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Patient guide

Bleeding between periods in perimenopause

By the Metrorrhagia.com editorial teamUpdated Medical review pending
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Educational content for students. Not medical or coding advice. Having symptoms? See the patient guide.

In perimenopause (usually starting in the mid-40s) periods can become shorter or longer, heavier or lighter, and you may skip some [ACOG]. But ACOG notes it is not normal to have bleeding or spotting between periods, after sex, or bleeding that's heavier or longer than usual, and says you should still talk with an ob-gyn about bleeding changes [ACOG].

Causes doctors look for

  • Polyps [ACOG]
  • Endometrial atrophy (a thin lining) [ACOG]
  • Endometrial hyperplasia (an overly thick lining), which isn't cancer but can sometimes lead to it [ACOG]
  • Endometrial cancer [ACOG]
  • Fibroids and ovulation changes [ACOG]
After menopause, any bleeding needs checking

Menopause means 12 months with no period [ACOG]. Any bleeding after that, even once and even a small amount, should be checked by a doctor [NHS].

Sources

  1. Perimenopausal Bleeding and Bleeding After Menopause American College of Obstetricians and Gynecologists
  2. Abnormal Uterine Bleeding (FAQ095) American College of Obstetricians and Gynecologists, reviewed Aug 2025
  3. Postmenopausal bleeding NHS

We link to primary medical sources so you can check our work. See the editorial policy and the full reference list.