57 – Bleeding on HRT: what’s normal and what’s not
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What is the main topic discussed in this episode?
Today on my podcast I've got Mr Azami Najee. He is a gynaecologist in London and also a great friend. We talk a lot about bleeding on and off HRT because it's one of the most common side effects of taking hormones. It's one that causes a lot of confusion and sometimes concern so we have a very reassuring chat about this topic. So Osama, you're here in real life. I've done two podcasts with you before, but remote. Yes.
What are the common concerns about bleeding on HRT?
So we're in Jack's lovely studio. You're feeling relaxed.
Very nice place, in fact. Yes. Thank you very much for having me.
No. Well, you're one of my favorite gynecologists, actually. Thanks a lot. And not just mine, but lots of women and lots of my colleagues as well. So you're in the hot seat. So I think I can just ask you a few questions because I am not a gynecologist. Yeah. Which is fine. I don't have anything against gynaecologists.
Very good gynaecology knowledge, I have to say, yes.
But it's interesting, isn't it? Because, you know, I specialise in women's hormones. They're made in the ovaries, but they're also made in the adrenal glands and they're made in the brain. But somehow a lot of gynaecologists, not you, I hasten to add, feel that the menopause and hormone problems has to belong to gynecologists. Whereas in my mind, gynecologists like yourself specialize in the womb, the ovaries, the reproductive organs, if you like, or the gynecological organs. Because if there's a disease, that's what you treat. Whereas you don't want to be treating a hormonal issue where hormones are all around our body. So it's a weird concept really, isn't it?
Absolutely. Quite often when we see patients, whenever the consultation... started to divert towards HRT. I always explain, HRT is not only about prescribing medications, it's a complete different scope of consultation. It requires having an extremely detailed history, discuss lifestyle, discuss sleep, diet, exercise, sports, and then HRT comes as an additional. So it does require a more detailed consultation to give it justice.
Yeah. And so, I mean, I'm very comfortable, obviously, prescribing hormones, assessing the person, looking at all the organs because I've been trained in a very general way, as you know. But one of the commonest side effects of HRT is bleeding. And I know myself, when I started HRT 10 years ago, obviously, I knew it was bleeding, but I got really heavy bleeding quite quickly. And I thought, gosh, no wonder women are scared. My periods have always been quite light. They've sort of come and go. They weren't really a big deal other than when I was a teenager, I suppose. But when they were very heavy, I was quite worried. But I knew that it's a common side effect, especially when you start taking hormones.
So I just waited a few weeks. And after about eight weeks, it settled down and it was fine. But it is common and it's one of the commonest reasons that we refer patients to you for bleeding. And there are lots of reasons for bleeding. And I wouldn't mind just spending a bit of time just sort of educating people about bleeding, not just on HRT, but in general, because, you know, it's quite alarming if you're not expecting bleeding and there are more serious causes and less serious causes. Sometimes we can try and tease it out from a history and often we have to think about investigations.
Indeed, yeah.
So what are the commonest causes of bleeding in a woman just generally?
Quite often, most of the times, the causes are reassuring and non-concerning. It's a functional transient or longer-term hormonal imbalance and sometimes can be triggered by pathology. And that's why to stress the fact that you said the extraction of the knowledge and the information from the history is crucial on this matter. But when it comes to HRT, We try to mimic what happens in the nature and often we get it right. Yes. Often the case of this scenario, it requires a little bit of more reassurance to the patients to tell them it is expected or not uncommon to have a little bit of unscheduled bleeding at the start. It's often the body trying to adjust accordingly to these extra hormones.
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