Perimenopause vaginal bleeding: what to know

During the menopause transition, ovulation may not happen in every cycle. Hormone fluctuations can change when bleeding starts, how long it lasts and how much blood you see. Some cycles may be skipped, followed by a heavier bleed. Bleeding between periods, after sex, or after a long gap without a period has several possible causes, including cervical or uterine conditions, medicines, pregnancy and infection. A changing pattern does not by itself identify the cause.

Keep a simple record of start dates, duration, flow, clots, pain and bleeding after sex. Note medicines, contraception and any chance of pregnancy. Use products that let you judge the amount of bleeding and replace them as needed. Book an appointment if the pattern is new, repeatedly disruptive or difficult to manage. Assessment may include a pregnancy test, examination, blood tests or imaging depending on your symptoms and history.

Seek urgent care for very heavy bleeding with dizziness, faintness, breathlessness, marked weakness or severe pain. Get prompt advice for bleeding during pregnancy, bleeding after sex that recurs, or bleeding after twelve months without a period. Contact a clinician if bleeding continues, returns often, or leaves you tired, because anaemia and structural causes may need treatment.

Ask what could explain the pattern, whether you need an examination or tests, how to manage heavy bleeding, and how contraception or medicines affect your risk.