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

Dear Menopause

April 24, 2025 15 mins

About

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

Healthy Hormones Website


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Information

Episode

118

Date

April 24, 2025

Length

15 mins
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  • 45: Ren Jones: Understanding the subtlety of the female experience in the fitness industry

    "I think that there's a great missed opportunity for trainers, professionals, nutritionists, and coaches to step down off of Mount Olympus and mingle with the mortals." Ren Jones was raised in a multi-generational female household and heard all the conversations that young men don't usually get exposed to.  He learned that there was a cloud […]

  • 44: Lou Johnson: Sparking conversations to normalise being human in the workplace

    "Break the stigma, take a stand – join the movement to normalise being human in the workforce!" "Share from the scar, not from the wound" – Lou Johnson (not the original source) Lou Johnson is an almost 55-year-old publishing professional with over 30 years of experience. She is a feminist and advocates for normalising conversations […]

  • 42: Roma van der Walt: Giving women power and agency during perimenopause

    "We want to give women the power and the agency to understand their health – wholly." In this episode of the Dear Menopause podcast, Roma van der Walt, founder of Vitelle, chats with Sonya Lovell about why it's important for women to understand and manage their metabolic health to improve their life span. Through science-backed […]

  • 41: Faith Agugu: Transforming the Narrative Around Women and Ageing

    "When women come together, magic happens." In this episode of the Dear Menopause podcast, Faith Agugu, a psychotherapist and empowered aging expert, chats with Sonya Lovell about the global positive ageing movement. Faith is a psychotherapist and empowered aging expert. She founded Silver Sirens, a community of women over 50 seeking to change the narrative […]

  • 40: Phil Hayes-St Clair: Fiercely advocating for women's health

    Find out why I'm chatting with a middle-aged man with a passion for perimenopause and menopause. "I think that the constant challenge for people working in science and medicine in particular is the way that that evidence gets translated. And I think that what you've mentioned before is a classic example of research not being […]

  • 39: Sonya Lovell: Changing the World for the Next Generation of Women

    Discover the power of female voices to create a better future for the next generation. "I just took it on as my job, to go and do the research for them, connect them with the people that I knew, research who was a good person to talk to, who wasn't." In this episode, I invite […]

  • 38: Best of 2022: Top 5 episodes as voted by you!

    Who will take the honour of the most downloaded episode in 2022? In this episode, we revisit the top 5 episodes you chose to listen to. Join me as I count them down, from five to one, and share a short extract from each. I loved pulling this episode together. With such diverse topics and […]

  • 37: Prof Rebecca Mitchell: Researching the intersection of menopause and women's careers

    How do we change the narrative around menopause in the workplace? Professor Rebecca Mitchell, of Macquarie Business School, is leading a study that draws together Macquarie Business School’s Health & Wellbeing Research Unit and Psychological Sciences researchers of the Faculty of Medicine, Health and Human Sciences, to answer that question. The project explores the intersection […]

  • 36: Susan Jarvis: Stripping away stigma and expressing sexuality (NSFW)

    Has menopause led to you shutting up shop on your sexuality? A few years ago, Susan Jarvis (in her own words) went from being a very horny, lustful ‘wench’ to someone who had virtually shut up shop on their sexuality. She once thrived on being a hot-blooded woman, it gave her confidence and energy knowing […]

  • 35: Kath Berry: A surprising discovery led to educating practitioners on managing menopause

    Want to hear the unusual way that Kath Berry became interested in understanding menopause better while treating her female clients in Ibiza? Then you'll love this episode! Kath Berry is an Aussie, living in Ibiza. She's also a world-class Acupuncturist, Author and Educator with over 25 years of clinical experience. Having gained her bachelor's degree […]

  • 34: Lyndal Sterenburg: The story of Es Una and changing women's lives

    Have you started feeling self-conscious at the beach? Are you covering up in a baggy old T-Shirt or worse, stopped going to the beach? Lyndal Sterenburg did too and one summer's day had a spark of an idea that would go on to change women's lives. Today Lyndal has a simple mission – for all […]

  • 33: Olivia Park: Is your exercise working for or against you?

    As a woman in her 40s (or older), do you want to learn how to exercise in a way that moves you forward but also honours your body through day-to-day fluctuations? Olivia Park is a women's health and performance coach who helps active women lift hard and live well both in and out of the […]

  • 32: Jodie Preiss: The importance of advocacy in the face of adversity

    Jodie Preiss is an incredibly resilient woman who faced unimaginable adversity in 2018.  Jodie's story starts with the unexpected and traumatic loss of a loved one quickly followed weeks later by a breast cancer diagnosis that escalated from low risk to alarming within days. Navigating and healing from major surgery, chemotherapy and medically induced menopause […]

  • 31: Dr Kelly Teagle: transforming menopause care for Australian women

    During a career in medicine that included time with the Royal Australian Air Force, Dr Kelly Teagle developed an interest in women’s medicine with further studies and experience in reproductive and sexual health. Ironically, at the age of 42 she experienced an early menopause herself. Her symptoms were debilitating but very responsive to treatment, which […]

  • 30: Maryon Stewart: Managing menopause naturally

    Maryon Stewart is the author of Manage Your Menopause Naturally and 27 other books. A world-renowned healthcare expert, she has helped tens of thousands of women around the world overcome PMS and menopause symptoms without using drugs or hormones. In 2018 she was awarded the British Empire Medal and was recognized as one of the […]

  • 29: Emma Lagerlow: Early menopause and the gifts of space and confidence

    Emma Lagerlow is a wealth and mindset coach, course creator, blogger, wife and mum to four – almost all teenagers. Emma experienced early  menopause, at 45 and in this episode we talk about how that unraveled for her, the impact it had on her life and the advice she has for other women as a […]

  • 28: Susan Dean: The power of story and nurturing our feminine

    Susan Dean is a life and business coach and the founder of Dean Publishing. Susan is passionate about helping entrepreneurs share their stories so that they can grow their brand and their business. And she is equally passionate about empowering women to nurture and lean into their feminine. In this episode we weave our way […]

  • 27: Justine Thompson: Menopause, yoga and fanny farts

    Justine Thompson is a passionate student & teacher of yoga. Trained in the Anusara tradition – a style of hatha yoga that weaves a heart quality through alignment based practice. A mother of 3, her experience of perimenopause collided with teenagers, resistance to aging & a complete lack of understanding. Justine is on a mission […]

  • 26: Amanda Thebe: Fitness, wellness wankery & the future of menopause care

    Amanda Thebe is a force and someone I have admired for a long time.  Recording our chat was a whole lot of fun, I hope you enjoy it as much as I did. Amanda is a Fitness and Women’s Health Expert, and the author of the Amazon best-selling book, Menopocalypse: How I Learned to Thrive […]

  • 25: Luan Lawrenson-Woods: Breast Reconstruction Awareness with BRA-va Art

    Luan Lawrenson-Woods is my guest to chat about a first-of-its-kind Instagram campaign being launched to raise awareness for BRA Day 2022 (Breast Reconstruction Awareness Day). The campaign, created by Luan, aims to raise awareness of breast reconstruction options and promote BRA Day on October 19. Luan is encouraging people to use Strava (the free digital […]

  • 24: Dr Shreya Andric: Menopause and skin changes

    I sat down with Dr Shreya Andric to discuss the changes to our skin during menopause, including the skin of the vulva and vagina. We discuss why our skin changes and what signs indicate that you should seek support from your GP or a Dermatologist. Conditions discussed include excema, psoriasis, thrush, Lichen sclerosus and Lichen […]

  • 23: Dr Lina Safro: Managing Menopausal Symptoms

    Dr Lina Safro and I sat down to discuss the management and treatment of menopausal symptoms, specifically we talk about MHT or menopausal hormone therapy. We also touch on the Women's Health Initiative (WHI) clinical trial findings which severly disrupted the use of MHT's in 2002 and continues to cause fear amongst some women and […]

  • 22: Prof Jayashri Kulkarni: Mental Health and Menopause

    Professor Jayashri Kulkarni is one of Australia's leaders in research and treatment of menopausal depression. I believe this episode, is the most important episode I have been able to bring to my Dear Menopause audience. Professor Kulkarni speaks about mental health and the part a women's hormones play in this area, in a way that […]

  • 21: Dr Marita Long: Talking to your GP

    This chat with Dr Marita Long ticked a bucket list for me and brings a long list of important topics to the table that I know you will love and learn so much from! Marita was open to answering all of my questions, was honest about gender bias and education gaps that exist in the […]

  • 20: Samantha Avery: The healing power of Reiki during menopause

    Samantha is a Reiki Master Teacher and Spiritual Healer practicing from her sunny healing center in Sydney, where she has practised for more than 16 years. Samantha supports clients through crossroads in their personal and professional lives to live a more empowered life. This includes supporting women who struggle with perimenopausal and menopausal symptoms. Sam's […]

  • 19: Sarah Rusbatch: Normalising sobriety

    Sitting down to chat with Sarah Rusbatch about her journey from binge drinking to a career in normalising sobriety was a blast. Sarah is warm, funny and incredibly knowledgable. Sarah is a certified Women's Health and Wellbeing Coach, an accredited Grey Area Drinking Coach and a Key-Note speaker sharing her journey to Sobriety and impact […]

  • 18: Erika Cramer: Reclaim your confidence

    In this episode, Erika Cramer and I chat about the trauma she has experienced in life, how she worked to  reclaim her confidence and today empowers women to show up, take up space and live confidently. Erika is a bold force and beautiful example of how you can heal your personal story to transform trauma […]

  • 17: Emily Foster:Menopause and Gut Health

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Emily Foster, RD is a […]

  • 16: Martha Bodyfelt: Finding love again in your 40s, 50s and beyond!

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. My guest in this episode […]

  • 15: Kelly Casperson, MD: Sex, Desire and Body Image

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Sitting down to chat with […]

  • 14: Luan Lawrenson-Woods: Menopause after cancer and the importance of self advocacy

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Luan Lawrenson-Woods is a woman […]

  • 13: Dr Ardelle Piper OBGYN: Vulvas, vaginas and so much more!

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Sitting down to record an […]

  • 12: Irene Falcone: Mindful drinking and challenging the norm

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Sonya sits down with Irene […]

  • 11: Mel Kettle: Menopause at work

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Mel Kettle is an internationally […]

  • 10: Lane Kennedy: Mindfulness, Meditation and Menopause

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Lane Kennedy is today’s no-nonsense […]

  • 9: Ange Clark: Nutritional changes through perimenopause and beyond

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Ange Clark  is an Advanced […]

  • 8: Sandy Davies: Formulating natural relief for intimate dryness

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Sandy Davies is the founder […]

  • 7: Alison Brahe Daddo: From model to menopausal mother

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Alison Brahe Daddo was a […]

  • 6: Anna the Anxiety Coach: Anxiety and panic attacks during menopause

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. In today's episode I was […]

  • 5: 3 Things To Do When Perimenopause Is Kicking Your Butt

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. In this episode I share […]

  • 4: Kylie Patchett: Perimenopause, body image and radiance.

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. Today's episode is a juicy […]

  • 3: Jane Elliott: Cancer, early menopause and Brighter Days

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. In today's episode I was […]

  • 2: Shelly Horton: Losing joy, HRT and putting an end to secret women's business

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. In today's episode I was […]

  • 1: Sonya Lovell: Welcome to Dear Menopause!

    Do you want to take away the guess work of perimenopause and menopause, save yourself time and energy and ditch the shame? Working with me you learn what's happening to you physically, mentally and emotionally, why and what you can do about it. Go to stellarwomen.com.au/stellar-circle/ to find out more. I am so excited to […]

  • Symptoms of Breast Cancer (YouTube Video #389)

    Symptoms of Breast Cancer In this eye-opening episode, Dr. Barbara 'Menopause' Taylor reveals a surprising truth—most breast cancers have no early symptoms. She debunks common myths, especially the widespread belief that breast pain signals cancer, and explains the difference between signs and symptoms. Learn why relying on symptoms alone can be dangerous, and how early […]

  • Sherri Dindal – Being The Real Slim Sherri and new beginnings in Midlife & Menopause

    Many of you will know The Real Slim Sherri from Instagram and TikTok – she is well known for her no- holds barred, unfiltered truths around growing up in the 70’s and 80’s, midlife, life as a Gen X woman and menopause.  I have loved her page ever since I discovered it and so was […]

  • What Stem Cell Therapy Taught Me About Recovery, Mindset, and Reinventing Downtime

    In today’s episode, I share my personal experience with stem cell therapy—and the unexpected lessons that came from being forced to slow down. Whether you’re choosing a procedure like stem cell therapy or suddenly dealing with an injury or illness, time off from your normal routine isn’t just inconvenient — it’s a major mental and […]

  • 193 Can Color Heal You? Dr. Deanna Minich Thinks So 🎨🧠🌿

    Forget everything you thought you knew about nutrition. This episode gets wildly colorful—literally. Dr. Deanna Minich joins Sally to decode how COLOR—yes, actual colors—can shift your health, your hormones, and even your mood. From purple carrots to chlorophyll, this convo goes deep on how to nourish your body and your energy. We’re talking:✨ Yellow for […]

  • Ep #152: Overcoming Gender Barriers in a Male-Dominated Industry with Captain Reyné O’Shaughnessy

    In this episode, Andrea Donsky, nutritionist, published menopause researcher, menopause educator, and co-founder of WeAreMorphus.com, talks to Captain Reyné O’Shaughnessy. She is a veteran commercial airline pilot with over 34 years at a Fortune 50 carrier and more than 10,000 heavy-jet flight hours, including being among the first women qualified on the Boeing 747. She's […]

  • 219 How to Support Your Mental Health and Stop Menopause Weight Gain

    Menopause is a natural part of life, but that doesn’t mean it’s easy. I’ve experienced the exhaustion, the thinning hair, the mood swings—and the confusion that comes when you feel like your body is changing faster than you can keep up. In this episode, I’m sharing my personal journey with menopause and the lessons I’ve […]

  • S4 Ep178: Mid-life Nutrition: Tips and Tricks From a Dietician with Dr. Alexandra Filingeri

    Any mid-life woman knows that once you hit your 40s, 50s, or 60s, things will not go well if you eat the same way you did when you were 20. But it’s confusing to know what to eat, and how much to eat, without downloading multiple APPs and carrying around a calculator  My guest, Alexandra […]

  • 164: Emotional Eating in Menopause – The Psychology Behind the Cravings

    Do you get cravings for the foods that make your soul feel fuzzy but your body feel icky? In this episode, Adele explains the psychology behind those cravings, how to make steps away from those cravings and how to be more mindful with your eating. Check out Adele’s FREE symptom assessment here: https://adelejohnstoncoaching.com/free-copy-of-our-symptom-assessment/ Adele is […]

  • Thursday Thoughts – Writing a Book

    This week on Thursday Thoughts, Lucy and I dive into a juicy conversation all about her brand new book Shiny Happy Singles — or Thrive Solo if you're tuning in from the US. We chat about the inspiration behind the book, what it really means to thrive on your own, and why this message is […]

  • From Midlife Crisis to Midlife Chrysalis: Chip Conley’s Roadmap to Reinvention

    In this episode of Hello Menopause, Stacy talks with entrepreneur, author, and Modern Elder Academy founder Chip Conley about what it really means to navigate midlife. Drawing from his own experience with prostate cancer and hormone therapy, Chip shares what it felt like to go through “male menopause” and how that informed his vision for […]

  • Bladder Issues in Menopause – The Hidden Bacteria You Need to Know

    If bladder issues in menopause are keeping you from jumping for bone density or for jumping for joy. Or if laughing and sneezing or a need to consider hydration needs against access to a bathroom are real life and every day concerns you… we’ve got you today.  Bladder issues in menopause don’t need to keep […]

  • Ep 176 -Restoring Blood Flow for Brain, Heart and Hormonal Health with Cathy Eason

    In this week’s episode,  Dr. Fiona Lovely speaks with Cathy Eason, a certified holistic nutritionist and clinical educator, about nitric oxide (NO), often called the “miracle molecule” for its vital role in blood flow and thus, overall health.  We talk about the groundbreaking findings from a pilot study on nitric oxide’s impact on women’s sexual […]

  • Ep 481: The 5,000-Year-Old Secret to Stopping Emotional Eating

    I’m showing you how ancient Buddhist wisdom can help you break the cycle of emotional eating with more awareness, compassion, and ease—just like I teach my clients. Get the full show notes and information here: https://drdebbutler.com/481

  • #129: 7 Essential Habits to Move Through Menopause with More Ease

    Midlife doesn’t have to be a crisis — it can be a genuine metamorphosis. In this episode, I’m not talking about just surviving menopause.I’m talking about moving through it with more ease, clarity, and actual calm. You’ll hear a segment from a training I recently ran, where I shared seven essential habits that helped me […]

  • 13 – HRT after 60: myths, facts and finding your own path with Ann Newson

    In this week’s episode, Dr Louise Newson is joined by her mother, Ann Newson, for a candid and deeply insightful conversation about HRT after 60, as requested by some ofour viewers.  Together, Dr Louise and Ann address the persistent fears around breast cancer and HRT, revisiting data from the controversial 2002 WHI study. They also explore the […]

  • Grading and Staging of Breast Cancer (YouTube Video #388)

    Grading & Staging Breast Cancer – Know the Hidden Dangers In this episode, Dr. Barbara 'Menopause' Taylor breaks down the critical differences between grading and staging breast cancer—and exposes the hidden dangers that often leave patients confused or misinformed. Learn how cancer cell "grades" reflect aggressiveness, how "stages" indicate spread, and why stage 0 (carcinoma […]

Dear Menopause

Are you experiencing changes to your physical, mental and emotional health you find hard to explain? Have you tried talking to your doctor/partner/employer/best friend and been left feeling unsupported? In this weekly show,  host Sonya Lovell interviews a range of experts and shares the stories of everyday people to help you understand what the hell […]

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