Most women who look this up have already decided to wait and see. This page exists to help you tell apart the patterns where waiting is reasonable from the ones where it is not — and there is one where it never is.
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Any bleeding after menopause — that is, after twelve months with no period — needs assessing. Not watching, not waiting for it to happen again, not deciding it was probably nothing because it was a single spot.
This is not a reason to panic. Most causes turn out to be benign, and thinning of the lining from low oestrogen is a common one. But endometrial cancer is one of the possibilities, it is one of the more treatable cancers when found early, and it is found by looking.
The reason this page states it so plainly is that the symptom is mild. A single episode of light spotting does not feel like an emergency, and that is precisely why it gets postponed.
Bleeding between periods, whether spotting or heavier.
Bleeding after sex, even once, and even if it was light.
Periods that have become much heavier — flooding, passing clots, changing protection every hour or two, needing to plan your day around it, or waking at night to change.
Periods lasting longer than a week, or cycles that have become much shorter or much longer than your own normal.
Bleeding while on contraception or hormone therapy that has not settled after the first few months.
The word doing the work in most of these is changed. What matters is less whether your pattern matches someone else's and more whether it has changed from yours.
Heavy bleeding is extraordinarily normalised. Women describe flooding through clothing, or organising their working life around their cycle, and then say the periods are “normal for me”.
It is also a common and under-recognised cause of iron deficiency, with or without anaemia. The fatigue, poor concentration and breathlessness that follow are frequently attributed to stress, age or menopause instead, and treated as a mood problem rather than a blood one.
So iron is worth checking whenever periods are heavy, and treating it often makes a bigger difference to how you feel than anything else in the visit.
Fibroids, adenomyosis, polyps, thyroid disease and clotting disorders all cause heavy bleeding and all have their own treatments. “Heavy periods” is a symptom, not a diagnosis.
A history first: the pattern, what changed and when, what you are using for contraception or hormone therapy, and whether there is any pain.
An examination, and usually a pelvic ultrasound, which is the single most useful test here and shows the lining of the uterus, fibroids and polyps.
Blood tests where indicated — commonly a full blood count and iron studies, and thyroid function where the picture suggests it.
Where the lining needs to be examined directly, a sample can usually be taken in the clinic. You will be told before anything is done, and what each step is for.
Cervical screening is a separate question and is not the test that answers this one, though it may be done at the same visit if yours is due.
Consultation ฿1,500–3,000 depending on complexity, plus the ฿300 clinic service fee. Any tests or procedures are quoted before they are done.
Bleeding soaking through a pad or tampon every hour for several hours in a row, bleeding with dizziness or fainting, or bleeding with severe pain or fever, should be treated as urgent rather than booked.
Bleeding in pregnancy, or where pregnancy is possible, needs assessing the same day.
Everything else on this page is “make the appointment” rather than “go now” — but postmenopausal bleeding is the one to make this week rather than next month.
No residency, referral or Thai insurance is needed. Assessment and ultrasound usually happen in the same visit, which fits inside a short stay.
You will see a female specialist. Consultations are conducted in English or Thai.
Assessment and ultrasound usually happen in the same visit, and most causes turn out to be benign — which is something you find out by looking rather than by waiting. Message us on LINE.
This page is general information, not a diagnosis. Any bleeding after menopause should be assessed promptly. Heavy bleeding with dizziness, fainting, severe pain or fever, and any bleeding where pregnancy is possible, need urgent assessment rather than an appointment. Consultations are conducted in English or Thai. THE FIT CLINIC — 8th Floor, EM Tower, EMSPHERE, BTS Phrom Phong, Bangkok. Open daily 10:00–19:00.