Menopause x Abnormal Vaginal Bleeding

What It Means Before Your Periods Stop

Bleeding May Shift Long Before It Stops

If your periods have not stopped for a full 12 months, but your bleeding pattern has changed, you are likely in perimenopause. Irregular bleeding during this time is common - but not all bleeding is normal.

This guide helps you understand what to expect, when to get checked, and what to ask at your next visit if your bleeding feels off. You don’t need perfect tracking to deserve care.

What Counts As Abnormal Bleeding in Perimenopause?

Bleeding between periods
Bleeding that is unusually heavy or clot-filled
Spotting after sex or outside your cycle
Bleeding that lasts more than 7 days
Skipping periods for months and then bleeding heavily

A shifting cycle is expected. But new patterns that feel “off” deserve attention — even if they’re hard to describe.

Common Causes of Bleeding Changes Before Menopause

Hormonal fluctuations from ovulation decline or sometimes multiple ovulations in one cycle

Uterine fibroids or polyps
Endometrial hyperplasia (excessive thickening of the lining)
Thyroid shifts or weight changes
Stress, medications, or birth control transitions
Cervical irritation or infections

Not all changes mean something is wrong - but tracking helps clarify. Bring a cycle tracker or symptom journal to your visit.

What Your Clinician May Check

Pelvic exam to check the cervix and vaginal tissue
Ultrasound to see uterus, lining thickness, and ovaries
Bloodwork to check hormones or thyroid levels
Pap smear or HPV test if due
Endometrial biopsy if bleeding is persistent or high-risk

These tests help rule out causes and guide safe next steps.

Many clinics can begin testing during the first visit. Ask: “What can we do today - and what can wait?”

Hormones and Irregular Bleeding

In perimenopause, estrogen can spike without enough progesterone to balance
This can cause thickened uterine lining and unpredictable bleeding
Hormone therapy (like progesterone or birth control) can stabilize patterns

Hormones may help - but they’re not the only option. Let’s talk through what fits your values.

Nourishing foods, hydration, and iron support can help during heavier months

When to Ask for More Evaluation

Bleeding that disrupts daily life or work
Needing to change pads or tampons every 1-2 hours
Bleeding after sex
Spotting that starts after years of regular cycles
Symptoms that persist more than 2–3 cycles
Family history of uterine or colon cancer

If Tests Are Normal, But You Still Feel Off

Ask: “What else could be causing my symptoms?”
You can come back if things change - your concerns are still valid after your visit.

Not Sure Where You Are?

It’s common to not know exactly where you are in the menopause transition. If your cycle feels unpredictable and bleeding feels different, you still deserve support.

If you’ve already gone 12 months without a period and are bleeding again, visit our guide on Postmenopausal Bleeding.