Perimenopause symptoms: bleeding between periods

During perimenopause, changing hormone patterns can make bleeding between periods more likely, but new or unusual bleeding should be assessed because other causes are possible. Perimenopause is the transition before menstrual periods stop. Ovulation may become less predictable, so the timing, flow and duration of bleeding can change from one cycle to the next.

Light spotting may appear between expected periods, after a missed period, or around a cycle that is otherwise different. Hormonal contraception, changes in contraception, vaginal dryness and irritation can also cause bleeding. Infection, including chlamydia, may lead to bleeding after sex or between periods. Growths such as endometrial polyps or uterine fibroids are other possible explanations. Less commonly, changes affecting the cervix or womb need to be ruled out. Bleeding between periods is a common presentation of several benign conditions, and it is also a symptom that can occur with cervical cancer or womb cancer; the bleeding itself does not identify its cause.

Keep a record of when the bleeding starts, how long it lasts, whether it follows sex, and whether you have pelvic pain, unusual discharge or dizziness. This gives a clinician a clearer picture of the pattern.

Arrange a routine appointment if the bleeding is new, keeps returning, happens after sex, or concerns you. A clinician may ask about your cycle, pregnancy possibility, medicines, contraception and other symptoms. Depending on your history, assessment may include an examination, pregnancy testing, infection testing, blood tests or imaging. Do not stop prescribed contraception or hormone treatment without discussing it with the prescriber.

Use a diary or phone note to track bleeding and related symptoms. If pregnancy is possible, mention this promptly because bleeding in pregnancy is assessed differently.

Seek urgent medical help if bleeding is heavy or rapidly increasing, or if you feel faint, weak, short of breath or unwell. Get prompt care for bleeding with severe or one-sided pelvic pain, fever, or a possible pregnancy. Bleeding after twelve months without a period should also be checked, even if it is only spotting.

If you are unsure how urgent the situation is, contact a local urgent-care service and describe the amount and timing of bleeding, along with any pain or dizziness.

Ask what causes are most relevant given your age, cycle changes, contraception and medical history. You can also ask whether you need testing for infection, polyps, fibroids or cervical changes, and which symptoms should prompt urgent review.