Menopause and very heavy bleeding

Hormone fluctuations can make periods less predictable before they stop, with bleeding that is earlier, later, longer, or heavier than usual. Heavy bleeding can also be linked to fibroids, polyps, changes in the womb lining, medicines, pregnancy-related causes, or pelvic conditions such as pelvic organ prolapse. Bleeding after periods have stopped is not considered a normal menopause symptom and should be checked. Tiredness, breathlessness, dizziness, headaches, or a racing heartbeat can occur when blood loss leads to anaemia.

Contact a clinician promptly and describe when the bleeding began, how often you are changing pads or tampons, whether clots are present, and whether you feel weak or light-headed. Keep a simple bleeding diary and list medicines, supplements, and any hormone treatment. Do not stop prescribed treatment without advice. Assessment may include an examination, blood tests, and imaging; the right plan depends on the cause, your symptoms, and whether you have reached menopause.

Seek urgent care if bleeding is soaking through protection repeatedly, you feel faint or confused, have severe pelvic pain, chest discomfort, shortness of breath, or marked weakness. Get prompt assessment for any bleeding after periods have stopped, even if it happens once. Emergency help is appropriate if you cannot stand safely or symptoms suggest substantial blood loss.

Ask what causes need to be ruled out, whether you need blood tests or a scan, and how to manage bleeding while waiting. Discuss how any treatment may interact with existing medicines, and ask which symptoms mean you should return sooner.