Menopause marks the end of your menstrual cycle, and therefore your ability to reproduce. When you begin to transition from being fertile to postmenopausal, your body can experience some new and often unpleasant symptoms. Indeed, it can be a rocky road with perimenopause periods until you reach menopause.
Why Does Your Period Change In Perimenopause?
The window of time between fertility and postmenopause is known as perimenopause. One of the first signs that you are transitioning into perimenopause is an irregular period. For example, your periods can behave very differently during perimenopause and it is often quite unpredictable. This can be concerning for many women in the beginning because most women follow a very predictable menstrual cycle throughout their fertile years.
Here are some changes you may notice in perimenopause periods:
- Longer in duration
- Shorter in duration
- Missed cycles
- Fewer days or weeks in between periods
- Longer weeks or even months in between periods
- Worsening or improvement in PMS, cramping, bloating, etc.
- Changes in the color of blood – may be redder, darker, or brown
You experience changes in your period because of fluctuating hormone levels, particularly estrogen and progesterone. Both hormones are produced in the ovaries under the direction of the pituitary gland in your brain. As women age, the ovaries begin to lose their functionality. That is, they become less able to produce estrogen and progesterone, as well as cease to release eggs once a woman is in menopause.
The hormone shifts that occur during perimenopause can be erratic because estrogen and progesterone levels begin to decline. However, it is not a slow and steady decline but is rather volatile, where estrogen levels can surge or drop rapidly at any given point. The overall trend amidst the hormonal chaos that can occur is that estrogen and progesterone will no longer be released from the ovaries, except estrogen in small quantities. After menopause, the majority of estrogen that you have in your body is released from fat cells.
Some women have an easier time managing perimenopause periods than others. However, almost all women will experience irregularity in their periods. Let’s take a look at common challenges with perimenopause periods and discuss some tips for managing them.
Period Problems in Perimenopause
Irregular Period Perimenopause – This is usually the first indication that a woman is in perimenopause and it can be disconcerting and frustrating for many women. While there is not much you can do to restore regularity to your period during perimenopause, you can prepare ahead of time.
- Make sure you have your preferred period products at the ready in your purse, car, desk, etc.
- Wear black underwear or even invest in some period underwear that is absorptive so that you do not ruin any clothing.
- Monitor your periods by tracking them with a period app, or write down your periods and symptoms in a journal or planner.
Missed Period Perimenopause – This symptom can be exciting or concerning for many women. Some women get excited about missed periods because that means they may be getting near menopause, which is diagnosed after you have not had a period in twelve months. Other women, especially at the beginning of perimenopause, may be concerned about pregnancy if they miss a period. To settle your mind about having missed periods:
Use a form of birth control to protect yourself from pregnancy if you do not wish to become pregnant.
If you are concerned you may be pregnant, settle your mind by taking a home pregnancy test. The cost of a home test can be worth the peace of mind. Alternatively, you could make an appointment with your doctor to have a blood test to see if you are pregnant or if your hormones, specifically follicle-stimulating hormone (FSH) is declining.
Track your periods, especially if you have been missing a few in a row. It can help you track if you are getting closer to menopause.
Late Period Perimenopause – Most of us are conditioned to be wary of late periods because they are usually associated with pregnancy during our fertile years. However, it is normal for you to have more days in between periods in perimenopause. The best thing you can do if your period is late is to track your period and be prepared for when your period arrives. And just like if you miss a period, if your period is later than normal and you are concerned you may be pregnant, take a home pregnancy test to settle your mind.
Perimenopause Periods Closer Together – Just like your periods may be late to arrive, your periods can also come closer together. It depends on the fluctuations in progesterone and estrogen. Progesterone actually plays a significant role in regulating your period and is particularly high in the middle of your cycle through when you start bleeding. In fact, progesterone is responsible for building up your uterine lining. Then, progesterone drops when it is time for the lining to shed. If your progesterone levels are fluctuating during perimenopause, you likely may have periods closer together. Take note of when your periods begin, how long they last, and how many days are between periods.
Spotting During Perimenopause – Spotting can be a frustrating perimenopause symptom because it means you always have to be prepared. Women who frequently experience spotting wear a disposable or reusable panty liner daily so that their underwear do not soil. If you are spotting every two weeks or even more frequently, it is usually a sign of hormonal imbalance, which can be normal if you are in perimenopause.
If you have concerns about spotting, check with your doctor to make sure your spotting is related to perimenopause and not caused by a different underlying condition.
Perimenopause Periods Lasting Longer – It is not uncommon for your period to last longer than it used to once you are in perimenopause. Indeed, many women wonder “how long is too long for a period during perimenopause? Certainly, irregular periods with changes in your flow are normal in perimenopause. However, you should meet with your doctor if your periods last longer or you bleed for more than one week.
Cramps But No Period Perimenopause – How frustrating, right?! Yes, it is common for you to experience cramping and miss a period. Likely, your hormones are trying to follow your usual cycle and you experience symptoms that you might experience before a period but when no period arrives it is a sign of hormonal imbalance. Take care of yourself just as you normally would before a period and document your symptoms. Also, make a note on your calendar. Many women report cramping and PMS before they normally would have a period, even in menopause!
Painful Period Perimenopause – Sometimes, your period, and the time leading up to it, can become much more painful than it was before you reached perimenopause. Thanks to hormones behaving erratically, your body can experience all of your premenstrual symptoms tenfold. However, as you near late perimenopause where your periods are at least 3 months or so apart, you can expect this to improve. However, painful periods can be associated with other conditions as well including endometriosis. Therefore, if you all of a sudden, or even gradually, begin having more pain with periods, meet with your doctor. A medical exam can help rule out other causes of pain.
What if your irregular periods are not from perimenopause?
While irregular periods are a normal part of perimenopause, the American College of Obstetrics and Gynecologists recommends that you contact your doctor to rule out other causes if you have bleeding that is:
- Very heavy
- Lasting longer than what is normal for you
- Occurring more often than every three weeks
- Happens after sex or in between periods
Abnormal bleeding can be caused by other conditions besides perimenopause. These conditions can include:
- Uterine polyps or fibroids
- Endometrial atrophy
- Endometrial hyperplasia
- Birth control pills
- Pelvic inflammatory disease
- Polycystic ovary syndrome
- Thyroid conditions
- Uterine or cervical cancers
If you are in the early phases of perimenopause, this is a great time to meet with your doctor to talk about how to best manage your symptoms. If your quality of life is severely affected by your period or any of the 34 symptoms of perimenopause, your doctor may recommend you try hormone replacement therapy. Together with your doctor, you can explore the best options for you.
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.