Post menopausal bleed

[jewelly]

Hi,
I'm a certified nurse midwife and saw a lovely lady 4 years menopausal. She had been taking progesterone & testosterone cream from a compounding pharmacy, but felt it was losing it's effectiveness. She was experiencing night sweats and vaginal dryness. I started her on some estradiol cream vaginally but she started having spotting, so she stopped the estradiol cream. She is wondering what she should do from here. Any ideas?

[Lara]

In general, estradiol should be combined with oral progesterone, rather than a progesterone cream. To protect the uterine lining and prevent build-up and bleeding.