Intermittent periods during menopause: what to know

During the menopause transition, the ovaries may release an egg less regularly. Periods can arrive closer together, become more widely spaced, or vary in flow and duration. Hot flushes, night sweats, mood changes, vaginal dryness and changes in sex drive may occur at the same time.

Menopause is confirmed after twelve months without a period, but bleeding after that point is different from an intermittent period and should be assessed. Pelvic organ prolapse, medicines, contraception, fibroids or changes in the womb can also affect bleeding.

Use a calendar to record bleeding days, flow, clots, pain and any new symptoms. Keep track of medicines and contraception, and consider pregnancy testing if pregnancy remains possible. A clinician can review the pattern and decide whether examination, blood tests or imaging is appropriate.

Ask about treatment if bleeding, sleep disruption, hot flushes or vaginal symptoms affect daily life. Treatment depends on the cause, health history and personal priorities.

Arrange prompt care for bleeding after twelve months without a period, repeated bleeding after sex, or a new change that does not settle. Seek urgent help for heavy bleeding with dizziness or faintness, severe pelvic pain, fever or marked weakness.

Ask whether your pattern fits the menopause transition, whether pregnancy or another condition should be ruled out, which tests may help, and how to manage troublesome bleeding or associated symptoms.