Menstrual symptoms during menopause

The transition before periods stop is called perimenopause. Ovulation may not happen in every cycle, so the gap between periods can vary and bleeding may last for a different length of time than before. Cramping, breast tenderness, headaches, hot flushes, night sweats, sleep disruption and mood changes may occur alongside the cycle changes. Vaginal dryness can also develop as oestrogen levels fall.

Menopause itself is reached after twelve months without a period. A period-like bleed after that point is not part of the usual transition and should be checked. Pelvic pressure or a bulge may have another cause, such as pelvic organ prolapse, rather than a menstrual change.

Record bleeding dates, flow, clots, pain and associated symptoms in a diary. Use products that suit your flow, stay hydrated, and try gentle movement, regular sleep and heat for cramps if these measures feel comfortable. A clinician can review contraception, medicines, thyroid symptoms and options for troublesome bleeding or hot flushes. Mention vaginal dryness, low sex drive or mood changes because each may need a different approach.

Arrange medical advice for bleeding between periods, bleeding after sex, bleeding that repeatedly soaks products quickly, bleeding that continues longer than expected, new severe pelvic pain, dizziness or unusual tiredness. Seek urgent help for very heavy bleeding with faintness, breathlessness or severe pain. Any bleeding after twelve months without periods needs prompt assessment.

Could my bleeding pattern be related to perimenopause, a medicine or another condition? What examination or tests are appropriate? Which treatments could reduce bleeding or cramps, and what warning signs should make me seek urgent help?