How common are heavy periods in perimenopause?

During perimenopause, ovulation may become less predictable and the womb lining may build up differently from cycle to cycle. Periods can therefore become heavier, longer, closer together, or more widely spaced. Hot flushes, sleep changes, mood shifts, or vaginal dryness may occur too. Heavy bleeding should not automatically be attributed to perimenopause, because fibroids, polyps, medication effects, pregnancy, and womb-lining problems can also cause it.

Note changes in cycle timing, bleeding volume, clots, pain, and symptoms such as tiredness or dizziness. Arrange a review if bleeding is difficult to manage, lasts longer than expected, returns frequently, or begins after a long gap without periods. A clinician may use your history, examination, blood tests, pregnancy testing when relevant, and imaging to decide what evaluation is needed.

Get urgent help if heavy bleeding causes faintness, severe weakness, shortness of breath, chest discomfort, or confusion. Seek prompt advice for bleeding after menopause, bleeding after sex, bleeding during pregnancy, or new pelvic pain with fever.

Could my cycle changes fit perimenopause? What other causes should be excluded? Do I need blood tests or an ultrasound? Which treatments could reduce bleeding? How will I know when menopause has occurred?