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Episode 214:
Show Notes
In this fifth episode of our Menopause Series, host Dr Lucy Burns interviews Dr Talat Uppal, a gynaecologist and obstetrician from Sydney, who specialises in heavy menstrual bleeding. Together, they discuss the often overlooked issue of heavy menstrual bleeding (HMB) and its impact on women's quality of life, while also providing valuable insights into its causes, symptoms, and treatment options. Here are some key points from their conversation:
- Prevalence and Impact: Dr Uppal notes that HMB affects about 25% of women of reproductive age, with some studies indicating it may be as high as one-third. The condition can severely impact a woman's physical, emotional, and social well-being, often going unaddressed due to stigma and normalisation.
- Bleed Better Initiative: Dr Uppal shares her journey in advocating for better recognition and treatment of HMB, leading to the creation of the "Bleed Better" initiative. The focus is on improving quality of life and addressing the issue in a compassionate and comprehensive manner.
- Understanding Normal vs. Heavy Menstrual Bleeding: The conversation outlines criteria for determining abnormal menstrual bleeding, including bleeding duration, flow intensity, and associated symptoms like fatigue and iron deficiency. Dr Uppal emphasises the importance of recognising these symptoms and seeking medical advice.
- Associated Pain and Conditions: About half of the women with HMB also experience pelvic pain. Conditions like endometriosis and adenomyosis are often associated with HMB, highlighting the need for comprehensive diagnosis and treatment.
- Causes of Heavy Menstrual Bleeding: The causes of HMB can be divided into structural (e.g., polyps, fibroids, adenomyosis, and cancer) and non-structural categories (e.g., clotting disorders, hormonal imbalances, and certain medications). Dr Uppal stresses the importance of addressing the underlying causes to improve patient outcomes.
- Impact on Lifestyle and Work: The discussion highlights how HMB can disrupt daily life, affecting work productivity, social interactions, and mental health. Women often normalise or trivialise their symptoms, further delaying treatment.
- Treatment Options: Treatment for HMB includes medical management (hormonal and non-hormonal therapies), lifestyle changes, and surgical options when necessary. Dr Uppal advocates for starting with the least invasive treatments and emphasises the importance of a personalised approach based on individual needs and preferences.
- Holistic Approach: Both Dr Burns and Dr Uppal advocate for a holistic approach to managing HMB, incorporating lifestyle modifications to address factors like insulin resistance and obesity, which can exacerbate symptoms.
- Encouragement to Seek Help: The episode concludes with encouragement for women to seek help and not suffer in silence, stressing that effective treatments are available and that improving quality of life is a primary goal.
This episode offers a comprehensive overview of heavy menstrual bleeding, providing listeners with valuable information on recognising symptoms, understanding the underlying causes, and exploring available treatment options.
Visit Dr Talat’s websites:
- Abnormal Uterine Bleeding Hub: https://www.womenshealthroad.com.au/abnormal-uterine-bleeding-hub
- Bleed Better website: https://www.bleedbetter.org/
Link to Menopause checklist:
Episode 214:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:17) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (0:58) Good morning, gorgeous ones. How are you today on this beautiful Tuesday morning as this recording comes to air? Lovely. I have the best treat for you today. I am with another expert in our menopause series. Her name is Dr Talat Uppal. She is a gynaecologist and obstetrician from Sydney and her expertise is in heavy menstrual bleeding, a topic that we don't talk enough about because remember, For so long periods, we're always sort of secret women's business, hush, hush, don't talk about them. Let's pretend nobody has them. And now it's time to bring it out into the open. We're gonna talk, we've got so much to get through today. So I'm super excited about it. Talat, welcome to the podcast.
Dr Talat Uppal (01:39) Thank you so much Lucy, it's such a pleasure to be here.
Dr Lucy Burns (01:41) Ah you are welcome. You are like leading the charge here on educating, you know, women, but also the general public on the concept of that has been coined Heavy Menstrual Bleeding or HMB. And it's interesting because when you know, and I know the medical term for this is often menorrhagia, which I think is actually quite helpful because it does give you sort of rage. But heavy menstrual bleeding is certainly a much easier term to remember and really just describes exactly what it is.
Dr Talat Uppal (02:17) That's right. Lucy, so heavy menstrual bleeding, basically we've moved away from menorrhagia only because it's more of a quality-of-life issue. So we want to bring the focus to the quality of life and are women sort of leading a suboptimal quality of life because of the heavy periods that they're having. That's the question.
Dr Lucy Burns (02:38) Yeah, absolutely. So leading, you know, as a world expert now in heavy menstrual bleeding and really leading this movement, you were involved, tell me a bit about the Bleed Better and the First Day and how that all works.
Dr Talat Uppal (02:47) Thanks, Lucy. So basically, I didn't actually start out to say, look, I want to start a charity or I want to necessarily be, you know, at the forefront of advocacy for heavy menstrual bleeding. I kind of fell into it, Lucy, because I kept seeing woman after woman who was depleted, iron stores, low, exhausted, tired. And it would make me reflect like, how can we do better. How can we do better as a community? How can we do better as clinicians? And how can we better meet the core needs of the women that we look after? So I think it actually started from a bit of indignance rather than anything else. I think that was my other emotion was, hang on, this affects a quarter of women of reproductive age. That's 25%. Let that sink in 25% of women. It's a massive number. And unfortunately, even though we've made gains in various ways, that number essentially, based on even recent online service, hasn't shifted much, Lucy. So really, we're still looking at between 25% and us in some studies up to a third of women will report that they're having heavy periods, either always or often. So I think that was where it started from the indignance that, you know, things that are less common and honesty is not a competition every part of medicine or every diagnosis is important to support. But really something that affects a quarter of women should have more air time and more funding and more recognition. And so that these women, especially because it's so fixable in many, many instances, we can actually help move patients with their, you know, acknowledging their preferences to better and kinder areas for them. So that was where I then did some research and I understood that, you know, if you want to advocate at a strategic level, you kind of are better off creating a not-for-profit so that it rests on that organisation. That was a lot of work in itself, but I'm very glad looking back that we were able to create that foundation on which we rested Bleed Better. And Lucy, the name actually was a very considered decision to bring the focus to the fact that we can improve from the baseline that we're often starting from. And so that and sometimes Lucy, the answers are not perfect or the solutions are not perfect. But I guess the main emphasis is on can we bleed better? Can we reduce the amount of bleeding women are losing? Can we help them with the pain? Can we just move them to a kinder space? And that's what the bigger picture feeling was around that initiative.
Dr Lucy Burns (05:35) Yeah, I love that. I love that. And I do, I think you're right, the outcomes-focused, you know, it's not a, it's how can we improve? So yeah, that's fantastic. Perfect. Beautiful. So for women who are out there going, okay, periods, heavy menstrual bleeding, you know, what is normal? Like I think people don't even know what normal is. So what, how do you help people decide what's normal?
Dr Talat Uppal (05:59.)Yes, I think that's such an excellent question, Lucy. So basically, I guess the first thing is that the heavy periods are more quality of life issue. So the technical definition of heavy periods is if there has been a compromise period that excessive loss is affecting a woman's physical, emotional, mental, social and or material well-being. So we know that women with heavy periods might be curled up in bed, not able to go to school, might not attend work or not be their best at work, best selves in terms of concentration. And also we know that you know, the tiredness, the fatigue, the shortness of breath for some patients, because it can result in iron deficiency and or iron deficiency anemia, which also then can have a whole layer of misery on top of the logistics of managing a heavy flow, which can be quite not a good and kind space for women. So emotionally also with this more and more recognition, they can't divorce the psychological end of any condition really from the physical impact. And we know that women with anxiety and depression may then obviously have an escalation in that space because they're not going through something that is positive. And so I guess that's the technical definition. But what helps better understanding what a normal period is the Federation of International Federation of Gynecology and Obstetrics, which is a global organisation called FIGO, has come out to put some yardsticks and say, look, you know, if you're bleeding more than eight days, if you are having, you know, a heavy flow, if you are having periods that are too frequent, more than 24 days apart, If you're bleeding, you know, so because some women can be burning the candle on both ends, they could have a heavy flow and then last long as well. So I guess there are certain technical areas. But in terms of the questions to ask yourself, am I using two types of protection? Am I using a tampon and a pad? Am I sort of flooding through my clothes? And that is not normal. Am I having clots, particularly if they're bigger than 50-cent pieces? Am I bleeding for longer than eight days? Am I waking up at night to change protection? And of course, the symptoms that I mentioned earlier, having any of those exhaustion and fatigue that may be related to the heaviness of the cycles. So I think those are some clues that will tell us that, yeah, it's possible that a person has heavy menstrual bleeding.
Dr Lucy Burns (08:32) Yeah. What's the crossover with heavy menstrual bleeding and period pain?
Dr Talat Uppal (08:36) Yes, very good question. So about half, half of women who have heavy bleeding will have associated pelvic pain, whether that's pain during their periods or at other times. And if we're looking purely statistically, so one in four women has heavy menstrual bleeding, and one in nine women have endometriosis. And there is a version of endometriosis called adenomyosis when it's in the lining of the womb. And so there's a lot of overlap between women who have bleeding and may also have pain. But I do worry that there are lots of women who actually have bleeding and don't have pain. And that's also a cohort that we want to reach out to because every symptom is important and it's really important that we work with you to minimise all of them. But you may actually not have pain and sometimes women trivialise the bleeding because they don't have pain.
Dr Lucy Burns (09:30) Yeah, that's amazing. I think it's so interesting, isn't it? Because, you know, I was lucky. I had, and I say lucky, I just had no, no pain and no heavy bleeding. And so, yeah, but, but I think because people don't talk about it and particularly the heavy bleeding, you know, cause it's embarrassing if you've, you know, you're staining the sheets or you’re bleeding, you know, people stop wearing white pants and all of these things, cause they're so worried about their they're bleeding and that's, it's actually not normal.
Dr Talat Uppal (09:59) And I think you're very right. There's so much shame and taboo still around menstrual health. And I constantly think that you know, why does it take so long to seek care? And truly you've nailed it, Lucy, that one of the reasons is that women are sometimes embarrassed and they are not comfortable or they have normalised it. I think they're such champions, they're multitaskers. They've just gotten on with it. And if I can tell you how many times I hear from my patients saying or it's just two days and those two days I don't go out, those two days I work from home, those two days, or it's just three days, it's just one day. So even the word just comes before the way that they describe the period. And then I'm trying to think of a tactful way of saying, but if it's a tsunami in these two days, it's going to rob you of your quality of life. But the natural tendency so many times is to normalise it and to trivialise it. And that's because I think they're so resilient and so used to just getting on with it.
Dr Lucy Burns (11:06) Mm. Yeah, absolutely. And, and yes, you're right. I mean, women are phenomenal, as we know, they're very stoic and, you know, the whole childbirth and all of the things we do. But, we can also, you know, we can try and make it easier for ourselves. It doesn't have to be as hard.
Dr Talat Uppal (11:25) Absolutely, absolutely. And I almost think it's like a car sometimes running on empty and they don't even at times appreciate what their baseline could be until that iron deficiency has been sorted, until that bleeding has been tractioned and until they've had the confidence to know there's sometimes an anxiety that am I having a cancer? Am I having a pre-cancer? Am I having something really awful? And all of those issues have been addressed and some sort of solid contraception for those who are in heterosexual relationships and sexually active has been offered. And all of those checklists have gone through. Then they think, well, that's actually not bad. That's how life should be.
Dr Lucy Burns (12:08) Yeah, absolutely. So I love that. So basically you're saying it's important because it interferes, like heavy menstrual bleeding interferes with our quality of life, interferes with relationships, with socialised, social situations, they've got to get up and change pads or tampons. It impairs work. They've got to, you know, and again, embarrassment. You're thinking, God, I've got to go to the toilet again. I've just, you know, gone half an hour ago. So their work life, their productivity, their social life, all of those from the physical aspects of the actual flow. And then the complications with things like iron deficiency as the next step on and that then impairing, causing fatigue, impairing your cognitive function. So your brain functions when you're iron deficient. And from our point of view, we see lots of women who, weirdly experience cravings related to their iron deficiency and when you correct their iron deficiency their cravings go away.
Dr Talat Uppal (13:10) Absolutely. I think it's just a space that causes such a kind of worms of negative scenario that we can actually traction quite easily. It is not that hard to replace iron whether orally or with intravenous support. But I think even more critical than that, that's very important, but is to actually address why they're bleeding and how we can support that to stop or reduce.
Dr Lucy Burns (13:33) Excellent, which is leading perfectly into my next question, which is what causes heavy menstrual bleeding?
Dr Talat Uppal (13:37) Okay, so similarly, the numbers here are 50-50, Lucy. So half of the time we go looking, we actually don't find a cause. And it may be Lucy that in future there are some fancy sort of hematological things that will be uncovered. But at this present time, roughly one in two women, we are able to establish a cause or a suggestion that this might be contributing to the picture. And in half of them, we're able to say, look, everything seems normal, but obviously the periods are not normal and the fact that you are bleeding heavily is not normal. And so we will manage that even though we haven't got a natural cause. And if we break that down further, the causes Lucy sort of fit into two groups. And this is again, FIGO, the organisation that's divided them to make it a bit easier for us clinicians and the community. Basically, one group is structural. So we are obsessing with the uterus itself and asking, are there things that are happening at this level that are contributing to the excessive loss? And then the other aspect is non-structural causes, which are general causes in the body that are now having an impact at the level of the uterus and the amount of bleeding that the woman is having. So if we come back to the first group, they are for, it's called palm coined and the PALM basically P stands for Polyps. So those little, I call them like little fleshy chandeliers inside the uterus and they're mostly benign. They're not usually malignant, but some of them can be malignant. So it's really important that we sort of are keeping not only a therapeutic lens to make this person more comfortable and reduce the bleeding, but we're also keeping a diagnostic lens so that we're not missing a pre-cancer or cancer, okay? So that's the first cause of polyp. The second cause is fibroid. So these fibroids are generally quite common, Lucy, as you know, and they are, can be found in more than a quarter of women. And in many women, they will be asymptomatic, but particularly the ones that are relevant for heavy bleeding are the ones that poke into the uterus. If they poke into the uterus, they're then raising the amount of lining that has to be shed and also the ones that are massive. So sometimes the fibres really, really big. So they are not only contributing to the bleeding, but then they're also creating pressure symptoms. So you can imagine in the context of a perimenopausal woman who might be waking up from hot flushes, from night sweats and then also from the bleeding and then also from the joys of the pressure of the uterus on the bladder. Because remember the bladder is right in front of the uterus. So if that's really big and massive, it's then going to reduce the capacity of the bladder and increase the number of times a woman needs to go and get up and wee. And so that's our second cause. And our third cause that I mentioned earlier is adenomyosis. Basically, the inside lining of the womb should be exactly there. It should stay in its lane but sometimes it actually comes outside and it's outside the uterus itself, that's endometriosis, and at other times it's in the wall. So notorious to causing heavy menstrual bleeding is adenomyosis, and that can be a suggestion that we can get through a high-quality ultrasound. The last cause, Lucy, that is related to the uterus is cancer. Now, If we put it in context, uterine cancer is not that common. It's one in 44 lifetime risk. And for example, I'm comparing it to breast cancer is one in seven women. So, however, obviously in women who are bleeding irregularly or abnormally, it is more common in that cohort. So again, if you're having periods that are heavy, it is so important to make sure rare as it is that we don't want to miss that person who is having a pre-cancer or a cancer. And then that other whole group of non-structural abnormalities. So they could be, you'll see something like a tendency to bleed that a woman has, and that might be, you know, like von Willebrand's disease. They might have had a malignancy and been put on a drug called Tamoxifen that is for breast cancer treatment, and that increases the lining and makes it more likely. Or they could have what we call anovulatory cycles. So it could be a hormonal cause basically. And this is more common in the reproductive agents, both in adolescents and also in perimenopausal women where the cycle has become, we have not released an egg, the lining of the uterus continues to thicken and then sheds with a vengeance. So these are some of the most common causes of heavy bleeding.
Dr Lucy Burns (18:03) Yeah, amazing. And I think, you know, from our point of view, so the cohort of people that we often, or the women that we often work with, you know, as you know, I work with women who are looking to improve their metabolic health. And so, you know, they may have overweight or obesity and insulin resistance, type two diabetes. And we see, you know, the stories that I hear from them are lots of often heavy periods, you know, they can't wait to get to menopause to finish the periods because they're so awful. And so looking therefore, I guess, at that metabolic level, you know, increased insulin resistance in particular in you know, it has multiple ways in which it contributes to both the size of the lining, the thickness of the lining increases to it adds to the risk of fibroids increases. We know that people who have excessive body weight increase their estrogen which increases the lining. There are so many ways in which you can see that it all funnels into the symptom of heavy menstrual bleeding.
Dr Talat Uppal (19:12) Yes. I think that's an excellent point, Lucy, you've made because it's not only the fact that it increases the risk of irregular cycles. We know that women with high BMI have a much higher chance of having irregular cycles, but they are also likely to be heavy. And like you rightly said, it's the unopposed estrogen in the cycles that tends to do that part of the symptomatology. But it's not only that, it's not only the symptoms and the misery of the actual heaviness of the loss and the consequences of that, but it's actually the actual risk that they're carrying. When I spoke about endometrial cancer being one in 44, what are our risk factors for that? We know that women, we type 2 diabetes, we know that increased BMI because of the estrogen, the excessive estrogen from the adipose tissue that they're exposed to that then makes the uterus vulnerable, which is not the only cancer that is vulnerable, mind you both ovarian, breast cancers also more likely, but certainly it has a direct effect on the endometrial lining. And so therefore women who haven't had the cohort that makes that is more at risk is high BMI, type two diabetes, not having had a child previously, early start of periods, or anything that prolongs our exposure to estrogen-delayed menopause family history. Occasionally there are women who have a family history of certain uterine type of cancers and abnormal bleeding. So these are, and of course age, anyone above 50, particularly 45, 50 above that age is slightly more likely. So we're starting to combine some of these risk factors. We are then more likely to be having hyperplasia, which is a pre-cancer or cancer, even though overall numbers are definitely not that high, is what I'm trying to say.
Dr Lucy Burns (20:58) Yeah, no, no, I hear what you're saying. And I think it's, you know, I love that. I've always talked about Goldilocks, the Goldilocks principle of, you know, too much is no good, too little is no good. It's the same with estrogen. You don't want too much estrogen. Yeah, you know, too much estrogen causes problems. Too little estrogen causes problems. We want it just right. And, you know, there's lots of things that we can do to adjust that I guess. So from our point of view we do lifestyle factors to reduce body fat, to reduce insulin and try and stabilise some of those hormones. But from a medical point of view, what treatment options do you offer for women?
Dr Talat Uppal (20:37) Yeah, so I think what you're doing, Lucy, is such amazing and phenomenal work because it is so important to consider that aspect. From a purely bleeding point of view, there are three main groups of support available for women who have this condition. One is medical management, and we do try to start with that with everybody because obviously it's almost like a pyramid and we always want to start with the least invasive option if possible. And then this is obviously outside where we're worried about a malignancy or a pre-malignancy. That's a totally different person where we need to straight away go to a more detailed possible probably surgical plan. But medical management, which can include hormones and non-hormones. So we can include, for example, there's a drug called tranexamic acid, which kind of tries to reduce some of the clotting at the level of the uterus. And there's also a drug called non-steroidals, which are like Ponsten, which is like methamamic acid or like Neurofen, for example. So these are better than, for example, Panadol, where Panadol will need traction pain, but methamamic acid or Ponsten has an ability to reduce inflammation, to reduce pain, but more importantly in this context, to actually reduce some of the bleeding as well. And so I often would prescribe that with tranexamic acid to start with on someone and also make them aware that the levonorgestrel IOD, which is popularly known as the Myrina, is found to be the most effective medical option for traction of heavy bleeding. And particularly the cohort of women that you're describing with high BMI with unopposed estrogen, that is a really good little almost like I think of it as a little soldier that we're putting in the uterus with them with permission. And that would then help release a small amount of progesterone. And progesterone is almost like the balancing hormone for heavy bleeding. And it is quite a powerful hormone to try and thin the lining and have the opposite effect of what estrogen is doing. So that's a great option for women. And then of course, there is the pill and there are certain injections as well that we can look at. Then if we're looking at surgery, you'll see there are milder options of surgery are less invasive, which again, we've recently had this heavy menstrual bleeding standard, which is an excellent piece of work that has been updated. And both the previous and the updated version really does get behind use of minimally invasive options first. So these are like day surgical procedures where we burn the lining of the uterus so that that part is removed. It's only suitable for women who have completed or do not desire fertility. And it's quite a good option, Lucifer, we went in the perimenopause because it kind of might be the bandaid that would help them get through that period. And then you also have minimally invasive options of like a little magic wand that we can scoop out the fibroid, which is poking inwards, not necessarily a large fibroid. Or we could sort of take out the polyp a bit better and level it out and then use the ablation. So lots of combinations. And the third main group, and of course there's a hysterectomy, which is usually reserved for either, you know, if there's a really large uterus and we're having significant pressure effects if we've used other things and they haven't worked, if there's a certain patient preference, or if there's a fear of malignancy or confirmed malignancy in certain cases or pre malignancies. Those are the relative, you know, a smaller group of women that should have the hysterectomy. And then the last one, Lucy, is radiological options. So you can actually have radiological embolisation or management of heavy menstrual bleeding. That's also a good option for women. So we're kind of spoiled for choice. Yeah.
Dr Lucy Burns (25:34) Yeah, yeah, absolutely. And I think, you know, one of the things that we talk a lot about on our at Real Life Medicine is it doesn't have to be this or that, like the, it's not just lifestyle and, you know, and nothing else. It's not just a pond stand and nothing else. It's looking at all of the options that are available to you and choosing, you know, the combination that suits you the best. Obviously, you know, I have a penchant for lifestyle medicine because I can see that by improving our underlying, so by changing lifestyle and improving our underlying hormonal profile, we therefore either don't need medication or we can use a lower dose. And the lowest effective dose seems to always be the best, same a bit like your surgical options, the least invasive. Yeah. And then,
Dr Talat Uppal (26:27) Of course, of course. the lowest tier is the best. It has the least mobility and the least risk profile.
Dr Lucy Burns (26:32) Yeah, absolutely. And then knowing that there are options, you know, higher, more medication or different surgical procedures for those people who have done everything. They've optimised their lifestyle, balanced their hormones, they've tried Pompstain, they've gone the Transomic, they've had their iron infusion, they're still bleeding. What's next, doctor?
Dr Talat Uppal (26:48)Yes, I agree, Lucy. And I think that lifestyle side is so important, even postoperatively, even where the bleeding has stopped. That is still such a critical part of patients journeys that I feel that it's so good to optimise. But like you rightly said, we can use a number of combinations. I think the focus has to be on whether am I actually getting to the point where these periods have become tame. Or Do I want to do something definitive with the surgical procedure? For example, Lucia had someone who said to me, I suffered for a decade for four hours worth of my time, one session. And literally wasn't even one session because she was counting from the time she came to the hospital from the day surgical procedure and the recovery time. Literally time on the table was half an hour. So sometimes women suffer so much for something that is so fixable.
Dr Lucy Burns (27:37) Totally, absolutely. And you know, every woman is different. I think that the idea, like everything, is that all options need to be presented and women then, because choice, I mean, there's power in choice, isn't there?
Dr Talat Uppal (27:52) Exactly, Lucy. And I think that when there are multiple options of care, it is good to be aware of all of them. And then, you know, like I always love it when women give me some philosophy, like some will say, look, I don't want any hormones. Then I'll ask permission that, okay, fine. Would you still be okay if I share some research with you and share some details? So just from an educational interest point of view, and then we will do exactly what you want us to do. So I think it's quite powerful to know all the options that are available and then make an informed choice.
Dr Lucy Burns (28:24) Yes, I love that. I love that. I think that, yes, power, there is definitely, knowledge is power, but having the right knowledge is the thing that then gives you that power.
Dr Talat Uppal (28:36) Yeah. And the other thing, Lucy, while we're talking about all different options is one thing around perimenopausal women that sometimes gets overlooked is their need for contraception for some of them. And what happens is when you are selecting something, keep that as part of your, you know, overall checkbox that what can we optimise with you and for you? Because even though your fertility is declining because we are getting, you know, towards the end of that reproductive age the actual risk is not zero of having an unplanned pregnancy. So it is important to keep that in mind. And as you know, Lucy, the Australian Menopause Society basically suggests anybody under 50 should have two years of contraception support proactively. And anyone above 50 should have at least a year after their final period.
Dr Lucy Burns (29:23) Yeah, absolutely. And I think you're right. There's I mean, there's some lot of chat around that perimenopause period. But I know and you know, obviously, women are now being a lot more informed about MHT or you know, the old name being HRT and and the benefits of that for them potentially. But for women who still need contraception, it's not suitable necessarily.
Dr Talat Uppal (29:51) Yes, so exactly. So MHT often does not provide contraception, even though it's such a great product in terms of managing hot flushes, in terms of managing night sweats. And in my opinion, one of the best ways to give estrogen is to give it through the skin. But then we kind of need when we're giving estrogen, we kind of need a product that's going to keep the uterine side from, like we've mentioned earlier, from developing excessively. And so in that way, I find the liver and ingestual IUD, the Myrina, actually is a good fit for some women. Obviously, not everyone's going to be happy with everything, but we work with you to try and find like you rightly said, the Goldilocks point where we're getting the maximum benefit with the least side effects. And so I find, Lucy, that if we have made sure that there isn't any underlying vulnerability, like a pre-cancer or cancer, having myrina And then having some transdermal estrogen is often a good combination for perimenopausal women because it helps them from the heavy bleeding point of view. It helps them from a contraception point of view if needed. And it also helps the cohort that is actually going to reach out for some trans from some estrogen to partner with that progesterone. So it becomes a vehicle, almost like a cake on which we kind of layer the icing, which is the estrogen.
Dr Lucy Burns (31:14) Yeah, absolutely. I love that. I love that. Dr Talat, this has been brilliant. Such a good conversation. So good to talk about periods. It doesn't have to be a secret women's business. We're allowed to say the word tampon out loud. It's really, really helpful just to start normalising it. It's not a secret women's business that we have to walk around and everything in a brown paper bag. So thank you for all the work that you're doing. If people want to connect with you, how do they find you?
Dr Talat Uppal (31:38) Thank you. So we've started Australia's first abnormal uterine bleeding hub. So which basically means that we're trying to run a number of services under one group and say, look, walk through our doors, whether they're virtual or actual. And we will then sort of assess you. We will, including an ultrasound, and we will then do the necessary work up to try and figure out why this is happening. We can give, we can replace iron if needed. And if needed, after all that, like we mentioned, menopause management or adolescent health or whatever is required from the perspective of the person at the set is very individualised care. We're based in Frenchs Forest in Sydney, but we do a lot of virtual work up as well. And so it's a team of women that includes a team of clinicians that includes a GP, a physio, for example, a social worker. We have advanced endometriosis surgeons and it's quite a big cohort of doctors that look after women with heavy bleeding. And so we would love to hear from you if you type women's health road and if Lucy you'll be kind enough to share our link. Thank you and Abnormal Uterine Bleeding Hub.
Dr Lucy Burns (32:45) I'll put the notes in the, yeah, the link will be in the show notes. Absolutely. Yeah, absolutely. And I think this is it, ladies. It's, you know, gone are the days where we just soldier on and, you know, I think, it'll be next better next period. Heavy menstrual bleeding is a serious medical issue. It's, you know, often symptomatic of something underlying. As you said, 50% of women will have something underlying that's causing it. And so it's time to look at it seriously and seek help for it. As I said, I'll put the link for Dr Talat's services in the show notes, but get yourselves checked out. You're welcome. You're welcome.
Dr Talat Uppal (33:20) Thank you, Lucy. Thank you so much. I think it's so important to basically have the quality of life that you deserve. You know what I mean? Like we really shouldn't be suffering from any quality of life issue that we can help you fix. Thank you, Lucy. Thank you very, very much.
Dr Lucy Burns (33:33) Absolutely, I love it. I love it. All right, thank you very much. Beautiful peeps have a gorgeous week and I will be back next week with another expert in our menopause series. Bye for now.
Dr Lucy Burns (33:44) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
