01
Understanding the issue
Menstrual cycles can change for many reasons. Perimenopause is one possible explanation, but pregnancy, contraception, medicines and other health conditions can also affect bleeding.
Changes during perimenopause
During perimenopause, changing hormone levels can make ovulation less predictable. Periods may occur more or less often, and the amount of bleeding may become lighter or heavier. You may also miss several periods before they begin again.
These changes are common, but there is no single pattern that everyone experiences.
When changes may have another cause
Changes to bleeding can also be associated with hormonal contraception, pregnancy, fibroids, polyps, thyroid problems, endometriosis, adenomyosis, infection or other conditions.
Bleeding between periods or after sex should always be medically assessed, even though it is often caused by something that is not serious.
Bleeding while using HRT
Some irregular bleeding or spotting can occur after starting or changing hormone replacement therapy, commonly called HRT. The expected bleeding pattern can depend on the type of HRT being used.
Speak with your GP if bleeding is heavier than expected, concerns you, begins after your bleeding pattern had settled, or continues beyond the period your healthcare professional advised. Do not change or stop prescribed HRT without discussing it with the prescriber.
Bleeding after menopause
Menopause is reached after 12 consecutive months without a period. Any vaginal bleeding after this point is called postmenopausal bleeding and should be checked by a doctor.
This applies even if it happens only once or involves a small amount of spotting or pink or brown discharge.
02
Practical next steps
• Record the first and last day of each period and note any bleeding between periods or after sex.
• Note whether the bleeding is lighter or heavier than usual and how often you need to change period products.
• Record associated symptoms such as pelvic pain, tiredness, dizziness, unusual discharge or pain during sex.
• Take a pregnancy test if pregnancy is possible and your period is late or has stopped.
• Make a list of your contraception, HRT, medicines and supplements before speaking with a healthcare professional.
• Arrange a GP appointment if the change is persistent, unusual for you, affecting daily life or causing concern.
03
When to seek further help
Contact your GP if you are concerned about a change in your menstrual cycle or bleeding pattern.
Medical advice is particularly important if:
• your periods become much heavier or longer than usual, or heavy bleeding is affecting daily life;
• you bleed between periods or after sex;
• you have severe period pain, pelvic pain, or pain when urinating, opening your bowels or having sex;
• irregular or heavier bleeding while using HRT does not settle within the expected time or begins after your bleeding pattern had settled;
• you have missed three consecutive periods, pregnancy tests are negative and you do not know why; or
• you experience menopause-associated symptoms or significant cycle changes before the age of 45.
Seek urgent medical assessment if you have recently missed a period and have unusual vaginal bleeding together with abdominal or pelvic pain.
Any vaginal bleeding after having no periods for 12 months or longer must be checked, even if it happens only once or is only a small amount of spotting or discharge.
