Perimenopause prolonged bleeding: what to know

Perimenopause is the transition before menopause. Ovulation may become less regular, so the uterine lining can build up and then shed at an unexpected time or for longer than you are used to. Periods may also arrive closer together, become heavier, or alternate with lighter bleeding and missed periods.

Hormonal changes are one possible explanation, not the only one. Pregnancy-related bleeding, fibroids, polyps, thyroid problems, medication effects, bleeding disorders, and changes in the uterine lining can also cause prolonged or unusual bleeding. A clinician may consider your age, pregnancy possibility, medicines, medical history, and bleeding pattern when deciding what evaluation is appropriate.

Keep a simple record of when bleeding starts and stops, how often you change pads or tampons, whether you pass clots, and whether you have pain, dizziness, breathlessness, or unusual tiredness. Bring a list of medicines and supplements to the appointment, including hormonal contraception and medicines that affect clotting.

Arrange a medical appointment if the bleeding continues, repeatedly lasts longer than your usual period, or is affecting daily life. A clinician may check for anaemia, discuss a pregnancy test when relevant, and recommend an examination or imaging based on your symptoms. Do not start or stop hormone treatment without clinical advice.

Seek urgent medical help if bleeding is soaking through protection repeatedly, you feel faint or very weak, you have shortness of breath or chest discomfort, or severe abdominal or pelvic pain accompanies the bleeding. Ask someone to help you get care if you feel unsafe travelling alone.

Bleeding after twelve months without a period should be assessed, even if it is light. Bleeding during a possible pregnancy also needs prompt medical advice, especially with pain, dizziness, or weakness.

You could ask: What might explain this change in bleeding? Do I need tests for anaemia or other causes? Which treatments could reduce the bleeding, and what side effects should I watch for? What symptoms should make me seek urgent help?