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

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.

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.

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.

Thank you so much for the information ❤

So helpful! Thanks!

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

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.

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

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

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. :)

Thank you for explaining in such detail!

Thank you very much for this video.

Great video you explained it so well, now I understand

Thank You for this information

So helpful! I found this at the perfect time.

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.

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! 🙏🏾🙏🏾🙏🏾

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.

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.

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

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! :(

Thank you for the info

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 KZfaq 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!!

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

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.

You are amazing ♥️

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!

Very helpful. Thank you!

Thank you so much you are amazing ♥️

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.

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 🙏

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!

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.

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. ❤

Thank you

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.

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)

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

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.

I had my biopsy under anesthesia 😊

This was very helpful.thank you

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?

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.

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.

@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!

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😮

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

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.

How well does progesterone cream absorb through the skin?

Thanks for the video. What about using an estradiol IUD, or vaginal gel or suppository?

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.

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

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.

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

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

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

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

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!

Dos evorol Conti patches cause a break through bleed please thank you ♥️🌹

Dos evorol Conti patches cause a break through bleed what does the cream do for you thank you ♥️

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.

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 ♥️

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

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.

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

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 .

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?

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 )

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

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.

What if you've had a complete hysterectomy. I'm only on the Estradiol patch .o5. lately been having a minor spotting not daily but maybe like in recent 2 Months

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.

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.

Thanks so much! I have had an ultrasound because of bleeding with normal results. I’m on .75 Climara patch and 2.5 mg progesterone at night and I continue with annoying almost daily spotting.. sometimes a bit heavy. Should I drop down to .5 estriodol?

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. 😔

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

Hi, can being in holiday in the sun cause an imbalance to my hrt. This happened last year and again now. I am getting spotting again. Last year I was on combi patches. Now I am on Utrogestan 100mg along with 750mg Oestrogen transdermal gel. I have these at night 2hrs after eating. The instructions say to take 1hour before food or 2 hours after food. I'm on holiday, I don't want bleeding. Please advise. I'm on holiday for another 4 weeks so won't see my gp until I get back.

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?

I have a skin tag down there

I’ve been on it for 4days and have been bleeding already.. is this okay. Also do we take both the ESTROGEL and protesterone at the same time or can I take one before the other. Thank you

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

Dr Susan, thanks to you, I started my BHRT with a Biote provider, my experience wasn’t good with them, the insertion of the pellet was so painful and after two weeks I still had a big bruise and pain in the area, but now, I can see some improvements, my question is about what he prescribed me, I have my pellet and also the progesterone pill (I am taking it at night) but he also send me DIM and he told me do not never miss that one or I will be bleeding again. My question is if Should I be concerned about taking that DIM? thank you so much for all you do for us…

What should a woman in perimenopause who is still regularly ovulating and cycling expect when starting hrt treatment for peri symptoms? I've started a .05 estradiol patch and daily oral 100mg progesterone tab which has done wonders for my symptoms. BUT Didnt ovulate this month (unusual for me, I track mucus signs and basal temps to confirm ovulation) but had a light to medium 3 day bleed around day 32-34.

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

Other doctors say over 40% on hrt bleed.

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

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?

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.

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.

How do we keep a perfect level of estrogeon when on biest cream daily? Do your levels continue to go up. How does your level plateau?

@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

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.

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.

I had an ablation done 5 yrs ago. still spotted lightly afterwards. now post menopausal at 48. going on combipatch. wonder if I'll have any bleeding again while on hrt since I've had the ablation. hope not!! .05/.025 patch. guess we'll see. ty for this info!!

Do you tele visits

7 years post meno then started low estrogen patch and 100 mg progesterone. The problem is that it messes with my tummy. I’m taking the progesterone vaginally. I’m having full on monthly periods! ANNOYING! I have a thick lining and all of the tests. Maybe raise progesterone to 200 or 300? Can I d that vaginally?

Hi Dr. Susan. I experienced bleeding after starting HRT with pellets. I had an US, and it revealed a uterine fibroid. I stopped pellet therapy because I was super concerned about cancer. Since stopping the pellet therapy, I am miserable! I feel like all of my menopausal symptoms have accelerated. I would like to go back to the pellets. What do you recommend?

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.

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