Perimenopause and your period: What changes to expect and how to manage them

Your period has one job: show up roughly once a month, stay for a few days, leave. For years — maybe decades — you could set your watch by it. So when that predictability disappears, it’s natural to wonder what could’ve changed.

If your cycle has gone rogue and you’re in your 40s or approaching them, perimenopause is a likely culprit. But irregular periods can also be a sign of other health conditions, stress, significant weight changes, or thyroid issues — which is why it’s worth understanding what’s happening and when to seek help.

When it is perimenopause, ‘irregular periods’ sounds simple enough, but the reality can be anything from surprisingly light spotting to flooding that sends you scrambling for supplies.

These changes can feel unsettling, especially when you’re not sure what’s normal and what deserves a call to your doctor. Understanding what’s happening and why can help you navigate this transition with far less anxiety and a lot more confidence.

What is perimenopause?

Perimenopause is the natural transition leading up to menopause — the point when your ovaries gradually wind down oestrogen production and your reproductive years come to an end [1]. For most women, this phase kicks off somewhere in their 40s, though it can start earlier depending on factors like family history, smoking, or certain medical treatments [2].

During perimenopause, your hormone levels stop behaving predictably [1]. Instead of rising and falling in their usual monthly rhythm, they become more erratic — rising higher than usual in some cycles and dropping very low in others — before eventually declining. When hormone levels fluctuate, it affects everything from your menstrual cycle to your sleep, mood, and energy levels.

Perimenopause officially ends 12 months after your last period, which is when you’ve reached menopause [1]. The average age women reach menopause is 51, though early menopause can happen before 45 [2]. Perimenopause typically lasts around four years, but some women breeze through in a few months while others experience symptoms for a decade or longer [1].

How hormones affect your menstrual cycle

Your menstrual cycle is run by a carefully choreographed hormonal dance — primarily between oestrogen and progesterone [3]. During your reproductive years, these hormones rise and fall in a relatively predictable pattern each month, triggering ovulation and then menstruation.

During perimenopause, this coordination starts to fall apart. Your ovaries produce oestrogen less consistently, and ovulation becomes irregular or may be skipped entirely in some cycles [1]. When a cycle passes without ovulation, progesterone levels drop, which can lead to heavier bleeding or irregular periods [3].

How does your period change during perimenopause?

Every woman’s experience is different, but some patterns show up often enough to prepare you for what might be coming.

Common changes in flow, frequency, and duration

Irregular periods are often the first sign that perimenopause has arrived [4]. Your cycle might shorten to 21 days or stretch out to several months between periods [1].

Heavy periods during perimenopause are incredibly common. When ovulation doesn’t occur, the lining of your uterus can build up more than usual before shedding, leading to much heavier bleeding than you’re probably used to [3].

Light periods or spotting can also happen. Some cycles might show as light bleeding or spotting between periods, while others might be surprisingly brief [4].

Missed periods become more frequent as perimenopause progresses. You might skip one or two cycles, then have a period return just when you’ve stopped carrying supplies [4].

The length of your periods can change, too. What was once a predictable five-day period might now last three days one month and a week the next.

It’s worth noting that while irregular bleeding is normal during perimenopause, you can still get pregnant during this time if you’re ovulating, even if your periods are all over the place [1]. If pregnancy isn’t part of your plan, keep using contraception until you’ve gone 12 months without a period.

Why does perimenopause affect your period?

The culprit behind all this chaos? Your hormone levels, which are now rising and falling, seemingly without rhyme or reason [1].

As your ovaries age and your egg supply declines, they become less responsive to the hormonal signals from your brain that typically regulate ovulation. Sometimes they release an egg, sometimes they don’t.

When ovulation happens, progesterone is produced, which helps regulate the thickness of your uterine lining. When ovulation is skipped, progesterone levels remain low, allowing the lining to build up irregularly [3]. This is why heavy bleeding and erratic periods are so common during perimenopause.

Tracking your period changes through perimenopause

Keeping track of your periods might feel tedious, but it’s useful — both for identifying patterns and for giving your doctor concrete information if you need support.

You can make notes in your phone calendar, a period app, or even jot down dates in a diary. Consider tracking:

• When your period starts and ends
• How heavy your bleeding is
• Any spotting or perimenopausal bleeding between periods
• Other symptoms like hot flushes, night sweats, mood swings, or sleep problems
• Any pain or unusually severe symptoms

This record becomes especially helpful if you’re considering treatment options or if your doctor needs to work out whether your symptoms are within the normal range.

What’s normal — and when to seek help

Not all bleeding irregularities at this life stage are due to perimenopause. Some patterns could point to other health conditions that need investigation [4].

See your doctor if you experience:

• Very heavy bleeding that soaks through a pad or tampon every hour for several hours
• Bleeding that lasts longer than seven days
• Bleeding between periods or after sex
• Periods showing up more frequently than every 21 days
• Any bleeding after you’ve gone 12 months without a period. Once you’ve reached menopause, vaginal bleeding is considered abnormal and needs checking out [4]

Your doctor will likely take your medical history, perform a physical examination, and may order tests to rule out other causes of abnormal bleeding — things like fibroids, polyps, thyroid problems, or, in rare cases, more serious conditions [4].

Common symptoms that accompany perimenopause and periods

Period changes rarely show up alone during perimenopause. Most women experience a whole constellation of physical and emotional symptoms alongside their menstrual irregularities [1].

Physical symptoms commonly include:

• Hot flushes (or hot flashes) and night sweats that can disrupt your daily life and sleep
• Vaginal dryness and changes to your libido and sex life
• Sleep problems and the kind of fatigue that can make it hard to get through the day
• Weight gain, particularly around your middle
• Headaches and general aches [1][4]

Emotional symptoms can also significantly affect your quality of life:

• Mood swings
• Low mood or depression
• Anxiety
• Brain fog and trouble concentrating [1][4]

Some women sail through with mild perimenopause symptoms that they barely register, while others have moderate or severe symptoms. If your symptoms are affecting your daily life, you don’t need to just grin and bear it — there are effective treatments available.

How to manage period changes and symptoms

While you can’t prevent perimenopause, you can absolutely take steps to manage symptoms and feel more comfortable.

At-home relief strategies

For heavy periods:

• Stock up on high-absorbency period products
• Give yourself permission to rest on your heaviest days
• Use a heat pack to ease cramping
• Take over-the-counter pain relief, like paracetamol or ibuprofen, as directed on the packet. Some women find medications containing mefenamic acid particularly helpful for period pain [5]
• Make sure your diet contains enough iron, as heavy bleeding can leave you running low [4]

For irregular periods:

• Keep period supplies with you so you’re not caught off guard if your period decides to make a surprise appearance
• Track your cycle to see if any patterns emerge
• Plan important events knowing that your periods might not play along

Lifestyle changes that support your wellbeing and manage menopausal symptoms:

• Regular exercise, which helps with weight management, mood regulation, and can reduce hot flushes
• Stress management through mindfulness, yoga, or whatever helps you unwind
• Staying hydrated and going easy on caffeine and alcohol, which can worsen hot flushes and night sweats
• Maintaining a consistent sleep routine to support hormone regulation and reduce stress-related cycle changes
• Keeping your bedroom cool at night to combat night sweats [4]

When medical support can help

If your symptoms are seriously affecting your everyday life, it’s worth having a conversation with a healthcare professional about treatment options.

Hormone replacement therapy can be an effective treatment option for managing menopause symptoms — it can help regulate periods, reduce hot flushes and night sweats, and improve mood and sleep [4]. Have a chat with your doctor about whether this could be a good option for you.

Hormonal contraception can be helpful during early perimenopause, as it can also regulate your cycle and reduce heavy bleeding [4]. Options include the pill, hormonal IUD, or contraceptive implant — your doctor can help you choose.

Other treatments your healthcare provider might suggest include:

• Non-hormonal medications for specific symptoms
• Treatments for heavy bleeding if it’s causing anaemia or disrupting your life
• Support for emotional symptoms like anxiety or depression [4]

There is a growing recognition that perimenopausal symptoms deserve proper medical attention and support — finally.

When to see a doctor about period changes

You don’t need to wait until things become unbearable before seeking help. Consider booking an appointment if:

• Your period changes are worrying you or causing anxiety
• Heavy bleeding is messing with your daily life or leaving you exhausted
• You’re experiencing severe symptoms that affect your work, relationships, or lifestyle
• You’re not sure whether perimenopause is behind your symptoms or if something else might be going on
• You’d like to discuss treatment options
• You have factors in your family history or medical history that might affect your experience [4]

Your doctor can help you understand what’s happening, rule out other health conditions, and create a management plan that’s tailored to your specific needs. This might include lifestyle recommendations, medical treatments, or referral to specialists.

Perimenopause and irregular periods are a normal part of life for most women, but that doesn’t mean you need to suffer through severe symptoms without support. With the right information, support, and medical guidance, you can keep feeling like yourself.

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