Bloodborne has three endings and an extra end boss, if you play your cards right.
Our Bloodborne guide assumes you're going to do a standard playthrough first of all, selecting one of two possible endings.
But if you have followed our directions for unlocking Bloodborne's third, true ending, then after you have battled Gehrman you must face the true final boss.
This guide page goes into detail on that boss and the battle against it, so if you don't want to spoil it for yourself, look away now.
Still, with us? Okay. After defeating Gehrman, you'll be thrown into a new battle. If you don't want to lose the Blood Echoes you won from Gehrman, or aren't ready to go on to New Game Plus after beating this new guy, the use a Bold Hunter's mark to get back to Hunter's Dream safely. In fact, I recommend this, so you can replenish your Blood Vials stash.
Otherwise, gird your loins. It's time for:
Moon Presence boss battle
There's a reason why this creature has used proxies in its plan to do ... whatever it was doing to Yharnam: it's not that big a deal when it comes to brass tacks. Then again, if anything is going to take down the manifestation of an ancient and hostile force, it's you, so perhaps Moon Presence really is all that and a bag of chips.
Like Darkbeast Paarl, Moon Presence attacks very quickly, but you can mostly avoid its attacks via the good old "butt kissing" approach we are by now so very familiar with; dodge in behind it and enjoy your comfortable smacking routine. That said, keep your stamina at a reasonable level, for better times are coming.
Every now and then the Moon Presence will emit a great big red flash, and this will eat up most of your health. Don't stop to heal. Go to town on that sucker: after exhausting itself with this light show, the Moon Presence just sits there, and you'll get back a hefty slice of your health via Regain. Ah ha ha!
If you need to, keep yourself topped up with Blood Vials after you've taken this excellent opportunity. You only need enough health to be a buffer against mistakes in your sniffing-the-boss's-butt technique.
Rinse and repeat this somewhat underwhelming process until Moon Presence is dead, and then enjoy the true ending.
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