Book a routine consultation when
- Your periods remain irregular or have changed from your usual pattern
- Periods stop for three months when you are not pregnant
- Bleeding is heavy enough to disrupt sleep, work, travel or daily activity
- Bleeding occurs between periods or after sex
- Pain is increasing or interfering with daily life
- The change is accompanied by dizziness, unusual tiredness, sudden weight change, excess facial hair, acne, hot flushes, pelvic pain or difficulty conceiving
Pregnancy should be considered whenever it is possible, even if the bleeding seems similar to a period.
Bleeding after menopause needs prompt assessment—even light spotting or a single episode. Contact your gynaecologist without waiting for it to happen again.
When bleeding needs urgent assessment
Seek urgent medical care if bleeding is very heavy or rapidly increasing, or occurs with fainting, marked weakness, breathlessness, severe abdominal or one-sided pelvic pain, fever, a positive pregnancy test, recent delivery, miscarriage or a procedure. Do not wait for a routine online reply.
What can cause a change in periods?
Possible causes include pregnancy, PCOS, thyroid disturbance, perimenopause, medicines, significant weight change, stress, fibroids, polyps, adenomyosis, endometriosis, infection, bleeding disorders and other conditions. The likely causes vary with age, symptoms and medical history.
An ultrasound can be useful, but it does not explain every bleeding problem and it does not diagnose PCOS by itself. The history and clinical context still matter.
What the assessment may include
The consultation usually begins with the bleeding pattern, pregnancy possibility, pain, medicines, contraception, pregnancy history and other symptoms. Depending on the situation, evaluation may include a pregnancy test, blood count, selected hormone or thyroid tests, examination, cervical screening or ultrasound.
Tests are chosen for a reason. Not every patient needs the same blood-test package, scan or procedure.
What to note before your visit
- First day and duration of recent periods
- How the bleeding affects daily life and whether protection is needed overnight
- Bleeding between periods or after sex
- Associated pain, clots, dizziness, fatigue or breathlessness
- Current medicines, contraception and pregnancy possibility
- Previous reports, scans and treatment tried
How treatment is chosen
Treatment depends on the cause, severity, anaemia risk, age, medical history, contraception needs and fertility goals. Options may include observation, correction of anaemia, medicines, hormonal treatment or a procedure when indicated. The decision should reflect both the clinical findings and what matters to you.
Clinical reference
NICE guideline NG88: Heavy menstrual bleeding—assessment and management.
RCOG: Postmenopausal bleeding (updated April 2025).
This guide is educational and cannot replace an individual medical assessment.
What else do patients ask?
When should irregular periods be checked?
Arrange assessment for a persistent change, absent periods, unusual bleeding or symptoms that affect daily life.
Is very heavy bleeding ever urgent?
Yes. Heavy bleeding with dizziness, faintness, breathlessness or chest pain needs emergency assessment.
Could pregnancy cause unusual bleeding?
Yes. If pregnancy is possible, mention this and seek prompt assessment for pain or bleeding.
What information helps at a consultation?
A bleeding diary, medicine list and previous reports can help explain the pattern and guide tests.