One of the key symptoms of menopause is a change in bleeding patterns. But as unusual vaginal bleeding can sometimes indicate more serious issues, it’s important to know what’s normal – and what’s not
What kind of bleeding can I expect at menopause?
As your hormones fluctuate wildly at this time, bleeding patterns can become very irregular in the years before your final period. It’s normal in these years for your period to arrive at unexpected times. Early in the transition, you may find your cycles become shorter. As you go further into menopause, you may go for longer without a bleed. This is all normal - but it’s important to be aware of what isn’t, as sometimes there are underlying causes that need to be addressed.
Common bleeding patterns
Spotting between periods
As you may know, spotting refers to very small amounts of blood that don’t require the use of sanitary protection. Some women notice this at the beginning or end of their period, or sometimes around the middle of their cycle, when they ovulate (yes, you can still ovulate before your periods stop, even if it’s not a monthly occurrence). HRT can also cause spotting, particularly when you first start taking it. Spotting is usually nothing to worry about but if it starts happening regularly it can be a sign of hormonal imbalance and it’s a good idea to check it out with your doctor.
A late, heavy period
As you might expect, if you skip a period, which is common in menopause, your womb lining continues to build up, so when your period eventually arrives, it may be heavy and painful. If this happens repeatedly, it can be debilitating and disruptive, plus raises your risk of anaemia from losing too much blood. So see your doctor to discuss medication that may help.
A shorter, lighter period
Another change that’s to be expected at this time. Hormone changes can mean your womb lining doesn’t build up as much before it breaks down.
When bleeding may not be normal
Although it can be hard to tell what’s unusual when you’re menopausal, the following may all be potential signs of abnormal bleeding:
- Very heavy bleeding
- Bleeding for longer than usual
- Bleeding more frequently than every three weeks
- Bleeding after sex or between periods
- Any postmenopausal bleeding – if you notice bleeding after you’ve gone a year without a period, this is abnormal
What could be causing it?
Here are some of the common causes of unusual bleeding at menopause:
- Polyps, which are benign growths that can develop inside the womb. If you have polyps on the cervix, these can sometimes cause bleeding after sex.
- Endometrial hyperplasia, a build-up of the womb lining that can happen when there’s too much oestrogen without progesterone. This can happen in menopause or after your periods have stopped. Over time, it can raise the risk of womb cancer and is the reason oestrogen-only HRT is only prescribed to women who’ve had their wombs removed.
- Endometrial atrophy, when the womb lining is too thin due to low oestrogen levels – this can also cause abnormal bleeding.
What should I do about vaginal bleeding?
Always see your doctor about any abnormal bleeding, particularly if it’s persistent or you’re postmenopausal. Rarely, it can be a sign of a serious condition such as womb cancer. But even if it’s nothing serious, losing too much blood may result in anaemia or iron deficiency, which causes fatigue. Your doctor will ask you about your symptoms and may refer you for further investigation, such as a pelvic ultrasound. "This happened to me and it’s not normal," says Karench on our Live Better With Menopause forum. "I was referred to the hospital and had a scan within 14 days. Thankfully everything was fine."