Is this bleeding normal?

Some bleeding changes are an expected part of perimenopause: periods arriving earlier or later, a skipped month, a lighter flow. Others need a doctor whatever your age, and the American College of Obstetricians and Gynecologists names them: bleeding between periods or after sex, a period longer than 7 days, soaking a pad or tampon every hour, cycles shorter than 21 days, and any bleeding after menopause. A small group needs help the same day. Tick what applies below and the checker puts each answer in its group.

How the checker sorts your answers

Each tick goes into one of three groups. The page never adds them up, and the most serious group you reach is the one shown at the top.

Get help today. ACOG gives one emergency rule for bleeding: changing pads or tampons every hour for more than 2 hours in a row, together with chest pain, shortness of breath, or feeling lightheaded or dizzy. That combination shows "call 999 or 911". The NHS page on bleeding between periods adds a second urgent case: a recently missed period, unusual bleeding and tummy pain together, because it can be an ectopic pregnancy. Heavy bleeding with dizziness, breathlessness or chest pain that falls short of ACOG's rule also lands here, as "call your doctor or NHS 111 today". That last line is our own cautious reading. Neither source sets a lower threshold.

Book an appointment. These are the items ACOG lists as abnormal uterine bleeding, plus the NHS signs of a heavy period: spotting mid-cycle or after sex, a period over 7 days, cycles under 21 days, a gap of 3 to 6 months, clots bigger than about 2.5 cm, bleeding through clothes, and feeling tired or breathless a lot. Bleeding after 12 months without a period comes first on this list. The NHS page on postmenopausal bleeding asks you to see a GP even for a small amount or a single episode, and says you should not wait more than 2 weeks to see a specialist after that.

Expected in perimenopause. ACOG says that around this time the number of days between periods may change, and that skipping periods or bleeding getting lighter or heavier is common. The checker counts earlier or later periods, a skipped month and a lighter flow as expected. Heavier bleeding is sorted with the items worth a visit, because the NHS perimenopause page asks you to contact a GP if you are bleeding more, rather than less, than before.

Each item in your result links to the article that explains it: heavy periods and clots for flow, bleeding for weeks for long periods, spotting between periods for bleeding at other times, two periods in one month for short cycles, and irregular periods for the timing changes.

A worked example

Say you are 48 and your periods still come. The last one ran for 9 days, you passed clots bigger than a large coin, and you have felt worn out for weeks. You tick "more than 7 days", "clots" and "tired or out of breath a lot". The result reads "Book an appointment" and lists three items. The long period links to the bleeding-for-weeks guide, the clots to the heavy periods guide, and the tiredness comes with a note that the NHS may offer a blood test for iron deficiency anaemia.

Now add "soaking through one every hour, for more than 2 hours in a row" and "lightheaded or dizzy". That meets ACOG's emergency rule, so the result opens with "Get emergency help now" and the appointment list moves underneath it, for later.

What the checker cannot see

It knows only what you tick. A doctor can examine you, do a pregnancy test, check for infection and, if your symptoms and age call for it, arrange an ultrasound or a sample of the womb lining. ACOG notes that abnormal bleeding can be an early sign of endometrial cancer, which is most common after menopause, in the mid-60s. That is the reason everything on the "book an appointment" list deserves a visit even when it turns out to be ordinary perimenopause.

My take

I'd act on anything in the "today" group the same day, even late in the evening. For the appointment group, I'd judge the visit by what you can bring: ACOG suggests noting the dates, length and type of bleeding (spotting, light, medium or heavy) for a few weeks before you go. The printable symptom diary has room for exactly that. If everything you ticked landed in "expected", keep the record anyway, because the next change is easier to spot against a few months of dates.