When to worry about a missed period with perimenopause

During perimenopause, ovulation and hormone levels can vary. Periods may arrive earlier or later, become lighter or heavier, or be missed. Hot flushes, night sweats, sleep disruption and vaginal dryness may occur alongside these changes, but symptoms differ between people.

A missed period is not proof that menopause has begun, and pregnancy remains possible until menopause is confirmed clinically. Other causes, including thyroid problems, medicines, stress and uterine conditions, can also affect bleeding.

Keep a record of bleeding dates, flow, clots, pain and other symptoms. Arrange a routine appointment for a persistent change, troublesome symptoms or uncertainty about pregnancy. A clinician can review your history and decide whether an examination, pregnancy test or other testing is needed.

Seek urgent care for soaking through pads repeatedly, fainting, severe dizziness, severe pelvic pain, chest pain or shortness of breath. Arrange prompt assessment for bleeding after sex, bleeding between periods, a new unusual discharge, or any bleeding after a full year without periods. Do not wait for the next cycle if pregnancy is possible and pain or bleeding occurs.

Ask whether your pattern fits perimenopause, whether contraception is still needed, and how to manage hot flushes, sleep problems or vaginal symptoms. Ask what amount of bleeding should trigger urgent review and whether your medicines could be contributing.