No More Bleeding on Hormone Replacement! | Empowering Midlife Wellness

[@lisaperkins6419]

The biopsy hurts a LOT! Don't let them do it without some sort of anesthetic. I am still traumatized right years later.

[@t.t.8878]

Over the years I had a uterine biopsy twice (40) yrs apart . It HURT, a LOT! This procedure has not changed for 50 years. The Dr said it's because women don't complain to the hospital . I agree. We need to speak up and let them all know we're tired of putting up with pain when it's not necessary! I did call the hospital & did complain but more woman need to let them know it must change or it won't.

[@Cyblps]

I told my doctor it was painful, and my doctor saw the physical condition I was in. She offered me cool, wet towels to cover my face. That was it.

[@BeeBeeBell]

Yes. I have had it twice once pre.enopausal and post. A little pinch it's NOT! Take 4 Aleve 2 hrs before you go.

[@janinedance102]

Here in Australia they do them under a general anaesthetic day surgery.

[@Cyblps]

Biopsy lasts more than 20 seconds, and the pain is unbearable. I almost vomited from the pain. If I ever have another biopsy, I will ask for pain meds or sedation.

[@bn12595]

This video has been so helpful . Been on hrt for 2 years. Started spotting. Realized that I started intermittent fasting 6 months ago. No food after 4pm. Wonderful for insulin resistance, but caused me to take my progesterone 4-5 hrs after last meal. Looked it up, progesterone absorbes 2x better with food. I was only getting half my dose.

[@jeepgurl1379]

Good grief, me too! I didn’t realize I needed to take it with food. I prefer to take right before bed.😩

[@kirstyfloyd5662]

I was told to take mine at bed!

[@energeticsoulhealer888]

What an AWESOME comment. Thank you for this. I also intermittent fast, so I don't take my progesterone around food at all. I end up taking it 6, or so, hours after, at bedtime. This makes total sense. Bless you!

[@amoy9411]

Awesome to know I’ll try that since having spotting issues too

[@carascottvo]

So grateful for your videos, Dr. H! I do have to say, though- I don't want to see anyone minimize the pain of an endometrial biopsy. I'm premenopausal, and I've had 2 for irregular bleeding. Now, I haven't had kids, so they do say it's more painful if that's the case, but let me tell you- mine were excruciating, and I wasn't warned the first time. It was awful. The second time, I was offered ibuprofen and valium, which did NOTHING. My OB/GYN, who is a woman, laughed at me and said, "It's not going to be that bad!" I made my husband come with me so he could have some perspective (and hold my hand), and he was like, "There's literally NO procedure a man has to go through that's anywhere NEAR this." I'm not really a soapbox-type person, but better pain control is needed if women are expected to endure these procedures in-office. If men had to go through this, you KNOW there would be fuzzy stirrups, morphine and margaritas! :(

[@doreenryan7325]

I’ve had 3 children and usually handle pain well but this hysteroscopy was pretty rough . I had cramping and bleeding quite a bit with bright blood ( not just spotting ) for 10 days. It worried me quite a bit as I expected it to be a lot less by the way it was explained. If you have not had children they are suppose to give you a cervix softener the week before the procedure. I had a general anaesthetic but when that wore off the pain was terrible.

[@carascottvo]

​@@doreenryan7325 Thank you so much for your comment, Doreen. I'm so sorry that you had a similar experience- and you've HAD kids! I've never even heard of the cervix softener thing- I'm super grateful to know that! You know, my GP is a guy, and he's got experience in the OB/GYN space, and he agreed with me. He said he'd prescribe something stronger for me if I couldn't find an office that would offer twilight sedation. For me, they had to clamp my cervix, which hurt and she warned me, but the scraping hurt a lot more. Eek, it was pretty bad! I felt like such a wimp- women who've had kids have told me, "Nah, it's just like a baby kicking me." Whoa, really? Not my experience. ;)

[@yetanothercluelessgardener]

Oh, I know what you mean. I've had an endometrial biopsy. It was horrible!! The doctor was male, but he was kind enough to warn me beforehand that it will hurt. He was very sympathetic too while he did the procedure, but it didn't help the pain. I was given painkillers before the test, but it did not help at all. I really feel this procedure should be done with some kind of medication that will numb the pain. Ibuprofen does nothing.

[@yetanothercluelessgardener]

@@carascottvo I have had 2 kids. Heck, I have suffered from endometriosis, and therefore extremely painful periods all my life. But the endometrial biopsy as I commented before, was VERY painful.

[@carascottvo]

@@yetanothercluelessgardener So much this. Ibu is completely useless! I was talking with a friend who had 2 C-sections and needed a biopsy. She said that she was told that because she didn't have any vaginal births, that it would hurt her, too. She was given a cervix softener the night before, and she said it wasn't super bad. I was never offered that. No one even broached the subject with me! I was so mad.

[@jeepgurl1379]

I realize people have their own channel and it is their own. What I appreciate from watching your channel is that 1) you ARE a licensed physician and 2) you have your personal preference, but you don’t shame using other HRT treatment.

[@hollywoodwear123]

Ok! I like the idea of no bleeding but I am confused given the different informations I am getting. The main reason why I need to get on hormone therapy is to protect myself from osteoporosis. I am going through the process of starting HRT, just met with the doctor and getting blood work this week. I am gathering information so I can ask her the right questions when I meet with her next week. I want to make sure I will get the full benefit of HRT mainly to prevent osteoporosis ( I am 59 and small framed). I was listening to a KZbin episode by a doctor Felice Gersh, and she was explaining the importance of cyclic therapy, and that giving progesterone continuously, will have a down regulating effect on estradiol. She explained the science behind this by the T. She was saying that the purpose of estradiol is to up regulate many body functions, and that this is how we get the positive effects on the brain, the bones, the mitochondria and so on, but that pretty much we do not get these benefits when progesterone is constantly there to down regulate estradiol. As a registered nurse I totally appreciate her explanations more so because backed by science, only I wonder if there are other scientific explanations that would also make sense for continuous HRT. There is not a lot of available research or maybe I am not good at finding the studies, but I want to make sure I get it right as I only have one shot at this due to my late start. Could you make a video where you explain why you think that I can still get the full benefit of HRT while being on it continuosly. And, I am posting my question on different you tube channels ran by HRT doctors in order to get different experts views on this important aspect of HRT. Thanks!!

[@Phoenixrises89]

I agree… would be great for an explanation on this…

[@c.h.7581]

I'd love to connect with you as I'm wondering similar stuff and feeling quite lost!!! ..Just finally convinced/bullied my gyne to start me on HRT.. but it seems to be a low-dose combo pill (Cyclacur: 2mg Estradiol, 0.5mg Norgestrel) and he's told me to stop it for 7 daysat the end of every 21-day pack.. like a contraceptive, but it's not.. so shouldn't I continue.. heeeelp!!!

[@serizer9]

Yes! I feel Dr. Gersh seems able to explain the science and reasoning why we should cycle and bleed or shed the lining. Makes more sense than just being “annoyed” by the pesky bleeding.

[@BuckeyeFan-always]

@hollywoodwear123 -any luck in finding answers? I’m on the front end of research, too and 3 months into continuous body identical HRT and keep having breakthrough bleeding that lasts a week at a time. I see the doc in 2 days to touch bases on this and don’t know what to say/😂do. I feel “stuck”- need the estrogen for the protective effects, yet, the issue with bleeding shouldn’t be there. ???

[@hollywoodwear123]

Ok! After more research, I have learned that continuous HRT is appropriate for women who have not had a period for at least a year. Women who have a menstrual cycle should not be on continuous HRT. I hope that a video will be made on this to provide all of us with more on this subject.

[@Brontephile]

I’ve been searching everywhere for this information. Thank you so much, it’s exactly what I wanted ❤

[@carlahabib1768]

I’m so grateful for this video. I went through vaginal bleeding and based on the information and comments I read on this video I asked my doctor to increase my daily PROGESTERONE dose from 200MG to 400MG a day for six days and the bleeding stopped. Now I’m back on my 200mg daily dose again. Thanks so much doctor Susan. You’re THE BEST!! ✨🙏❣️

[@gabrielanita8319]

Shall I stop the HRT until the bleeding stops and once stopped to start again but with a smaller dose of Estrogen and equal amount of Progesterone? I used to take 50 Estrogen patch twice a week and 100mg Estrogen but on empty stomach as Dr recommended but then I increased myself the dose of Estrogen to 100mg and same 100mg Progesterone in the morning. When I went to gynecologist she told me to increase the dose of Progesterone to 200mg but at night. I did that and just after 3 days after I started having lots bleeding as on my period but not super heavy. Now I wonder if I should stop all HRT till the bleeding stops?

[@carlahabib1768]

@@gabrielanita8319 Hi, according to what the doctor Susan said on this video and according to my doctor as well you should never take progesterone on an empty stomach or in the morning but at night after a meal. Did you watch the whole video?

[@carlahabib1768]

@@gabrielanita8319 I wouldn’t stop the HRT. Talk to your doctor about increasing your progesterone even higher just until the bleeding stops. I’m on a 0.025 mg/day estradiol two patches a week and on a 200ml progesterone pill daily. Hope this helps.

[@gabrielanita8319]

@@carlahabib1768 Hi. Thank you for your reply. Yes, I watched the video and as I mentioned I started taking the Progesterone at night after food and a higher dose of 200mg. I think that's what triggered the bleeding. I'm thinking to stop the Estrogen all together for the moment and maybe the Progesterone too, until bleeding stops. The video was very helpful. Thanks

[@arindacruz1648]

Thank you, thank you, thank you! I was told that I had to stop HRT because of the bleeding and fibroids that I have. I was provided the option of taking medication to stop hot flashes. However, I'm concerned about the effects of not having estrogen in my body and how that contributes to heart disease, diabetes, dementia, etc. I'll be advocating to live my best life. I appreciate your knowledge and advice. ❤

[@sfitch69]

Should you have the fibroids removed?

[@c.h.7581]

It sounds like you need to find a menopause/hormone specialist! ..I've had trouble with this in Greece.. my gyne first of all just said "We don't give HRT.. we're modern." ..but after doing my own research, I kept on at him and he's since started me on a low-dose pill (Cyclacur: 2mg Estradiol, 0.5mg Norgestrel) and he's told me to stop it for 7 days at the end of every 21-day pack.. like a contraceptive, but it's not.. so not sure this is right! Also noooo mention of taking it with food (I take it morning empty tum, sometimes still in bed, to not forget!) So, I'm not feeling very confident in him now and have looked at alternatives. There are fertility clinics here that have specialists who work with menopause.. maybe where you are there's something similar!

[@yourhollywooddream]

How do you get testosterone in perimenopause/menopause? Maybe the question should be, how do I find a doctor who can prescribe it for me? Thank you for making such informative videos!

[@yvehooson9262]

After going through the menopause for 6 years naturally I started to suffer from very debilitating symptoms and was begrudgingly prescribed HRT by my GP. I was amazed at the difference and felt like my old self again... I was so happy, until 9 months down the line when the spotting began (I was also suddenly dreaming I was pregnant most nights!!! I've never had or wanted children so it was quite a shock) and was told to stop while I waited for the ultrasound investigation you mentioned. That was a 3 month wait because of the Covid backlog on the NHS (I'm in the UK) and then began a tug of war between the Specialist at the hospital and my HRT ignorant/opposed GP (who I had to battle to get HRT in the first place) - this lead to another, longer, wait as the GP demanded yet more tests be done, despite the Specialist being certain it was all benign. As you can imagine, I became very upset at it all and did not know who to believe at first. Even though the lovely Specialist explained everything in great detail and assured me it was perfectly safe to go back on HRT, I have hesitated, it's almost a year now. Thank you for explaining this all so clearly here, you've reminded me how certain the Specialist was that I would be fine, and why. After listening to you, I think I might have caused the peaks and dips by taking my pills erratically and in the morning on an empty stomach often (who read the instruction leaflets, right? 🙄) after about 7 months in, as my work routine changed. I think I feel educated enough to give HRT another try now. :)

[@niasquire]

I have had my third round of pellets after not having a good response to patches. Life is good; feeling awesome as you can imagine. Then today boom I go to the bathroom and see blood. Of course I panic and immediately think CANCER!!! You totally eased my mind 🤎🤎🤎. I will be calling my doctor on Monday I probably do need to have My dose increased. One thing of advise I will take from you, I take my progesterone in the evening but not necessarily with food. I will start incorporating this. Thank you so much for your knowledge!

[@RMSrealestate]

How did everything work out? I'm on my third round of pellets as well and spotting! Dr said up progesterone to 200 mg

[@maureenbrown4243]

Thank u so much, I was scared to death! Iv had several test, I have some fibroids, and have had them since I was a teenager, never had one issue with them. I was told, they didn’t need to be removed. I’m now 59, and have had some spotting(mild) never heavy! I’m so glad, I came across this video! I asked family members on both sides, has anyone pass from uterine cancer, bit sides never has! 🙏🏾🙏🏾🙏🏾

[@karlaheminger7257]

Thank you soooooo much for this info. I've had breakrhru bleeding everytime. Even with a small amount of estrogen. But now I understand the how/why of the progesterone! I'll be making the adjustments starting today. Hopefully I can get it figured out. Thank you. sincerely, Karla vae

[@dionnemars3030]

Omg! Thank you soooo much this is the best clear concise guidance I’ve received while dealing with this spotting… it is now 5 months I’ve been dealing with this and I was tempted to just stop taking the meds all together.

[@larahuffmaster5857]

Same, girl, but then my estrogen patch was lowered from .10 to .05 and I haven't bled in over 4 weeks. Praise the Lord!

[@earthlover1]

I started with two heavy periods a year ago. My gyno started me on HRT 50 estrodiol patch and 100mg nightly of Prometrium October 5, 2023. She suggested the Mirena IUD. I had a terrible experience with the Mirena about 10 years ago. I had it for 9 months and I bled everyday that I had it in, cystic acne, migraines... The only reason I kept it in so long was because it cost $500 so every month I would say one more month hoping things would improve because my gaslighting doctor kept telling me it would. Fast forward to recently my gyno said she would give me one at no cost. She said hormones change and it would be worth a try. I agreed and had it inserted on October 18, 2023. She told me to stop the Prometrium that I started on October 4th. I was bleeding when I had it inserted. I have bled everyday since. I held out 7 months and had it removed on May 17, 2024. I started on 100mg of Prometrium nightly again. My Estrodiol patch was increased in December 2023 to a 75 patch because I was still experiencing vasomotor symptoms plus migraine. I was having 15+ migraine and headache days a month. 50 estrodiol patch decreased my migraine days but 75 has been a huge improvement. A couple weeks ago my gyno suggested trying a new patch Estalis 250/50. Of course I am willing to try anything to stop bleeding. I didn't look into Estalis. I presumed that all patches were made with bioidentical hormones. Sadly the Estalis combi patch is a progestin NOT progesterone. Attaching a picture to show what happened to my face within a week. I started the patch on a Monday by Wednesday the following week my face had cystic acne all around my mouth and I had a migraine that lasted Wednesday to Monday. I compteplated putting the Estalis back on last Monday on change day to give it another week. It did decrease my bleeding to spotting a couple days but I couldn't do it. The migraines are debilitating. I thankfully had some 75 estrodiol patches so I put that back on and called my gyno to say I couldn't do the Estalis. She called me a prescription in for the 75 patch and I started on 200mg of Prometrium nightly. I have been bleeding heavily since. What a mess. Because the gyno made the choice to start me on HRT and the IUD at the same time I don't know if my bleeding is from the HRT or the Mirena IUD. I had the Mirena removed 2 months ago but have read testimonials from women that it took some a few months to completely rid their bodies of the hormones from the Mirena. I can't remember how long it took to stop my bleeding last time I had it removed. Some women are telling me that my bleeding is from the HRT. The only way I can know is to completely stop everything and go through the Hell of my migraines and symptoms returning. My workplace is not understanding at all. They took an entire day a week from me last year without consultation. When I asked they said it was for missed days. I only missed 4 days of work in 10 months. I had to work many many days with migraine. The 4 days I missed were because they were unbearable. I got the day back because I fought for it. I don't want surgery either. I'm scared. I literally have the worst luck of any person that I know.

[@earthlover1]

Also gynecologist prescribed northindrone this week and I have had a migraine everyday.

[@simplyouniquev4450]

Thank you Dr. Susan Hardwick-Smith. I’ve been on HRT for about 10 months & I started spotting at about month 8. The first time it scared me & it lasted about a week. I’ve had spotting 2 other times since then.

[@RMSrealestate]

Did your Dr let you know to up the Progesterone dose? I'm in same situation. Hope you have answers soon.

[@Avoid_Low_Frequency]

Thank you thank you thank you for all of this beautiful information!!! I feel so good with HRT and did not want to stop!!! My partner wishes to expend his gracious thank you! We are both very happy

[@Corrans]

Been watching a few of yoir videos now, and I SO agree with your views...who wants a period? We want constant steady hormones all the time.

[@sarahavena8537]

Thank-you Dr…..started to have post menopausal bleeding I’m almost 65, been on hormone replacement going on a decade; had a biopsy a year ago was fine. But: been intermittent fasting, last meal by 4:00pm ….so at bedtime my stomach is empty, hope this is the reason for this bleeding episode.

[@spainevee12e4]

Evrol patches for 7 months. Post menopause 4 years. Starting bleeding after 2 months. Have been heavy bleeding for 7 months, not spotting even though I have upped progesterone to 200mg and also the mini pill to try and stop it. Private patient and sick to death of no solution. I have stopped taking estrogen patch and continued with progesterone and bleeding has stopped. Going to try again and reintroduce Evrol 25 patch. If it doesn't work I am coming off hrt.

[@essanjay8604]

I choose to continue having a withdrawal bleed because for me taking progesterone continually just isn't an option - it makes me feel dreadful. Once the progesterone leaves my body it's like a huge dark cloud lifts - exactly how it was in my fertile years with my own hormones! It would be a shame if some women are put off HRT just because they want to avoid a bleed - it's only a few days inconvenience for a whole lot of oestrogen benefit. I use micronized progesterone as a pessary for 14 days every other month. Using the capsules vaginally minimizes the unpleasant side effects I experience if I try to swallow them! I've been on this regime for over 10 years and it works just fine for me.

[@Teragram68]

Someone said if the oestrogen is at a correct level the progesterone tablets side effects lessen, was that not the case for you? I’m the same with progesterone constantly battling the dark mood. I use my progesterone vaginally too. X

[@essanjay8604]

I only need a medium dose of oestrogen to keep my symptoms at bay. Not sure it would be wise to go higher just to try and offset progesterone side effects. I just do whatever I can to minimize progesterone exposure!

[@Teragram68]

@@essanjay8604 totally get you there, I have just knocked back 1/2 a pump on the oestrogel to see if the bleeding stops. I have been referred for an emergency scan. tbh I think for the current issue it is either I’m not absorbing the progesterone properly or I need a different one. I currently have Utrogestan and oestrogel continuous regime. Its only been 4 cycles on continuous, but 18 months since my HRT journey began. The switch to continuous was due to turning 55, i may have to go back to sequential. Its quite a minefield imho progesterone messes with my head completely, I have always been very insecure with little confidence but its gets so much worse. I do feel my GP is winging it as lovely as she is. Told my partner I feel like weaning myself off the lot due to lack of medical input, maybe its just my mood. 😞

[@marzenarongione4968]

I have a problem with progesterone as well Would you please tell me what dose are you taking vaginally for 14 days? Even given vaginally, it makes me extremely bloated and I gain weight immediately. I am continuing to experiment with different doses Hopefully something will work

[@essanjay8604]

@@marzenarongione4968 I use 200mg for 14 days at bedtime. I have a scan of the endometrium annually. I think it's entirely possible that half this dose would be adequate for me personally but everyone's different. Bear in mind also I am a decade past menopause. This may be totally unsuitable for younger women.

[@Shelley6821]

I am post menopausal and on the bioidentical estadiol patch, testosterone cream and progesterone pill. My Dr told me to make sure to take 7 days off a month from the progesterone pill otherwise the receptors get "clogged up" after awhile. Have you heard of this and is that even safe to do?

[@kathystclair9485]

In the beginning of this HRT journey, I had a doctor who was very much a proponent of HRT. She put me on 0.1 mg of estradiol patch twice weekly and 400 mg of progesterone nightly. Had no spotting at all. She retired and about a year ago I started having spotting and the doctor I now have always wants to know, and then she does the ultrasound. Everything was very normal. It happened again and did another ultrasound and again, normal. She is not a proponent of HRT. In fact, she dropped my progesterone to 200 mg nightly. I asked her what about testing, she said it is not necessary. I have been spotting the past couple days again, but I have doubled my progesterone this time instead of calling again since it has only been 3 months since my last ultrasound which again was normal. This video has given me insight on what my problem may be. I intermittent fast and do not eat past 6 pm. I am up until midnight, and I am taking my progesterone on an empty stomach. So, I am going to start taking it 2 hours after I have had my last meal and see if that helps. I'm just concerned about not being able to sleep as well, but it is definitely worth the try. Thank you for this informative video.

[@BuckeyeFan-always]

Did you try it? How are you doing now?

[@dandersohn]

I’m 7 years post meno and started HRT in sept. 2022. I started spotting off and on then Jan 2nd in ER for heavy bleeding. I had a pelvic ultrasound also uterine, they found nothing. Biopsy nothing Hysteroscopy nothing! I’m taking lowest dose of estrogen Patch and 200 ml progesterone I’m not sure what to do Feeling defeated. Having two periods a month now. Zero hot flashes but I’m not sure it’s worth it 😢 Docs aren’t helping. They say it’s not the HRT ??? How can that be when I had zero bleeding for 7 years ??? Confused

[@emmajane7745]

I don't think you need progesterone after menopause. Check out menopause barbie

[@janemasini2810]

I'm on estradot 100mg and mireena coil, had biopsy all clear been on this over a year, I'm 54, I've been spotting and having periods everything month , then I stop for 10 days then I go back spotting😮

[@lindaw140]

My experience w biopsy wasn’t too bad. I stopped HRT because of the bleeding. Now I am listening to this and found out whether I need to reevaluate my options. My family doc advised me to stop using HRT as bleeding wasn’t something she thought safe for me.

[@hearmywordzd8203]

Great video you explained it so well, now I understand

[@maximac222]

Thank you for this video! I had a d&c in January for bleeding. I'm 10ish yrs post menopausal. The bleeding is annoying. I just assumed it was the price to pay for taking hrt 💁‍♀️. My dr said to give it a couple of weeks (post procedure) for the bleeding to stop. It currently has but I'm holding my breath, crossing my fingers that it will not start up. I'm on 300 mg of progesterone 🫣 I love how I feel on hrt and cannot imagine not having it!

[@missyhaussler9704]

So helpful! I found this at the perfect time.

[@deirdrewalsh1134]

I’ve been not taking my progesterone enough. I tend to skip many tablets. That could explain. Thank you so much

[@sylviaking8866]

The progesterone protects you from uterine cancer. Keep taking it.

[@ADHDandFabulous]

Thank you so much, Dr. Hardwick-Smith, for the thorough explanation. Just discovered your channel last night and lots of going ons with my body is clearing up :) love how simple your explanations are.

[@tonimartinez2019]

I have been on HRT for years and had bleeding after menopause. My doc discovered it was a benign cyst in my uterus and surgery removed it. No more bleeding.

[@nancyv4431]

I was on HRT for 6 years and started spotting. Got an ultrasound, an MRI and a biopsy. Nothing. My thyroid medicine needed adjustment at this time. The biopsy was fine. My gyno used a local lidocaine and I barely felt it. Increased my progesterone to 400 mg. Bleeding stopped.

[@astralarchaeology5840]

Thanks! I'm thinking I need to up mine as well. Now at 200mg still bleeding.

[@angelaramsay1778]

very helpful, thank you. day 2 cramps and mild bleeding

[@katgrant2256]

Thank you for explaining in such detail!

[@virginia6793]

Other doctors say over 40% on hrt bleed.

[@carolanncoleman137]

Did not bleed til I went on the time released-plus the made me tired/ back to what dr Susan suggests- pharmacy prescription 100-200 mg a night

[@BeeBeeBell]

I read that too.

[@lindaw140]

My experience w biopsy wasn’t too bad. I stopped HRT because of the bleeding. Now I am listening to this and found out whether I need to reevaluate my options. My family doc advised me to stop using HRT as bleeding wasn’t something she thought safe for me. I am very healthy in my mid 50’s, I used patch. My OBGYN thought I was a perfect candidate for HRT. I did a couple of Ultrasounds and it showed good except last time the thickness of my uterus wall grow a bit (7mm or unit I forgot)

[@marielasantiago9195]

Hi if I'm in perimenopause and I star hormone replacement therapy and I started bleeding again it's normal? I was not have my period for 7 months before the hrt

[@sylviaking8866]

Thank God for doctors like you. Thank you for sharing your knowledge.

[@dcantwell119]

I was on birth control pills continuously for years due to endometriosis they worked fabulous. Now they switched me to hrt combination patch. I started bleeding. Never had that problem on bc pills. I wish I could just go back to taking them. I don’t think men would put up with what we are made to endure.

[@K-E2019]

I was taking Combi patch and started bleeding after about eight months, so switch to the higher progesterone Combi patch. Did fine on that patch for another couple of months then started bleeding again. Finally went to an estrogen patch, and an oral progesterone. 🤞 It’s been 10 months .

[@helenhernandez2197]

same for me!!! switched to estrogen patch & 200 mg progesterone it stopped the combo patch bleeding but now bleeding again. They said try & double my progesterone for 5 days. So 400 mg i'll try. 👀

[@K-E2019]

@@helenhernandez2197 I tried the micronized progesterone and I could not take the side effects. I just asked for 2.5 mg of Provera . May be synthetic but I do so poorly on the micronized . I could not do it .Its almost been a year with no bleeding 🤞

[@janicebright9578]

This information is super informative and I truly appreciate this. I’ve been dealing with breakthrough bleeding for months, and my doctor appears to not be as first in this topic so now I have a starting point to either allow my doctor to better assist me or shop for a more equipped position.

[@MrMarcela001]

I had my biopsy under anesthesia 😊

[@inhim4158]

Me too. Same time they took out the polyps. Just got pellets again after being off hormones for 2 years. 200 MG Progesterone. No issues.🙏

[@barbaraevans5593]

oh that little hysteroscopy and removal of 2 polyps..yeah that was gonna be about $4000 at the facility my doc wanted me to go to, yes outpatient so ask before you go

[@lindaw140]

My experience w biopsy wasn’t too bad. I stopped HRT because of the bleeding. Now I am listening to this and found out whether I need to reevaluate my options. My family doc advised me to stop using HRT as bleeding wasn’t something she thought safe for me. I am very healthy in my mid 50’s, I used patch. My OBGYN thought I was a perfect candidate for HRT. I did a couple of Ultrasounds and it showed good except last time the thickness of my uterus wall grow a bit. My biopsy showed good results no problem.

[@talithakushlan8084]

Thank you so much for this. It is so helpful.

[@Susan-xg7qn]

My bleeding/spotting is happening after 4 years on the same does of Estrodil and progestrone , not sure why yet, but I am going to try the talking progestrone while still have food in me, was never told that, thank you

[@jeepgurl1379]

Iris been 4 weeks now. I think I’m getting progesterone reaction (dizziness, anxiety).

[@simplyouniquev4450]

@Dr. Susan Hardwick-Smith I have come back to this video to rewatch it several times. I started HRT almost 1 yr. ago. Unfortunately, 3 months ago I started having what appears to be a regular monthly cycle. In March after an appointment with my GYN, she increased my progesterone to 200mg & kept my Estradiol patch at 0.1 mg. I am at my whits end bcos this is month 3 of having a full on monthly cycle. Not to mention the increased progesterone has my emotions all over the place as well as increased bloating. Any further advice you can give would be great. Help!

[@starznmyis]

Thank you very much for this video.

[@traceyallely7220]

Thank You for this information

[@patriciapyper4617]

You are amazing ♥️

[@elainehopkins7904]

So glad I found your channel Dr Smith. I have been on HRT - continuous, now for two and a half years and every now and then I start spotting. Is this normal? I can go for months being ok then back spotting again for few days at a time. Thank you for your helpful videos 🙏

[@cintiaspataro3205]

@DrFelice Gersh's recommendations are a bit different, in fact what ahe says is that we would intentionally want the uterus lining to shed monthly (mimicking a period) so all the died and yawky cells go away monthly

[@janinedance102]

Does she recommend changing from cyclical to continuous at some point or staying on cyclical forever?

[@cintiaspataro3205]

@@janinedance102 well, it always depends on the individual, seriously I would like you and everyone to hear her because the way she explains of course is appropriate and with the exact reasons of why, what and in each case. What I say is that it makes absolutely sense from me (that I am after the benefits of long term health beyond just calming ugly symptoms :) I hope this helps!

[@jennysiepka9900]

@@janinedance102 she is a proponent of cyclical forever. She believes that static dosing is not how the woman's body was in childbearing years, so we should mimic this. I tend to agree with her reasoning however... my provider is not willing to do this with me. And i am hesitant to drop out my prog for the 10-14 days on my own.....

[@suesmith2360]

​@@jennysiepka9900I am going through the same decision making but am sick of spotting and the period pain. I'm going to try it

[@doodieevanshenagan3330]

Yes I love everything about Dr.Gersh……she actually says if there’s a lil bleeding, we need to celebrate cuz that means what our Dr prescribed is working! I’m 73 yrs old & am on the Estradiol patches(2 X’s/week) plus progesterone pill at night…200 mg. & compounded Testosterone. Been on this regimen for6 mos.& saw bright red blood, not a period but enough to be surprised, didn’t smell either, only lasted 2 days then went away. Listened to Dr.Gersh & she explained that this is great. I am so happy to know that. So bottom line is don’t take progesterone in morning(cream) & pill at night, will stop the proliferation of the uterine lining……so I’m taking it at night & some mornings per week.

[@EmDeePhotography]

I had pellets put in December. On January 19-25, I had a period. Now it looks like it is coming again almost a month later. I am confused as another doctor on YT said having a period on HRT is normal, but spotting should be looked at. I' m confused.

[@McBeth.]

Thanks - I needed this info. Now I know how my doctor ought to approach fixing this. Was on Premarin (oral) and progestin for 5 years. Switched to estrogen patch and a different progesterone and began getting a full period every three weeks. I suppose I could always go back to taking the Premarin orally...I only changed to patches because I didn't want my liver filtering the estrogen and thought transdermal would be a better delivery system. I think I may have been wrong about that. Time will tell. I'll see if the progesterone can be increased because these patches have sorted out my hot flashes and vaginal atrophy perfectly. They're a bit of a pain but they work well.

[@alisonjones3057]

I have had two experiences of bleeding on hrt , I was sent to the hospital to get checked out the fist time it was discovered that I had polyps on my cervix the second time I had a large ectropion on the cervix. I would still encourage women to get checked as there are several other reasons for bleeding when taking hrt .

[@stephaniesteed7653]

I started hrt pellet therapy while I was premenopausal so I never went a whole year without a period. I think that’s why I still have a cycle. This is all so confusing.

[@SF-oz9kf]

I had a full period 18 months after I thought I was in menopause. I have been on estradiol 2 mg and progesterone 50 mg. I'm thinking it may be because the progesterone is too low? I had an ultrasound and am awaiting the result. I'm a little worried. 😔

[@apacur]

How well does progesterone cream absorb through the skin?

[@rdiemidio65]

I'M only on my 2nd week. I'm on 0.1 mg estradiol patch and I take 200mg progesterone pill at night. I'm hoping not having enough food in my stomach and maybe not absorbing enough of the hormone.

[@KB-we6pf]

Started with CombiPatch with the low progesterone first. Started bleeding after a few months . Then went to the CombiPatch with higher P was fine for a few months then it started again . Now will try estradiol, patch and progesterone at night. 😐 Hoping this works 🤞 ( had ultrasound and all was well there luckily )

[@DisneyLissy]

This sounds exactly like me. Did you figure out the right regimine?

[@amywjn]

So helpful! Thanks!

[@jeannejones5449]

Is low progesterone the cause for breast discomfort on hrt?

[@BeeBeeBell]

Estrogen may be too high. Tell your MD.

[@torimanning666]

DR. Susan, I am thankful for the information. I have a question about fibroids and HRT. Unfortunately, due to a delay in my compound progesterone being delayed, I went about 2 1/2 months without progesterone. I have gained 8 pounds around my middle, have uncomfortable pain in my belly and severe bloating. I was on a very low dose of estradiol for 8 months and went off for about 7 months. Went i went back on I asked to be pushed up to 0.075 and no progesterone. I am a little concerned about the pain, bloating and bleeding. Can you please provide me information on what I should do.

[@Candiceknits]

I started a hormone cream 5 of estrogen 200 of progesterone. After one week I started spotting. I was like ok my body needs to adjust. By Second week I was having a full on heavy period that would not stop. After 10 days of bleeding heavily I was done. I quit the cream. It’s been 5 days since I stopped using the cream and I am still spotting daily. I know I have 2 small uterine fibroids was diagnosed with those last year. Previous to starting hormone therapy I had not had a period for 8 months.

[@mirellasa4949]

Same situation but my Dr said I must stop for a week but after a week and a half of having blood I am now spotting! Then he said I need to halve my progesterone. I don't think he knows what he's doing. 😢😢Time to change Dr!

[@stacyfrakes2931]

I have had a terrible time with bleeding while on HRT. I have had a pelvic ultrasound and 2 endometrial biopsies. The ultrasound revealed many fibroids but none within the endometrium. My doctor recommended an IUD. I now have an IUD and taking progesterone pill each day and still having bleeding (more than spotting). I think I will ask my doctor about the hysteroscopy. Thank you for this information. I am at my wits end with the bleeding on one hand and feel so much better from the menopausal symptoms with the hormones on the other hand.

[@mariamunguia8863]

Hi Stacy how are you doing? I hope all is well your right the hrt helps us with so many things but the bleeding is so annoying. I hope your well and let us know the out come so we can learn. Thank you Stacy!💞

[@dandersohn]

Same exact story here. My OBGYN is lowering my estrogen dosage patch and hoping for the best. I’m still having bad tummy issues and feeling the progesterone is to blame but it could be that I already had these problems and they’re just coming to a head. I’m fasting and changing my diet drastically hoping for change.

[@cindybrown1398]

I doubled my P after bleeding for 3 months , its stopped overnight

[@totallychillgirl8072]

Seems like you don’t have enough estrogen.

[@stephaniesteed7653]

@@cindybrown1398how did you get your doctor to double up your progesterone? To what amount if you don’t mind me asking. I am having spotting a lot it’s driving me crazy. I never went a whole year without a cycle so I think I am still pre menopausal so my doctor has me on progesterone and estrogen every day which I am wondering if taking the progesterone and estrogen every day to early might have caused this. How are you doing now?

[@isabellesender]

Brilliant. Thank you.

[@reneelyttle]

Dr Susan, When is the right time of day for progesterone? Estrogen? Testosterone?

[@patriciapyper4617]

Thank you so much for the information ❤

[@lucysnowe3571]

I am due to have a pipelle biopsy. My doctor told me it's not as painful as a hysterectomy? Has anyone experienced this pipelle?

[@patriciapyper4617]

I had a break through small bleed l am on evorol Conti patches post menopause 😭😭♥️

[@kjbrocky]

The only women I know who started bleeding again were only those using the pellets, not those using other forms of bio identical HRT.

[@beautyisme94beauty40]

Great info, however what if you have no uterus (hysterectomy) and are still spotting using HRT!

[@janinedance102]

Will a progesterone IUD with estrodial patch stop spotting from HRT?

[@Kim-ri1hg]

I started Estradiol patch and topical progesterone compound cream 7 months ago. I started bleeding. My doctor put me on a progesterone pill higher than the cream and bleeding stopped. She still ordered a vaginal ultrasound. She said the limo was a bit thick and even though I’m still not bleeding she is ordering me for an endometrial biopsy. :( Meanwhile- hot flashes have resumed along with the WORST night sweats! 😢😮 At this point I’m worried. And wondering what is after this if that is okay. 🤷‍♀️ I’m really wanting the Mirena IUD or give up. To go through this for every minor bleed at 54 Not interested. This is why women give up. What a hassle.

[@BuckeyeFan-always]

How are you doing now?

[@AL-ns5jc]

W have the Climara pro patch which is a combination patch. It’s supposed to stay on 7 days but yesterday it was basically off and I put it back on. Only the outer edges were really in contact with my skin, now I’m spotting. I’m gonna try a different route because the patch is just not working for me.

[@lkpnda287]

I use this patch and sauna daily what you can ise is those stickers that go over a Continuosus glucose

[@BeeBeeBell]

This happened to me. Ended up with a DNC then did oral est/prog.

[@ImHandlingIt]

Im 47, haven’t had a period for 4 months, but was having symptoms of insomnia, vaginal dryness, low libido, and night sweats. Labs were at post menopausal levels. Testosterone was also in the toilet. Dr, prescribed compounded estradiol 2mg/Testosterone 2 mg cream (4 clicks/1 gram in AM and 100 mg progesterone. In just the first few days, symptoms improved. But on day 10, I started spotting and now have a full blown period with cramps and related loose bowels. I was told bleeding could happen when starting BHRT. But this soon? Could this be a true blue period stimulated by the hormones? Or a coincidence?

[@nancyg9318]

Im on the. 75 patch and 10 days of pergesterone every 3 months. I sometimes I bleed like a period, and other times, it's just endless spots. My lining was normal, biopsy normal right before going on hrt. Thoughts?

[@jennysiepka9900]

but COULD testosterone have an effect on the uterine lining if your testosterone decides to spin off into Estrogens?....

[@bridgetodigo409]

Thank you

[@patriciapyper4617]

Thank you so much you are amazing ♥️

[@eneydatoledo6470]

Mine has been going on for 5 months already, That spotting can’t even have normal sec 😢

[@sfitch69]

Very helpful. Thank you!

[@drsusan]

Thanks for watching!

[@annieuk4164]

I'm on evorel conti patches, both estrogen and progesterone. After 4 months started bleeding/spotting. Should I take extra progesterone ?

[@barbaratankersley7117]

Thank you for the info

[@kathystclair9485]

Hi Susan. I take my progesterone at bedtime which for me is at 11:30. I stop eating at 6 pm. I was never told by my doctor to take it with food. So, since that is the case, I would think it is too early to take it as I need it also for sleep. Any suggestions you may have would be helpful. Thanks for your informative content.

[@danskdna8550]

Take it at 11:00 with 2 crackers? I do that.

[@jeepgurl1379]

I also have read that taking it with food may INCREASE the strength of the pro pill. I go to bed at 9:30pm and sometimes eating dinner at 7pm. I don’t think this time frame is working for me. Started experiencing dizziness. After taking it and still have the symptoms before driving to work… not good. I sleep better though.

[@shawnjohnson3670]

My wife has really benefitted from the HRT, but the bleeding has not stopped for 2 months. She also has really heavy periods. Her doc is scheduling her for a D&C. Why ablation is not being suggested, I don’t know

[@drsusan]

I actually agree that would be a great option

[@Minkagurl]

Is it possible to have an ablation and still bleed from HRT?

[@creativespaces9355]

I'm post menopause, been on BHrt pellets for 18mos. Started having breakthrough bleeding, had trans/pelvis ultrasounds, adenomyosis is the diagnosis. Will the ablation work to stop the bleeding? I've increased the Progesterone but still having issues 6 wks later.

[@gardendaisy]

I just started getting a little spotting just after a week or so since im taking P and E

[@patriciapyper4617]

I am post menopause l am on evorol Conti patches had a break through bleed l was given a estrogen cream for down there l only put a bit inside next day had a break through bleed stopped using it please advise please thanks ♥️

[@christinepanos6062]

If you take birth control pills back to back you do not bleed. Been doing that for years. 55 and have not stopped and switched to HRT

[@Phoenixrises89]

I was the same for 20yrs…

[@user-dg6vc3sh3m]

Why is she saying uterine bleeding is no good when others say it means everything is working well. So fricking confused

[@melissaboggess4781]

I was on the pellets for 6 months. Started spotting on the first round. Ended up with vaginal ultrasound, histogram, d and c. Everything normal. Switched to patches lots of bleeding. Another vaginal ultrasound. This is all in 6 months. Upped my progesterone for a week so far. Not heavy bleeding but still spotting. They want to do another biopsy if it doesn’t stop. I think I may just need a higher dose of progesterone. I just don’t know if I need another biopsy. Haven’t changed my level of hormones at all

[@larahuffmaster5857]

And you may need your estrogen lowered

[@5trace]

I've been on hormone replacement 5 yrs without problems except for when I first started had some spotting did biopsy all was clear since then over 4 yrs.2 months ago I switched compound pharmacy started getting cramping on and off that then became intense Then today gushed pretty good for about an hour brown thick yucky old blood. I had already went to GP with the cramping and I have an ultrasound scheduled for the 18th ..now I'm really worried and stressing out. Will call my GP in morning see if I can get moved up for ultrasound tell her I'm now bleeding. I'm wondering if this new compound pharmacy would have anything to do with it? I never had problems before or just a coincidence ? I hate procedures etc the biopsy was brutal I had 5 yrs ago. Thanks in advance for any thoughts on this

[@aysegul6682]

A friend said as she aged, her dosage had to be changed as her body changed.

[@kimwhite9131]

Hi Dr. Susan, I emailed you awhile ago about post menopausal bleeding on HRT and you were so kind to answer a lot of questions. My problem is that I'm still bleeding. I'm 53 post menopausal for 3 years and on HRT 2 yrs and bleeding/ spotting a good amt. We've tried adjusting everything (on 0.1 estradiol patch 200 mg progesterone also tried .05 patch and 100/200 mg progesterone) nothing stops it. My gyn is scheduling another endoscopy with D&C and says if that doesn't work that I should consider a hysterectomy or maybe an ablation. What do you think? Should a post menopausal women have an ablation? During our earlier correspondence I thought you said a post menopausal woman shouldn't get an ablation. What would you suggest a hysterectomy or ablation? Thanks, I am absolutely at my wits end!

[@cj705]

Mirena coil is the best option if micronised progesterone doesn’t keep the womb lining thin.

[@kimwhite9131]

@@cj705 I thought this too and my doctor was going to place a mirena coil during my hysteroscopy but couldn't because I have a very small, arcuate shaped uterus that wouldn't accommodate it.

[@BuckeyeFan-always]

Any updates? How are you doing now?

[@virginia6793]

Only 5%?

[@danskdna8550]

That is minimum dose for protective qualities, .05%.

[@patriciapyper4617]

I got a break through bleed on evorol Conti patches please thanks ♥️

[@patriciapyper4617]

The cream for down below what does that do thank you ♥️