Menopause and spotting between periods

During perimenopause, ovulation may become less predictable and the uterine lining can shed at unexpected times. Spotting can also be linked with contraception, hormone therapy, fibroids, polyps, infection, thyroid changes, or irritation of the vagina or cervix. If periods have stopped for a full year, bleeding is no longer bleeding between periods; it is postmenopausal bleeding and needs assessment. The bleeding pattern alone cannot establish its cause.

Use a diary to mark bleeding days, flow, clots, cramps, sex, discharge, and the dates of your usual periods. Bring a list of medicines and note whether you use contraception or hormone therapy. Arrange an appointment when spotting is new, repeats, follows sex, or interrupts daily life. Use pads if helpful for monitoring, and avoid changing prescribed treatment without clinical guidance.

Get urgent help for very heavy bleeding, faintness, marked weakness, severe pain, fever, or possible pregnancy. Arrange prompt assessment for bleeding after periods have stopped, bleeding between cycles that keeps returning, or bleeding with unusual discharge. A clinician may perform an examination and select further tests based on your age, cycle history, medicines, and findings.

Does this pattern fit the menopause transition? Could my contraception, hormone treatment, thyroid, or a uterine condition be involved? What examination or tests are appropriate? How should I record bleeding, and when should I contact you again?