Excessive bleeding around menopause

Hormonal fluctuations during perimenopause can alter the timing, flow, and duration of periods. Heavy bleeding may also result from fibroids, polyps, adenomyosis, thyroid problems, medication effects, pregnancy-related causes, or changes in the womb lining. After menopause, any vaginal bleeding needs evaluation because the possible causes differ from those during the transition.

Keep track of when bleeding starts, how long it lasts, whether clots occur, and whether you feel tired, dizzy, or short of breath. These details help distinguish a changing cycle from a problem causing blood loss.

Contact a clinician promptly for bleeding that soaks through protection quickly, repeatedly interrupts sleep or activities, lasts longer than expected for you, or returns after periods have stopped. Bring a list of medicines and note contraception, pregnancy possibility, pelvic pain, and related symptoms. Do not start hormonal or herbal bleeding remedies without advice.

A clinician may examine you and decide whether blood tests, imaging, or sampling of the womb lining is appropriate. [Menopause](/conditions/menopause/) can explain cycle changes, but it does not remove the need to investigate unusual bleeding.

Seek urgent care if heavy bleeding causes faintness, severe dizziness, weakness, confusion, chest discomfort, breathlessness, or a fast heartbeat. Severe pelvic pain, fever, or bleeding during a possible pregnancy also needs urgent assessment. If bleeding has occurred after menopause, arrange medical review even when the amount is small.

What could be causing this bleeding? Could my medicines, fibroids, thyroid, or womb lining be involved? Which tests are needed, and what amount of bleeding should send me to urgent care?