Anovulation during perimenopause

Some cycles still include ovulation and others do not. The interval between periods can shorten or lengthen, and bleeding may become lighter, heavier or more erratic. Pregnancy remains possible while ovulation still occurs intermittently.

In a cycle without ovulation, the ovary does not produce the expected progesterone pattern. Oestrogen may still stimulate the womb lining, but the lining can shed at an irregular time. This can lead to a missed period, spotting, prolonged bleeding or a flow that differs from your previous pattern.

Hot flushes, night sweats, sleep disruption, vaginal dryness and mood changes can occur during the same transition, but symptoms vary. Perimenopause may explain a changing cycle, yet pregnancy, thyroid problems, fibroids, polyps, medicines and other causes of abnormal bleeding may still need consideration.

Keep a record of bleeding days, flow, clots, pain, hot flushes, sleep and any bleeding after sex. If pregnancy could occur, use a pregnancy test after a missed period and continue contraception until a clinician confirms it is no longer needed for your circumstances.

Discuss troublesome bleeding or menopause symptoms with a clinician. Depending on the pattern, assessment can include a pelvic examination, blood tests, ultrasound or examination of the womb lining. Management may target heavy bleeding, provide contraception, or treat hot flushes and other symptoms after your personal risks and preferences are reviewed.

Get urgent help for bleeding that rapidly soaks through period products, fainting, severe dizziness, breathlessness, or severe pelvic pain. Pain or bleeding with a positive pregnancy test also needs urgent assessment because pregnancy-related complications must be excluded.

Arrange a medical appointment for bleeding after sex, persistent bleeding between periods, a substantial unexplained change in your usual flow, or any bleeding after menopause has been established. These patterns should be evaluated even when hot flushes or other perimenopausal symptoms are present.

Ask whether your bleeding pattern fits perimenopause, which alternative causes should be checked, and whether you need blood tests, ultrasound or womb-lining assessment. Clarify your contraception needs and compare options for heavy bleeding, hot flushes, sleep disturbance or vaginal symptoms.