Let’s Talk About Periods In Perimenopause: How Do Periods Change?

Let’s talk about periods in perimenopause. There’s a whole lot of stigma surrounding periods in general, let alone periods in perimenopause.

But as you reach perimenopause, it can be worrying because you don’t know what to expect. What’s normal? What should you be concerned about?

Today, we’re ripping off the plaster (which was never meant to be there in the first place) and deep-diving into perimenopausal periods.

What is perimenopause?

First up, let’s understand perimenopause by answering what exactly is perimenopause?

Menopause itself is diagnosed when you reach the end of your menstrual cycle, when you’ve gone for 12 months or more without a period or spotting. On average, this hits around 51 years old.

Perimenopause is the phase before menopause. Perimenopause symptoms usually take place for around 4 years, which is the average. That said, perimenopause hugely varies from person to person. Some women experience perimenopause symptoms for only a few months, while others can experience perimenopause symptoms for up to 10 years.

In perimenopause, your hormones start to change, specifically oestrogen and progesterone. These hormone levels will change from month to month, impacting ovulation and, therefore, the rest of your cycle.

That’s why it’s common to see a wide range of implications on your menstrual cycle, from irregularity to missed periods entirely.

Other symptoms of perimenopause: how to know you’re in the perimenopause

This article is about how perimenopause impacts your periods. However, if you’re unsure whether you’re perimenopausal, it’s worth considering if you’re experiencing some of these common symptoms of perimenopause:

• Hot flushes (also known as hot flashes)
• Night sweats and difficulty sleeping
• Memory problems and a lack of focus
• Finding it difficult to urinate
• Anxiety
• Vaginal dryness
• Change in libido or sexual satisfaction

Perimenopause vs menopause – what’s the difference?

What’s the difference between perimenopause and menopause?

The perimenopause vs menopause confusion is actually very simple to clear up and revolves around your periods.

Menopause is when you have not had a period or any vaginal bleeding – including spotting – for 12 consecutive months or more.

Perimenopause, on the other hand, literally means “around menopause.” Perimenopause is when you have symptoms of menopause but your periods haven’t stopped, even if they are irregular and showing some change to what you were initially used to.

Perimenopause is, essentially, a transitional phase which ends when you reach menopause. That said, you can still experience a wide range of menopause symptoms in perimenopause.

What are the typical age ranges for perimenopause to start?

While the average starting age of perimenopause sits between 40 and 44 years old, some women can begin their perimenopause journey as young as 30.

Usually, perimenopause will start around 8 to 10 years before you reach full-blown menopause.

If you have reached menopause before the age of 40, this is called premature menopause, which can be caused by certain medical conditions and surgical menopause.

Periods during perimenopause

So, what are periods like during perimenopause? The answer, though I know you’ll find it frustrating, really does vary from woman to woman. No two menopause, or perimenopause, journeys are the same.

With that in mind, then, let’s take a look at some of the ways your periods can change during perimenopause.

1. Perimenopause and spotting between periods

If you’ve noticed that you are spotting between periods and you’re perimenopausal, don’t panic. This is actually a pretty common perimenopause symptom.

When your body’s hormones change the way they do during perimenopause, the endometrium or uterine lining thickens, which results in spotting.

Spotting in perimenopause usually starts before your period starts or just as it ends. It’s not uncommon, too, to see some spotting mid-cycle, close to ovulation.

It becomes something to raise concern about when you’re spotting every 2 weeks. This could be down to a hormonal imbalance. Even if this is just a perimenopausal period, it’s best to speak to your doctor for further tests to make sure.

How to manage spotting between periods

Spotting between periods can be frustrating because it’s tricky to predict when it’ll happen. So, it’s a good idea to track your spotting to try and pinpoint a pattern.

Keep a journal to track periods, making sure you take note of:

• When did your period start?
• How long did your period last?
• How heavy, on a scale of 1 – 5, was your period?
• When did you experience spotting and to what extent?

It’s worth, too, investing in some panty liners. That way, if you do start spotting, you’ll avoid leaks and stains. There are a wide range available, made form different materials and in different lengths. You can also purchase reusable ones that are made out of fabric, so you can wash and reuse them multiple times.

2. Heavy bleeding during perimenopause

Heavy bleeding, although uncomfortable, is quite normal during perimenopause. When your oestrogen levels are climbing and your progesterone levels are significantly lower, your uterine level will build up. That’s why you’ll see heavy bleeding during your period while your lining sheds.

If you’ve missed a period, too, the lining could build up further, which contributes towards a heavier bleed than usual.

But what counts as “heavy bleeding”? Periods are considered heavy if:

• You soak through a tampon or a pad per hour for several hours
• You need to “double protect.” Essentially, you need to use a tampon and a pad to avoid leaking
• You have to wake up in the middle of the night to change your tampon or pad
• Your period lasts for longer than 7 days

Heavy bleeding is not a fun experience. If your periods were previously light and manageable but your perimenopause period is heavy, know that you’re not alone.

Finding it uncomfortable to exercise or continue with daily tasks is a common side effect of heavy perimenopausal periods. You may find that you’re exhausted, too, so it’s important to keep an eye on it. Consistently heavy bleeding could lead to conditions like anemia.

How to manage heavy perimenopause periods

Heavy periods – whether that’s a perimenopausal period or one before this phase – are uncomfortable at best. They can cause significant pain, so don’t be afraid to reach for some pain relief. Ibuprofen is the go-to for menstrual cramps.

Research suggests, too, that your bleeding might lighten up when you take ibuprofen. You may be able to take 200mg of this medication every 4 to 6 hours throughout the day. That said, please make sure you book an appointment with a healthcare professional to discuss medication and treatment. Every woman is different and your doctor will be able to guide you on a treatment plan that works for you.

If you’re experiencing significant pain and ibuprofen isn’t helping, it’s important you speak with a healthcare provider. There may be underlying reasons why your perimenopausal period is significantly heavier and, thus, more painful. It’s always better to get checked out.

3. Dark or brown blood during perimenopause period

If you’re seeing dark or brown blood in your perimenopausal period, stay calm. It’s a relatively common thing to see, but any changes to blood colour can cause a little panic.

The reason you see dark or brown blood when having a period during perimenopause is because it’s old blood leaving your body. It’s usually nothing to worry about at all.

You might also see some spotting throughout the month, taking on the same dark or brown colour.

It’s also common that darker blood comes with a change in discharge. It might now be thinner and watery, or equally it might now be thicker and clumpy.

How to manage dark or brown blood in perimenopause period

Realistically, dark or brown blood in a perimenopausal period isn’t usually something to worry about and, therefore, doesn’t usually need to be managed.

That said, if you’re worried about your menstrual flow, it’s worth having a chat with your doctor. Sometimes, a change in colour could be a symptom of an underlying condition. Most often, though, it’s usually because your body needs a bit of time for old blood and tissue to exit the body.

If darker or brown blood comes with a bad odour, you might have an infection. Make sure you see a doctor if this is the case.

4. Short cycles during perimenopause

Some women find that their periods are significantly shorter in perimenopause. This is usually due to low oestrogen levels, meaning your uterine levels are thinner. Therefore, your bleeding might be lighter and end quicker.

If you’ve had a period in perimenopause that is around 2 or 3 days shorter than what you’re used to, that’s pretty common. As such, your entire cycle could last 2 or 3 weeks rather than 4. If you feel like your last period has only just ended and you’re already having your next one, while it’s not a barrel of laughs, it’s not uncommon.

How to manage shorter cycles during perimenopause

The reason people may worry about shorter cycles in perimenopause is because there’s a chance of leakages and it makes it tricky to track.

It’s worth getting some protection in that respect. Pads, period underwear or panty liners will help. However, I would highly advise against using tampons or menstrual cups unless you’re having a period. This is because it can be painful without any lubrication.

5. Longer cycles during perimenopause

Just like some women experience shorter cycles during perimenopause, some have longer cycles, too.

This often happens at the later stage of perimenopause, though. At this point, your cycle might last a lot longer.

Cycles are counted as “longer cycles” if they last for more than 38 days. This is also linked to anovulatory cycles (cycles where you don’t ovulate.)

How to manage longer cycles during perimenopause

If you’re trying to manage longer cycles during perimenopause, it’s worth investing in a menstrual cup or a set of blood-wicking underwear. Stock up, too, on pads and tampons.

6. Missed cycles during perimenopause

You can blame your changing hormone levels if you have missed a cycle in perimenopause. In the later stages of perimenopause, you might start to have cycles so far apart that you can’t remember the last time you bleed. When you’ve had no bleeding, including spotting, you’ve reached full-blown menopause.

Remember that, if you’re still having periods – no matter how far apart they are – you’re still ovulating, meaning you can still get pregnant.

How to manage missed cycles during perimenopause

In perimenopause, missed cycles are usually nothing to worry about. If you’ve missed a few cycles, it’s best to take a pregnancy test. That way, you can assess whether your symptoms are tied to perimenopause or early pregnancy.

Some symptoms of early pregnancy include:

• Nausea (not just in the morning!)
• Tender breasts
• Frequent need to urinate
• Having a sensitivity to scents
• Heartburn

If you don’t want to conceive and you’re perimenopausal, make sure you’re using birth control every time you’re having sex. Remember, you are fertile until you’ve reached menopause.

7. Irregular periods during perimenopause

All of the symptoms we’ve gone through all revolve around general irregularities. It can be challenging to pinpoint a pattern, making it tricky to track, especially as you edge closer to menopause. If you’re feeling frustrated, confused and a little bit angry about it, that’s totally fair enough.

How to manage irregular periods during perimenopause

Remember that these changes are temporary and all part of a bigger transition. These symptoms do have an end point, I promise. Once you stop ovulating and reach menopause, you won’t have perimenopausal period problems.

However, knowing this doesn’t offer instant relief. So, here are some things you can do while you’re waiting to reach menopause:

• To avoid staining your clothes, wear black or dark underwear or period pants
• Wear panty liners daily, even if you don’t spot. This will help protect you from any leaks and spotting.
• Track your periods and symptoms (you can use an app, a journal, a calendar – whatever works for you.)

Fertility and perimenopause

As your periods start to change in perimenopause, so does your fertility. However, your fertile days are not over until you reach menopause.

Can I get pregnant during perimenopause?

You can get pregnant during perimenopause. If you don’t want to get pregnant, make sure you’re using birth control every time you have sex.

Perimenopause periods: when to see a doctor

Perimenopause can really do a number on your periods and menstrual cycle, bringing with it so many changes. While many of these chalk down to perimenopause itself, there are red flags that should indicate a trip to chat with your GP.

If you’re experiencing any of these symptoms, book an appointment with a healthcare professional:

• Extremely heavy bleeding, where you need to change your tampon or pad every hour or two
• You’re bleeding for longer than 7 days
• You’re having a period (not spotting) more frequently than every 3 weeks

Periods during perimenopause: in a nutshell

Perimenopausal periods can be a tricky transition. The thing about periods is, until we reach perimenopause, they tend to be stable and consistent. So, when our cycle changes, it can be tricky to determine a pattern, causing frustration and worry.

That said, the more you know about what to expect in terms of perimenopausal periods, the more prepared you can be. For the most part, it’s about preventing the side effects of some of these changes, such as wearing panty liners to avoid leakages, keeping track of your side effects and details of your period and using pain relief when needed.