Bleeding on Hormone Therapy: What Every Woman Should Know

Muscle is increasingly recognized as central to healthy aging and longevity. Yet severe loss of muscle mass and strength remains a significant challenge for some women after menopause—and our therapeutic options are limited.So I want to ask a question that may feel uncomfortable: Is there a place for anabolic-androgenic steroids (AAS) in carefully selected postmenopausal women?The evidence is limited, but it is not nonexistent. Small studies in older and postmenopausal women have shown promising signals around muscle protein synthesis, lean body mass, and bone density with anabolic therapies. Other research has explored whether adding testosterone to estrogen may provide additional benefits for bone and body composition.These studies are small, and they certainly don’t give us definitive answers. But I believe they give us enough to stay curious and keep asking questions.None of this means anabolic steroids should become routine treatment for postmenopausal women. This is not a recommendation. It is an exploration of the science we have, the science we are still missing, and whether anabolic therapies could someday have a carefully defined role for women experiencing severe muscle loss after menopause.Sometimes keeping an open mind is where better research—and better options for women—begin.Interested in booking an appointment?Click here: https://completemidlifewellnesscenter.com In-person care in Houston and Cypress Virtual medical care across Texas, California, and New MexicoDr. Susan Hardwick-Smith is a nationally recognized, board-certified OB/GYN, Certified Menopause Practitioner, author, physician executive, and authority on menopause, hormone therapy, sexual wellness, and women’s healthspan. She founded Complete Midlife Wellness Center, serving women in Houston and through virtual care. Previously, she built Complete Women’s Care Center into the nation’s largest all-female OB/GYN group. Named a Texas Super Doctor 20 times, she is a member of the Texas Super Doctors Hall of Fame and a former national Physician Executive of the Year. Dr. Susan is the best-selling author of Sexually Woke, host of the Empowering Midlife Wellness podcast, and author of the forthcoming Create Her. She makes complex medical science practical, helping women live healthier, stronger lives in midlife and beyond. She has also completed nine full Ironman triathlons and more than a dozen marathons and supports women’s health initiatives in Sierra Leone and Malawi.Follow Dr. Susan on social media:Instagram: www.instagram.com/drsusanofficialFacebook: www.facebook.com/drsusanofficialPodcast: https://apple.co/3ePe5NJTikTok: www.tiktok.com/@drsusanofficial Bring Dr. Susan’s Voice to Your StageInterested in booking Dr. Susan for a keynote, panel discussion, podcast interview, media appearance, or special event?Speaking & Media Inquiries: https://drsusan.com/speaking-media/ Get Sexually Woke: Awaken the Secrets to Your Best Sex Life in Midlife & Beyond: https://amzn.to/3rm47IU Pre-order Create Her: Aging Into the Healthiest Version of Yourself:https://drsusan.com/create-her-book/ Join the Well Past Midlife Masterclass:www.wellpastmidlife.com

Testosterone gel and testosterone cream may sound interchangeable—but does the formulation actually change how much testosterone gets into your bloodstream?I recently came across research that made me take a much closer look at this question, and the difference surprised me.In this video, I compare research looking at topical testosterone in postmenopausal women and explore why the same milligram dose does not necessarily produce the same blood testosterone level when delivered in different formulations.We’ll talk about what the studies show about absorption and serum testosterone levels, why blood tests don’t always tell the whole story, and how factors including SHBG and protein binding, androgen receptor variation, and intracellular testosterone production can complicate the picture.I also take a closer look at the Global Consensus recommendations for testosterone therapy in women—and an important limitation: much of the evidence behind current recommendations comes from studies using a low-dose testosterone patch that is not currently available.I’m also currently participating in a large testosterone study in collaboration with Baylor College of Medicine. The study is still underway, so we don’t yet have final results, but we are already seeing preliminary data that adds another interesting piece to this conversation. I share some of those early numbers in the video and explain why they caught my attention.The bigger point? Testosterone therapy in women is nuanced. Dose matters. Formulation matters. Blood levels matter. But so does the individual woman and how she responds.This is something I just learned more about, and I couldn’t wait to share it with you.Studies discussed:1. Fooladi E, et al.Pharmacokinetics of a Transdermal Testosterone Cream in Healthy Postmenopausal Womenhttps://pubmed.ncbi.nlm.nih.gov/24845394/2. Heald A, et al.Testosterone Gel and Serum Levels in Postmenopausal Women with HSDDClinical Endocrinology. First published March 15, 2026.https://onlinelibrary.wiley.com/doi/10.1111/cen.701193. Global Consensus Position Statement on the Use of Testosterone Therapy for Women https://pubmed.ncbi.nlm.nih.gov/31474158/Want to learn more about testosterone?Watch my must-see Testosterone for Women playlist, where I break down the science, myths, treatment options, emerging research, and the questions women should be asking about testosterone therapy.Watch the Testosterone for Women playlist on YouTubehttps://www.youtube.com/playlist?list=PLXB0Z6uY3JgEInterested in booking an appointment?Click here: https://completemidlifewellnesscenter.com In-person care in Houston and Cypress Virtual medical care across Texas, California, and New Mexico

When we talk about GLP-1 medications like semaglutide and tirzepatide, the conversation usually centers around diabetes and weight loss.But there may be a much bigger story unfolding.Researchers are increasingly interested in the effects GLP-1 receptor agonists may have beyond the scale—including their relationship with systemic inflammation, cardiovascular health, metabolic function, and the brain.That raises an intriguing question: Could very low doses of GLP-1 medications eventually have a role in conditions where chronic inflammation is part of the problem?In this video, I explore why GLP-1 microdosing has caught my attention and the potential implications for conditions such as:• Autoimmune disease• Chronic pain syndromes• PCOS• Mood and mental health conditions• Alzheimer's disease and cognitive decline• Cardiovascular diseaseIt's important to be very clear: GLP-1 microdosing for these conditions is not established medical therapy. We don't yet have large-scale clinical trials showing that microdosing treats or prevents these diseases.What we do have is an expanding body of research into the broader biological effects of GLP-1 receptor agonists—and some fascinating questions worth following.In this conversation, I'll explain what we're learning, what remains unknown, and why careful medical supervision is essential when considering any off-label approach.At Complete Midlife Wellness Center, we believe good medicine requires both evidence and curiosity: following the science we have today while paying close attention to where it may take us tomorrow.Interested in learning more about our approach to GLP-1 microdosing? Visit CompleteMidlifeWellnessCenter.com to learn more or schedule a consultation.Click here: https://completemidlifewellnesscenter.com In-person care in Houston and Cypress Virtual medical care across Texas, California, and New Mexico

Bleeding after menopause can be frightening—but not all bleeding means the same thing, especially if you're taking menopausal hormone therapy (MHT).In this video, I explain the updated guidance from the American College of Obstetricians and Gynecologists (ACOG) on the evaluation of postmenopausal bleeding and what these recommendations mean for women both on and off menopausal hormone therapy.This distinction is incredibly important. Women using a combination of estradiol and progesterone often require a different clinical approach than women who are not taking hormones. In many cases, bleeding while on MHT does not mean you should panic or stop your hormones. It may simply indicate that your hormone regimen needs to be adjusted.I'll walk you through:The latest ACOG recommendations When a transvaginal ultrasound and an endometrial biopsy are recommended How evaluation differs for women taking MHT versus those who are not Why individualized care is essential When bleeding is expected, when it should be evaluated, and what I recommend based on current evidenceUnderstanding these differences can help you make informed decisions and avoid unnecessary fear while ensuring that any concerning symptoms are appropriately evaluated.Reference:Updated Guidance Regarding the Role of Transvaginal Ultrasonography and Endometrial Sampling in the Initial Evaluation of Postmenopausal Bleeding (ACOG, 2026)https://journals.lww.com/greenjournal/fulltext/10.1097/aog.0000000000006275Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com We offer virtual medical care in Texas, California, and New Mexico

Can a shingles vaccine do more than prevent shingles?Emerging research suggests it might.A recent study published in Alzheimer's & Dementia found that older adults who received the two-dose recombinant shingles vaccine (Shingrix®) had a significantly lower risk of developing dementia, including Alzheimer's disease and vascular dementia, compared with those who were not vaccinated. While this research does not prove that the vaccine prevents dementia, it adds to a growing body of evidence suggesting a potential protective effect on brain health.In this video, I explain:What shingles is and why it occurs Who should receive the Shingrix® vaccine The latest research on shingles vaccination and dementia risk What these findings mean—and what they don'tAs always, medical decisions should be individualized. Talk with your healthcare provider about whether the shingles vaccine is right for you.Subscribe for evidence-based conversations about menopause, healthy aging, and women's health.Read the research:Susan dos Reis, et al. Reduced Risk of Dementia with Recombinant Zoster Vaccine in US Adults Age 65 or Older. Alzheimer's & Dementia. March 2026.https://doi.org/10.1002/alz.71407 Interested in booking an appointment with me? Click here: https://completemidlifewellnesscenter.com

Creatine has been part of the conversation in sports nutrition for decades, but it may be even more important for women in midlife.As estrogen declines, maintaining muscle becomes more difficult, bone loss accelerates, and many women notice changes in energy, strength, and even cognitive function. Creatine is one of the most extensively researched supplements available and has been shown to support muscle strength, healthy aging, bone health, and brain function.In this video, I explain:Why creatine matters for women in midlife The science behind its benefits Common myths and safety concerns Who should consider taking it—and how to use itIf you're looking for one evidence-based supplement that can make a meaningful difference as you age, creatine deserves your attention.Interested in the creatine I personally recommend?Thorne Creatine: https://bit.ly/4dfg6Po

Testosterone therapy for women is one of the most debated topics in modern menopause medicine—and one of the areas where misinformation is most common.Over the past year, I have been collaborating with Baylor College of Medicine's world-renowned urologist and sexual medicine specialist Dr. Mohit Khera, to better understand how testosterone can be prescribed safely and effectively for women.One of the key questions we set out to answer is surprisingly simple: What testosterone blood levels do women actually achieve when using testosterone gel at the recommended female dose, and how do those levels compare with appropriately dosed pellet therapy?In this video, I discuss:Our research comparing blood levels with testosterone gel vs. pellet therapy in women. Why optimal testosterone therapy depends on appropriate dosing and careful monitoring, not simply the method of delivery. When to draw testosterone blood tests, which laboratory tests to order, and the differences between LC-MS and ELISA testing.I also discuss the following publications:Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019) Efficacy of Changing Testosterone Gel Preparations (AndroGel® or Testim®) Among Suboptimally Responsive Hypogonadal Men The 50-Year Amsterdam Transgender Cohort Study (long-term safety data)At Complete Midlife Wellness Center, we believe testosterone therapy should never follow a one-size-fits-all approach. Every woman deserves an individualized treatment plan, expert monitoring, and dose adjustments based on her unique needs and goals.Whether you choose to work with us or another provider, make sure your testosterone therapy is managed by clinicians with specialized expertise in women's hormone health. Testosterone affects much more than sexual function—it also plays an important role in cognition, bone density, muscle health, energy, mood, and overall quality of life.Learn more about Complete Midlife Wellness Center:www.completemidlifewellness.comSchedule a consultation:https://completemidlifewellnesscenter.com/book-your-appointment/

The internet is buzzing about a new trend called "vagina-maxxing"—the idea that women should optimize their vaginal microbiome to achieve the "perfect" vaginal health profile.But how much of this trend is actually supported by science?In this video, I break down what we currently know about the vaginal microbiome, why certain Lactobacillus species are associated with vaginal health, and whether genetic testing, probiotics, supplements, and various vaginal wellness products truly deliver on their promises.We'll discuss:What "vagina-maxxing" actually means The role of the vaginal microbiome in women's health Why Lactobacillus crispatus gets so much attention The different vaginal community state types (CSTs) What the research says about vaginal probiotics The difference between evidence-based treatments and marketing claims Whether you really need microbiome testing Vaginal wellness treatments including the O-Shot®, PRP, Emsella®, vaginal laser therapies, labiaplasty, and vaginoplasty When these treatments may be appropriate—and when they may not What women should focus on instead of chasing the "perfect" vaginal microbiomeThe truth is that vaginal health is far more complex than a single test result or social media trend. While the vaginal microbiome is an important part of women's health, there is no such thing as a perfect vagina, and many of the claims circulating online deserve a closer look.If you are experiencing vaginal dryness, recurrent infections, discomfort, sexual concerns, pelvic floor symptoms, or simply have questions about your vaginal health, there are evidence-based options available. The right approach depends on your symptoms, goals, and stage of life.As always, my goal is to help you separate science from hype so you can make informed decisions about your health.If you'd like personalized guidance, we'd be happy to help. Schedule a consultation with our team at Complete Midlife Wellness Center to discuss your concerns and explore the options that may be right for you.https://completemidlifewellnesscenter.comRESOURCES:Live Vaginal Laser Therapy & O-Shot Procedurehttps://youtu.be/_ZZYgWAgUYIUrinary Incontinence? Here are your optionshttps://youtu.be/BvN2-Z3SIdQLabiaplasty 101https://youtu.be/jRAsEXTPU9AAmazon - VagiBiomhttp://bit.ly/4oTuzHXAmazon - Genetic testinghttps://a.co/d/03BqtsZSARTICLES:Randomized Trial of Lactin-V to Prevent Recurrence of Bacterial Vaginosishttps://www.nejm.org/doi/full/10.1056/NEJMoa1915254Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trialhttps://pubmed.ncbi.nlm.nih.gov/41855531/

Progesterone is one of the most important reproductive hormones in a woman's body, yet there is often confusion about what progesterone levels actually mean and whether they should be measured.In this video, I explain what progesterone is, how it is produced, how levels change throughout a woman's reproductive life, and why interpreting a progesterone blood test is often more complex than many people realize.We'll discussThe role of progesterone in the menstrual cycle and reproductive health How progesterone levels change from the reproductive years through perimenopause and menopause The normal rise and fall of progesterone during a menstrual cycle Why progesterone levels can vary dramatically from day to day in perimenopause Common signs and symptoms associated with declining or fluctuating progesterone When progesterone testing may provide useful information—and when it may not Why symptoms and clinical context are often more informative than a single laboratory valueOne of the most important concepts to understand is that progesterone is not a static hormone. Its levels change throughout the cycle and can fluctuate significantly during perimenopause, making a single blood test difficult to interpret in many situations.My goal is to help you better understand the physiology of progesterone so you can make more informed decisions about your health and have more productive conversations with your healthcare provider.Interested in booking an appointment? Click here: https://completemidlifewellnesscenter.com

Now that we understand much more about the potential health benefits of menopausal hormone therapy, I want to tackle one of the questions I hear most often: when should you start hormone therapy, when should you stop it, and is there ever a point when it's too late to begin?We know that starting estradiol close to menopause can help support healthy blood vessels and may reduce the risk of cardiovascular disease and other age-related conditions. But what if you weren't offered hormones when you first entered menopause and are now 10 or more years beyond it?In this video, I discuss what the research actually shows about starting estrogen later in life, who may benefit, who may not, and why some of the perceived risks have often been overstated or misunderstood.I'll also take a closer look at the Women's Health Initiative study that changed the course of hormone therapy conversations more than 20 years ago. We'll discuss what the study found, the limitations that were recognized over time, the lessons we learned from it, and why its conclusions do not apply equally to all women.I'll also discuss the ELITE trial and what it taught us about the timing of hormone therapy, including findings that suggest estrogen may help preserve vascular health when started closer to menopause. I'll explain what the researchers discovered, how these findings have influenced our understanding of hormone therapy today, and what they may mean for women who are considering treatment now or wondering whether they missed their opportunity to benefit from it.Whether you're considering hormone therapy for the first time, wondering if you should continue taking it, or questioning whether you've missed your opportunity to benefit from it, I'll walk you through what we know today. By the end of this video, you'll have a clearer understanding of the evidence behind starting, stopping, and starting hormone therapy later in life—and the questions you should be asking when making these decisions for yourself.If you'd like personalized guidance, you can schedule an appointment with me or one of our Menopause Society Certified Practitioners. We offer in-person care in Houston and Cypress, Texas, as well as virtual appointments for patients throughout Texas, California, and New Mexico.https://completemidlifewellnesscenter.comhttps://completemidlifewellnesscenter.com/on-hormone-consultations/info/https://completemidlifewellnesscenter.com/virtual-medical-care/