Breakthrough bleeding – what causes it and how to manage it

Associate Professor Kirsten Black

Knowing how to identify and investigate abnormal bleeding in women during the menopausal transition, the menopause, and while on MHT can be challenging. This talk will address common bleeding presentations in the perimenopause and discuss when and how to investigate them. The first line of investigation in peri and post-menopausal bleeding is a transvaginal ultrasound. This presentation will assist practitioners interpret the ultrasound findings of the endometrial thickness and provide guidance as to when to an endometrial biopsy may be warranted. It will also address the particular situation of women on tamoxifen treatment.


Associate Prof Kirsten Black is an academic gynaecologist at the University of Sydney where she is Joint Head of the Discipline of Obstetrics, Gynaecology, and Neonatology. She works clinically at the Royal Prince Alfred and Concord Hospitals in contraception, preconception care, general gynaecology and menopause. Her PhD is from the London School of Hygiene and Tropical Medicine, University of London and she is a member of the Faculty of Sexual and Reproductive Health in the UK. Her research interests are in sexual and reproductive health and she chairs RANZCOG’s special interest group in this field. Between 2016 and 2017 she chaired the working group that developed the Heavy Menstrual Bleeding Clinical Care Standard for the Australian Commission on Safety and Quality in Health Care.