Bleeding Between Periods During Perimenopause

Ovulation becomes less consistent during the transition toward menopause. Changing oestrogen and progesterone signals can alter when the womb lining builds and sheds, leading to shorter, longer, lighter, heavier or skipped cycles.

Age or perimenopausal symptoms do not establish the cause of unexpected bleeding. Contraception, pregnancy-related causes, infection, endometrial polyps, uterine fibroids and changes in the cervix or womb lining can overlap with a changing cycle.

Bleeding between periods, after sex or after menopause should be discussed with a clinician. The assessment may consider your complete bleeding pattern, pregnancy possibility, medicines and family or personal medical history before deciding on examination, blood tests, infection tests, imaging or sampling of the womb lining.

Keep a cycle diary that marks every bleeding day and distinguishes spotting from heavier flow. Record clots, pelvic pressure or pain, bleeding after sex, discharge, hot flushes, sleep changes, contraception and any medicine that can influence bleeding.

Do not assume pregnancy is impossible during perimenopause; test if it could apply. Arrange a consultation for a new or recurring change, increasing heaviness or bleeding that affects daily activity. Bring your diary and medication list to help clarify the pattern.

Obtain urgent assessment if bleeding quickly saturates menstrual protection or causes faintness, severe weakness, breathlessness or chest discomfort. Severe pelvic pain, especially if one-sided, shoulder-tip pain, or bleeding with a positive pregnancy test should not wait. Fever with pelvic pain and unusual discharge also requires prompt care.

Ask whether the pattern is consistent with irregular ovulation and what other causes need excluding. Clarify whether contraception is still needed, which tests are appropriate and what options could manage the bleeding once its cause is understood.