The latest episode of And Just like That has tackled the topic of menstruation, highlighting one of the potential symptoms of the menopause and perimenopause, sometimes known as 'flash periods'.
In this week's show, while Charlotte York Goldenblatt’s eldest daughter Lily struggles with using tampons for the first time, her mother is having her own menstruation issues.
Revealing she hasn't had a period for four months herself, an exasperated Charlotte laments: “Just when I’m finally done with my period and I thought I would not have to deal with this s*** anymore.”
As she walks away, viewers see a red spot on the back of her white boilersuit and her friend Carrie Bradshaw informs Charlotte that her period “may not be as done as you think.”
While the ‘flash period’ is largely addressed in a light-hearted way within the show, it does draw attention to the issue of unexpected bleeding during the menopause and the perimenopause.
What are 'flash periods'?
One common symptom of perimenopause, the stage before the menopause, is irregular, unpredictable periods.
"This can include a ‘flash’ period, which is bleeding after a period of time of not having one," explains Miss Tania Adib, consultant gynaecologist at The Lister Hospital (part of HCA Healthcare UK).
"Your periods become irregular due to unpredictable ovulation. When you have them, they could be longer or shorter in length than your normal cycles, and you may experience heavier or lighter bleeding."
This inconsistency of periods is a good early indicator that you could be entering menopause.
“Perimenopause is the stage before the menopause when hormonal changes to the reproductive cycle begin to take place," she says.
"This can start as early as the mid-thirties and last until your late-forties. You will still be having periods, but usually, they will be a shorter cycle because of lowered progesterone levels.
"Perimenopause will last until your periods have stopped for a length of twelve months, which is when you reach menopause."
For most, Dr Miss Meg Wilson, consultant gynaecologist at London Gynaecology, says that symptoms such as 'flash periods' are usually nothing to be concerned about.
Watch: Cynthia Nixon discusses Kim Cattrall's absence from And Just Like That
However, she does advise seeking medical advice if you do start to experience them.
“Irregular periods and a change in your cycle should be discussed with your doctor as it may need further investigation for the cause," she explains.
"If it is a sign of changing hormones levels and you are experiencing other symptoms of low oestrogen levels, you may benefit from hormone replacement therapy.”
In some cases women who have already gone through the menopause can also experienced unexpected bleeding, something that Miss Adib recommends seeking help for.
“Women over the age of 45 who have not had a period for over a year are usually diagnosed with menopause," she explains.
"After this point, any vaginal bleeding requires investigation as it is classed as abnormal bleeding. The cause is often something very treatable, but occasionally it can be symptomatic of a more serious disease."
Causes of bleeding after the menopause include:
· Thinning and/or inflammation of the lining of your vagina or uterus
· Growths called polyps in the cervix or uterus (polyps are not usually cancerous)
· A thickened endometrium, which can be caused by taking HRT
· Cervical or uterine abnormalities
According to Miss Adib around 10% of cases of abnormal bleeding post-menopause are linked to uterine or cervical cancer.
Treating abnormal bleeding depends on its cause, so a number of tests will be carried out.
"This can include taking your history and asking questions about your health, a physical examination, blood tests, and a colposcopy which involves looking inside your vagina and cervix and taking samples for testing," she continues.
"The treatment you have will depend on the results of your tests and the cause of your bleeding. Your gynaecologist will discuss treatment options with you once they have determined the reason behind your bleeding.
"Make an appointment with your GP or directly with a private gynaecologist if you experience bleeding after the menopause,” she adds.