118: Postmenopausal Bleeding: Causes, Concerns, and When to Seek Help

Your brain is undergoing a massive renovation during menopause, and Neuroscientist Dr Jennifer Hacker Pearson is here to help you understand the how and why. With nearly three decades studying neuroplasticity, the brain's ability to change itself, Dr Jen offers revolutionary insights into why perimenopause affects every woman differently and how you can harness this transformation.When estrogen levels fluctuate during perimenopause, your brain essentially panics. There are estrogen receptors throughout your neural networks, and as this crucial hormone decreases, your brain must create "workarounds" by changing its structure, function, and connectivity. This rewiring explains everything from mood swings to cognitive changes, but it also presents a golden opportunity for personal growth."Menopause is actually a gift," Dr Jen explains, challenging society's often negative perspective. Rather than viewing it as decline, she frames it as a developmental transition, a chance to become your truest, most authentic self. The extensive neural reorganisation happening during this time creates ideal conditions for consciously shaping who you want to be in your post-menopausal years.Dr Jen shares practical tools for directing this transformation, recommending meditation to reduce neuroinflammation (which increases as estrogen decreases) and journaling to understand how past experiences have shaped your brain. She also discusses fascinating research on how previous hormonal experiences like pregnancy might better prepare women for menopause, and explains why declining estrogen levels may contribute to women's higher risk of Alzheimer's disease.Download Dr Jen's free 5-minute meditation designed specifically for women in perimenopause, and discover why embracing this transition rather than fighting it could be the key to thriving through midlife and beyond.LinksGet free Meditation hereDr Jen's websiteDr Jen InstagramDr Jen LinkedInThank you for listening to my show! Join the conversation on Instagram

We need to talk about the glaring inequity in Australian healthcare that's affecting millions of women. After 18 months on menopause hormone therapy, testosterone has transformed my life, restoring my vitality, sharpening my focus, lifting my mood, and reawakening my sexuality. Yet accessing this life-changing treatment reveals a troubling gender bias in our healthcare system.While nine testosterone products for men are subsidised through the PBS, Androfeme - the only female-specific testosterone cream in Australia - remains unsubsidised, costing women over $100 per script. This forces many of us to use male-formulated alternatives that require daily careful self-measurement, an imprecise and frustrating workaround that no woman should have to endure.The numbers are staggering: an estimated 1.34 million Australian midlife women experience Hypoactive Sexual Desire Dysfunction (HSDD), yet face significant barriers to diagnosis and treatment. Despite testosterone therapy being used safely and effectively for women since the 1940s, with Australian-made Androfemme recognised globally as a gold standard treatment, women continue to bear financial burdens that men don't face for essentially identical symptoms.The solution is straightforward: include Androfemme on the PBS, just as other menopause treatments have recently been added.Share this episode with friends, family, healthcare providers, and decision-makers. Together, we can amplify women's voices and demand the equal treatment we deserve. Women's health is not a luxury - it's time our healthcare system reflects that truth.Links:National Women's Health Advisory Council's ReviewWhat is HSDD?Australian Paper on HSDDTestosterone has been treating women since 1940'sTestosterone for women: what you need to knowThank you for listening to my show! Join the conversation on Instagram

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.LinksHealthy Hormones WebsiteThank you for listening to my show! Join the conversation on Instagram

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:Real Life Medicine WebsiteThe Real Health and Weight Loss PodcastReal Life Medicine - InstagramReal Life Medicine - FacebookThank you for listening to my show! Join the conversation on Instagram

The relationship between menopause and neurodivergence remains largely unexplored territory in women's health—until now. In this groundbreaking conversation, neuropsychologist A/Professor Caroline Gurvich shares fascinating insights into why cognitive symptoms during perimenopause may signal more than just typical hormone fluctuations.For many women, perimenopause becomes the unexpected moment when long-overlooked neurodivergent traits suddenly demand attention. "About 98% of people said their ADHD symptoms became worse across those perimenopausal years." Even more revealing, numerous women receive their first ADHD diagnosis during midlife, despite having experienced symptoms since childhood. This raises questions about why these conditions often go unrecognised, particularly in women, until hormonal shifts disrupt longstanding coping mechanisms.Listen in to learn more about Estrogen's protective effects on dopamine - a neurotransmitter central to ADHD - which diminishes during perimenopause, potentially unmasking symptoms that were previously manageable. Beyond ADHD, A/Prof Gurvich discusses how autism, dyslexia, and other neurodivergent conditions may present differently during menopause, and the compelling connections between PMDD, perinatal depression, and neurodivergence.Whether you've wondered about undiagnosed ADHD, experienced increasing cognitive challenges during perimenopause, or simply want to understand the fascinating intersection between hormones and brain function, this episode offers invaluable insights and practical guidance. Listen now to better understand your changing brain and discover strategies to thrive during this transformative life stage.Links:HER CentreHER Centre - Cognition and HormonesMENO-D Assessment Scale to detect depression in menopauseThank you for listening to my show! Join the conversation on Instagram

Supplement confusion is at an all-time high, with social media feeds flooded with miracle promises targeting menopausal women. But how do you know what you actually need, what works, and what's just expensive snake oil?Pharmacist and nutritionist Sarah Gray brings her dual expertise to this conversation, offering practical guidance for navigating the overwhelming world of supplementation. Unlike most health professionals who specialise in either conventional medicine or natural approaches, Sarah bridges both worlds, providing uniquely balanced insights into what supplements might actually benefit women in midlife.This episode delivers specific, actionable advice you can use immediately. Learn the simple trick for identifying quality supplements (look for the AUST-L or AUST-R code), understand which baseline blood tests you should request from your doctor, and discover why blindly following supplement trends can waste your money and potentially harm your health. Sarah warns against the common practice of continuously adding supplements without removing any, explaining how this can lead to accidental overuse of certain nutrients.We take a deep dive into the essential blood work every midlife woman should request annually. Sarah explains how certain symptoms commonly attributed to perimenopause could signal nutritional deficiencies that won't necessarily improve with hormone therapy.And you don't want to miss our discussion about Creatine - arguably the most evidence-backed supplement for women in midlife - which offers benefits for muscle strength, mood regulation, and the immune system.Take control of your health by understanding exactly what your body needs rather than what clever marketing suggests you buy. Your journey through perimenopause and beyond deserves an evidence-based approach to supplementation that works.LinksSarah Gray - Nutrition Pharmacist websiteSarah on InstagramSarah on FacebookThe Benefits of Creatine by Dr Mary Claire HaverWhy Creatine Matters for Women 40+ by Harvard Lifestyle MedicineEffects of six-month creatine supplementation on patient- and clinician-reported outcomes, and tissue creatine levels in patients with post-COVID-19 fatigue syndromeThank you for listening to my show! Join the conversation on Instagram

In this popular episode, Dr. Talat Uppal, an obstetrician-gynecologist specialising in heavy menstrual bleeding, shares her expertise on a condition affecting one in four women yet rarely discussed openly. This eye-opening conversation sheds light on how women often normalise suffering through periods that drastically impact their quality of life.The discussion reveals shocking statistics: 25% of women experience heavy menstrual bleeding, yet more than half never seek medical help. Dr. Uppal provides clear indicators of abnormal bleeding – passing large clots, changing protection every 1-2 hours, waking at night to change, using multiple protection types simultaneously, and embarrassing "flooding" episodes. These symptoms can lead to iron deficiency, anaemia, and significant quality of life impacts.Learn about the spectrum of treatment options, from medications like Tranexamic Acid to the highly effective Mirena IUD and surgical interventions including endometrial ablation. She emphasises that most women find significant relief once properly treated, with many asking, "Why didn't I have this earlier? Why did I suffer so much?"Perhaps most powerful is the exploration of how heavy bleeding becomes normalised at multiple levels – by women themselves, healthcare providers who don't offer full treatment options, and society that suggests women should simply endure until menopause. This normalisation condemns many to years of unnecessary suffering when effective solutions exist.The conversation offers practical advice for women seeking help, emphasising the importance of advocating for yourself and being knowledgeable about available options. Have you been suffering in silence? This conversation might be the catalyst for transforming your quality of life. Listen, learn, and advocate for your menstrual health.ResourcesWomen's Health Road Clinic - websiteWomen's Health Road - InstagramWomen's Health Road - LinkedinThank you for listening to my show! Join the conversation on Instagram

Updates on the rapidly changing landscape of menopause care in Australia and globally, focusing on revolutionary PBS changes making hormone therapy more affordable and the growing momentum around women's health initiatives.• Pharmaceutical Benefits Scheme (PBS) now includes Estrogel, Prometrium, and Estrogel Pro (as of March 1st), with Slinder joining May 1st• PBS prescriptions require specific coding - you may need a new prescription to access subsidised pricing• FDA removed warnings from testosterone in the USA, highlighting the need for Australia to update outdated warnings on vaginal estrogen products• The "So Hot Right Now" Medical Conference created an inclusive learning environment for healthcare providers to discuss menopause care• Government funding for GP education ($1.5 million) lacks sufficient scope and evaluation mechanisms• Dr. Lisa Mosconi leading a $50 million research program to reduce Alzheimer's in women by studying the relationship between protective hormones and brain health• Jo launches Sheela Consulting - Unapologetic Advocacy, focusing on women's health policy and advocacyIf you've missed any of our expert conversations over the past two years, go back and listen, and please share them with anyone who needs this information.To listen to my previous episode and interview with Assistant Minister Ged Kearney, please head to episode 110.Links:Johanna Wicks - LinkedInSo Hot Right Now Medical ConferenceDr Lisa Mosconi - CARE fundingAustralian Government $573M fundingThank you for listening to my show! Join the conversation on Instagram

What happens to our sexuality during menopause? Far from signalling an end to pleasure and intimacy, this transition offers an unexpected opportunity for sexual rediscovery and deeper connection. Psychologist and sexologist Laura Lee joins me in this episode to masterfully unpack the evolution of desire through midlife, challenging our cultural fixation on "loss of libido" by revealing how desire simply changes form. Sexual communication can feel particularly challenging during menopause, when changing bodies and shifting desires create vulnerability. Laura provides practical strategies for starting these conversations without the paralysing pressure many couples feel. Rather than dreading "the talk," she suggests sharing resources, expressing genuine curiosity, and validating one another's experiences to foster meaningful dialogue about evolving needs.Perhaps most thought provoking is Laura's invitation to expand our sexual menu beyond the narrow, penetration-focused definition of sex that dominates cultural narratives. By embracing a broader understanding of sexual connection—from sensual touch to passionate kissing—we create more opportunities to say "yes" to pleasure, even as our bodies change. This expansion allows us to discover new pathways to pleasure uniquely suited to our midlife bodies.Ready to transform how you think about sex during menopause? Listen now to discover how this transition can become not an ending but the beginning of your most authentic sexual experience yet.Links:Laura's websiteThank you for listening to my show! Join the conversation on Instagram

How do you navigate life after cancer when everything feels different? Join me for a raw discussion that dives deep into the emotional and physical realities of cancer recovery. In this episode, Shari Todd and I share similarities in our vulnerable journeys through cancer diagnosis, treatment, and what life looks like on the other side. And what it took for us to get there.You will hear a candid conversation about the weight of expectations, mental health struggles, and the often-overlooked challenges faced during recovery and the complexities of an induced menopause. We unpack the power of radical acceptance, the coaches that support us with this and the crucial role of community support in healing. Shari’s insights reflect her experience of resilience and adaptability that resonates beyond her personal story, advocating for shared experiences among women facing similar challenges. Join the conversation and break the silence around these essential topics. Remember to subscribe, share, and leave a review! Your feedback helps me support others on their journeys.Links:Shari Todd on InstagramTactic Nutrition on InstagramThank you for listening to my show! Join the conversation on Instagram