If you’re bleeding a lot during menopause — and a doctor has confirmed menopause — then something may be very wrong.

For this post I asked Dr. Gino Tutera, an OB/GYN and a specialist in bioidentical hormone replacement therapy, if heavy bleeding could be normal during menopause.

“No,” begins Dr. Tutera. “But this is the answer if the woman is fully into menopause as would be evidenced by laboratory testing or having no menses for a full year.”

Obesity can cause menstruation to stop — including for 12 months in a row.

So if you’re of menopausal age and have not had a period in 12 months — BUT are obese (particularly severely obese) — you should have laboratory testing done to confirm the presence or absence of menopause.

If you’re bleeding from your menstrual cycle, then this contradicts going through the menopause, as by definition, the menopause is the end of your menstruation.

So if you’re going through menopause but are also experiencing heavy bleeding—the cause is certainly not your period—and you’ had better get this checked out promptly by a gynecologist.

But are you sure you’re even going through menopause in the first place?

A woman, close to the start of menopause, may go several months without a single period. Then she starts bleeding heavily—and she assumes that this is another period.

However, if the bleeding doesn’t resemble her typical menstruation, maybe she IS in menopause. As mentioned, lab testing (a blood test) can show if a woman is in menopause.

“During the transition into full menopause,” says Dr. Tutera, “it is very common to have significant variations in the timing of periods and amount of bleeding. The ovaries are just not functioning consistently day to day.”

What could bleeding heavily during menopause be caused by?

Causes include: benign uterine or cervical polyps, endometrial thickening or thinning, cancer of the uterus, vagina or cervix, or cervical infection. This list of causes, including the cancers, is not complete.

Dr. Tuteradr. tutera initially specialized in obstetrics and gynecology and then moved on to treating hormonal imbalances in women. He passed away in 2015.