the curtain on what she calls the "metabolic triad of menopause" – a perfect storm of declining estrogen, rising cortisol, and increasing insulin resistance that creates the ideal conditions for stubborn weight gain.
As a GP who retrained in lifestyle medicine after experiencing her own health challenges, Dr. Burns offers a refreshingly honest perspective on why traditional approaches to weight management fail so many midlife women. Using the powerful analogy of a locked woodshed, she explains how high insulin levels essentially padlock your stored fat, making it impossible to access no matter how much you restrict calories or exercise.
What makes this conversation truly valuable is how Dr Burns connects the dots between hormonal changes, metabolic health, and practical lifestyle solutions. She introduces her "six S's for success" – sustenance, sleep, stress management, strength training, sunshine, and social connection – as foundational pillars for reclaiming metabolic health during menopause and beyond.
The discussion takes fascinating turns through hormone therapy considerations, the psychological aspects of food addiction, and why so many of us grew up alternating between strict dieting and giving up entirely. Throughout, Dr Burns maintains that improving metabolic health should be the primary goal, with weight loss simply being "a happy side effect" of addressing the underlying hormonal imbalances.
If you're exhausted by diet culture but still concerned about your health during menopause, this episode offers a science-based approach that works with your changing physiology rather than against it. Discover why muscle is your "metabolic organ," how stress impacts your ability to lose weight, and practical steps to break free from the metabolic challenges of midlife.
Ready to stop blaming yourself and start understanding the real science behind menopausal weight changes? Listen now and discover why it's time to focus on metabolic health, not just the number on the scale.
Links:
The Real Health and Weight Loss Podcast
Real Life Medicine - Instagram
Real Life Medicine - Facebook
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Dear Menopause - 118: Postmenopausal Bleeding: Causes, Concerns, and When to Seek Help
Transcript
Welcome to the Dear Menopause podcast . I'm Sonya Lovell , your host Now . I've been bringing you conversations with amazing menopause experts for over two years now . If you have missed any of those conversations , now's the time to go back and listen , and you can always share them with anyone you think needs to hear them . This way , more people can find these amazing conversations ,
If you like this episode you’ll love
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