Thickened uterine lining during perimenopause

Perimenopause is the transition before menopause. Ovulation can become less predictable, so oestrogen may stimulate the lining while progesterone does not arrive in the usual pattern. The result can be a lining that looks thicker on a scan or bleeding that is late, prolonged, heavy, or absent for a while. A scan is interpreted in relation to where you are in the cycle, which is harder when periods are irregular.

A thickened appearance may also reflect a polyp or endometrial hyperplasia. It does not prove either condition. Hot flushes, night sweats, mood changes, or low sex drive can occur during perimenopause, but they do not determine the cause of uterine bleeding.

Keep a simple record of bleeding dates, flow, clots, pain, and missed periods, then share it at an appointment. Bring details of contraception, hormone treatment, medicines, pregnancy possibility, and relevant medical conditions. A clinician may repeat imaging at a different point in the cycle, examine the cervix, or suggest an endometrial sample when bleeding is persistent, very heavy, or otherwise concerning. Treatment may address cycle control, anaemia, a polyp, or another identified cause.

Arrange a clinical review for bleeding between periods, bleeding after sex, repeated missed periods followed by heavy flow, or a pattern that is new for you. Seek urgent care if bleeding is soaking through protection quickly, or if you have faintness, breathlessness, severe pain, or unusual weakness. A missed period in perimenopause can be hormonal, but pregnancy is still possible until menopause is established.

Ask whether the scan was timed against your cycle, whether the lining looks even, and what would justify sampling. Discuss options for controlling heavy or irregular periods, how to check for iron deficiency, and which symptoms mean you should return sooner. If pregnancy is possible, ask which test and contraception advice apply to you.