Timing shifts
A cycle may shorten, lengthen, or skip without following the pattern you knew before.
Irregular or heavy periods
Your period changed. You deserve to know why.
Perimenopause can change timing and flow, but bleeding that is heavy, prolonged, or unexpected still deserves a careful review.
The pattern may change from one cycle to the next.
Periods may arrive closer together or farther apart, last longer or shorter, or become heavier during perimenopause.
Flow changes
Bleeding may be lighter one month and much heavier the next, sometimes with clots.
Longer disruption
More days of bleeding, cramps, fatigue, and uncertainty can interfere with sleep, work, and plans.
Perimenopause is one explanation, not the only one.
Changing ovulation can make bleeding less predictable. Pregnancy, medicines, fibroids, polyps, thyroid conditions, bleeding disorders, and changes in the uterine lining can also affect bleeding.
Cycle and pregnancy context
Timing, skipped cycles, contraception, and pregnancy possibility all shape the first steps in evaluation.
Blood loss matters
Heavy or prolonged bleeding can contribute to iron-deficiency anemia and leave you weak, breathless, or exhausted.
Other causes stay visible
Your age, health history, medicines, and bleeding pattern help determine whether imaging, laboratory testing, or tissue evaluation is needed.
Care starts with the bleeding pattern and its cause.
The right next step depends on how much you are bleeding, your stage of menopause, pregnancy considerations, anemia risk, and what the evaluation finds.
ApproachWhat it may includeWhat to know
Review the pattern
Cycle timing, flow, medicines, contraception, pregnancy possibility, and health history.
A clear timeline helps separate expected perimenopausal change from bleeding that needs more evaluation.
Check contributing causes
Blood counts, pregnancy testing, thyroid or other labs, imaging, or uterine-lining assessment when indicated.
Testing is selected from your age, risk factors, symptoms, and bleeding pattern.
Treat the identified cause
Hormonal or nonhormonal medicine, anemia care, or a gynecologic procedure.
Options should match the diagnosis, your health, and whether pregnancy prevention or future pregnancy matters.
Clinical care, built around the whole picture
Your bleeding pattern gets a real clinical review.
Our menopause specialists take changing cycles seriously, screen for causes beyond menopause, and explain when in-person gynecologic care is the safer next step.
Listen first
Your pattern, health history, medicines, goals, and concerns shape the evaluation.
Look beyond menopause
We consider menopause alongside other causes and explain when an exam, testing, or local care is needed.
Plan the next step
Virtual care can begin the review, guide treatment choices, and make the right referral when hands-on care matters.
Clinical leadership
Barbra Hanna, DO, FACOG, MSCP
Founder, board-certified OB/GYN, Menopause Society Certified Practitioner
Meet the care teamYou do not have to guess whether this is normal.
Meet virtually with a menopause specialist to review your bleeding pattern, health history, and the most appropriate next step.
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Most major commercial insurance plans accepted.
Coverage varies by plan and location. Not currently accepting Medicare, Medicaid, or HMO plans.