Irregular bleeding during perimenopause: what to know

Perimenopause can make cycles shorter, longer, heavier, lighter, or occasionally absent as ovarian hormone patterns shift. The lining of the womb may build and shed unpredictably when ovulation does not happen regularly. Heavy periods, missed periods, and irregular periods can therefore occur together. Hot flushes, night sweats, mood changes, and low sex drive may also appear, but they do not explain every bleeding pattern. Fibroids, polyps, pregnancy, thyroid problems, medicines, or infection can cause similar changes, so a new or disruptive pattern deserves a proper review.

Keep a simple record of bleeding dates, duration, pad or tampon changes, clots, pain, and any bleeding after sex. Note missed contraception or pregnancy possibility, medicines, and symptoms such as tiredness or breathlessness. A clinician may offer a pregnancy test, blood tests, pelvic examination, infection tests, or imaging. Ask about treatment choices if bleeding affects sleep, work, exercise, or intimacy; treatment should match the cause and your health history.

Seek urgent care for bleeding that is rapidly heavy, causes faintness or severe weakness, or occurs with severe pelvic pain, fever, or possible pregnancy. Arrange prompt review when bleeding lasts unusually long, returns repeatedly, happens after sex, or leaves you short of breath or exhausted. Do not assume that every change is perimenopause, particularly if the pattern is new, escalating, or different from your usual cycles.

Ask: Does this pattern fit perimenopause or need another explanation? Could I be pregnant? Do I need blood tests, an examination, or imaging? What can reduce heavy bleeding? Which symptoms mean I should seek urgent care?