Why periods can become irregular after 40

Cycle changes deserve assessment when they are new, persistent, troublesome, or accompanied by unusual bleeding. Age alone should not be used to explain every change.

During perimenopause, ovulation may not happen in every cycle. Periods can then come closer together or farther apart, and the flow may be lighter or heavier. Hot flushes, night sweats, disturbed sleep, vaginal dryness, or mood changes can occur alongside menstrual changes.

Other explanations include pregnancy, hormonal contraception, fibroids, uterine polyps, thyroid disorders, polycystic ovary syndrome, and medicines that affect bleeding. Bleeding after sex or between periods needs its own evaluation rather than being assumed to be perimenopause.

Keep a calendar of bleeding days, flow, clots, pain, bleeding after sex, and related symptoms. Note contraception, medicines, and the date of the last period that felt typical. Take a pregnancy test if pregnancy is possible, even when cycles have recently become erratic.

A clinician may discuss pregnancy testing, a blood count if bleeding is heavy, thyroid assessment, a pelvic examination, or imaging depending on the pattern and your history. Treatment is directed at the cause and at concerns such as heavy flow, pain, contraception, or menopausal symptoms.

Seek urgent care for very heavy bleeding accompanied by dizziness, fainting, shortness of breath, chest discomfort, marked weakness, or severe pelvic pain. Sudden one-sided pain with bleeding and a possible pregnancy also needs immediate assessment.

Book a timely appointment for bleeding between periods, after sex, or after menopause, as well as a sustained change in your usual cycle. Report new pelvic pressure, increasing abdominal swelling, or fatigue that interferes with daily life.

Ask which causes fit your bleeding pattern, whether you need a pregnancy test or blood tests, and whether an examination or ultrasound is appropriate. Explain whether you want contraception, hope to become pregnant, or need help with perimenopausal symptoms because these goals affect treatment choices.