Breakthrough bleeding in perimenopause

Changing ovarian hormone patterns may make ovulation and the timing of the uterine lining less predictable. Even so, age alone should not be used to explain every change in bleeding.

Perimenopause can bring spotting between periods, skipped cycles followed by bleeding, or a change in flow. Other possibilities include pregnancy, medication effects, fibroids, changes in the cervix, infection, or a growth inside the uterus such as an endometrial polyp.

Bleeding after sex, bleeding after a long gap without periods, pelvic pain, or a new discharge gives the clinician useful clues. Chlamydia can present with bleeding between periods or after sex, although these symptoms have many possible causes.

Record when bleeding starts and stops, whether it is spotting or a flow, how often you change period products, and whether pain, discharge, dizziness, or bleeding after sex occurs. Note any hormonal treatment, blood-thinning medicine, missed contraception, and the date of your last usual period.

Arrange a clinical review if the pattern is new, keeps returning, or differs clearly from your usual cycle. Depending on your situation, assessment may include a pregnancy test, blood tests, an examination, infection testing, or imaging of the uterus.

Seek urgent medical care for very heavy bleeding, fainting, marked dizziness, shortness of breath, chest discomfort, severe or worsening pelvic pain, or bleeding with a positive pregnancy test. These signs can reflect substantial blood loss or a pregnancy complication and should not wait for a routine appointment.

Ask whether your pattern needs a pregnancy test, blood count, infection check, pelvic examination, ultrasound, or sampling of the uterine lining. Also ask how your medicines or contraception could affect bleeding and what change should trigger earlier reassessment.