Overview
During the perimenopause (the stage leading up to the menopause), you may experience changes to your periods and normal period cycle, including heavier bleeding or irregular periods, which happen earlier or later than usual. Menstruation changes are a common symptom of this natural stage in your life.
As you approach the menopause (when your periods stop altogether and you can’t get pregnant naturally anymore), your ovaries produce less of the hormones oestrogen and progesterone. This can cause many symptoms including hot flushes, mood changes, poor sleep and changes to your periods, like their frequency. You may find that your periods are getting closer together, they become more irregular or happen less often, and they may become heavier or lighter, among other changes.
These period changes are usually nothing to worry about, but if, for example, you’re having a period a lot more frequently than normal (every 2 to 3 weeks), there could be an underlying medical problem, so it's best to discuss this change with a doctor.
Read on to discover what can cause changes to your periods during perimenopause, how to manage these changes and when to see a doctor.
Why are my periods closer together during perimenopause?
The first sign that you’ve started the menopause (usually between age 45 and 55) is usually a change in the normal pattern of your periods.
Your menstrual cycle starts on the first day of your period and ends the day before your next period starts – but its length differs from person to person. A menstrual cycle of 21 to 40 days is considered a normal range, but often, around 28 days is seen as more usual. However, the latest research suggests that fewer than 20% of women tend to have a 28-day cycle. This is why you need to get to know your own body to work out what’s normal for you.
When you have irregular periods, the length of your menstrual cycle keeps changing, either starting earlier or later than it normally would have.
During perimenopause, your oestrogen levels go down as you start ovulating (when your ovaries release an egg) less frequently, which makes the lining of your womb thinner than usual. This oestrogen deficiency can cause your periods to become lighter than normal and shorter (lasting fewer days than usual), so your menstrual cycle may last 2 or 3 weeks rather than the 4 or 5 weeks it usually does, for example. As a result, your periods can become closer together.
These hormonal changes can also cause heavier periods, or you may not have them at all for months on end.
Menopausal symptoms like irregular periods, hot flushes, night sweats, vaginal dryness, poor sleep (insomnia) and mood swings may happen months or even years before your periods stop. But everyone is affected differently by menopausal changes and some people may even have normal periods up until the time they stop altogether.
Read more about unusual menopause symptoms to look out for, menopause brain fog and menopause joint pain.
What else causes irregular periods?
There are a number of reasons why your periods may become irregular – including more or less frequent – and sometimes, this is normal for you and you don’t need to worry about it. But sometimes, an abnormal bleeding pattern may be a sign of something more serious and it’s best to see a doctor.
Other than the menopause, common causes of irregular periods, including less and more frequent bleeding, include:
- being pregnant – if you think you may be pregnant, do a home pregnancy test
- hormonal contraception – including the progesterone-only contraceptive pill and an intrauterine system (IUS) like the Mirena coil
- hormone replacement therapy (HRT)
- extreme changes in weight such as rapid weight loss or weight gain
- stress
- exercising too much
- medical conditions like thyroid gland disorders or polycystic ovary syndrome (PCOS)
- fibroids
- bleeding disorders
- sexually transmitted infections (STI)
Other less common causes of frequent bleeding include cancers such as womb (endometrial) cancer and cervical cancer.
Is it normal to bleed for 3 weeks during perimenopause?
As you go through perimenopause, your periods may last longer and become further apart. Evidence shows that having periods that last 8 days or longer is common when you’re going through this natural stage in your life.
You may also bleed more heavily if you’re obese (if your body mass index, or BMI, is 30 and over) or have a fibroid, and as you approach the time when your periods stop altogether.
So, for some people, it may be normal to bleed for 3 weeks during the perimenopause, but it’s best to see a doctor for their advice, as they may want to do some tests to make sure there's nothing else causing your longer periods, and that you’re not losing too much blood and becoming anaemic. Read below for when else to see a doctor about periods in perimenopause.
When to see a doctor about perimenopause periods
When you’re going through perimenopause, it’s normal to experience changes to your periods, but sometimes, an abnormal bleeding pattern may be a sign of an underlying issue that needs medical attention.
Call an ambulance or go straight to an emergency department if you’re bleeding from your vagina and you have:
- severe tummy (abdominal) pain
- very heavy bleeding that won’t stop – that is, you’re having to change your sanitary products every hour, or are passing blood clots larger than 2.5cm (about the size of a 10p coin)
- tummy (abdominal) pain that won’t go away and you think you may be pregnant (this may be a sign of a miscarriage or an ectopic pregnancy)
- you feel tired and lack energy (lethargy), you’re short of breath, have heart palpitations and a pale complexion (these may be signs of anaemia)
- a fever, you feel faint or very unwell, or have any other signs of sepsis
Although it's common during the perimenopause and usually nothing to worry about, sometimes, bleeding can point to an underlying medical problem, so see a doctor as soon as possible if you're bleeding from your vagina and:
- it’s lasted longer than 7 days
- it’s happening every 2 to 3 weeks or more frequently
- it’s happening during or after sex, or between your periods
- you haven’t had a period for 1 year or more before it started
- you could be at risk of an STI
- you have abnormal vaginal discharge
Also, see a doctor if your periods have become unusually heavy for you, or they’re painful.
How to manage irregular periods during perimenopause
Treatment for irregular or frequent bleeding depends very much on what’s causing it. If you’re bleeding frequently, you may need some tests to see if there's any other underlying medical reason for your bleeding. For example, a doctor may want to do an ultrasound scan to check the thickness of your womb, some blood tests or a test for STIs.
If an underlying cause is found, this may need medical treatment that a doctor will advise you on. But, if your bleeding problems are caused by the perimenopause alone, there are some things you can do to manage them yourself.
For example, if you have short, unpredictable periods, consider wearing daily protection such as panty liners, pads or period pants (the environmentally-friendly option).
Painful or heavier periods can be treated with some non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen that you can get in a pharmacy or supermarket, or with stronger NSAIDs that you would need to get from a doctor. Speak to a pharmacist or doctor first about how to safely get and use these medicines.
The Mirena coil is often recommended as a treatment for controlling heavy periods during the perimenopause – and can be used as part of HRT.
Hormonal medications like the combined oral contraceptive pill (commonly called the pill) or HRT can also sometimes be used to regulate bleeding, depending on your age and other underlying medical conditions. HRT may be especially helpful if you have other menopausal symptoms.
Some types of HRT allow a ‘withdrawal bleed’, which happens every month like a period. These are usually given if your periods haven't stopped. Other types usually don’t cause any bleeding and are given if your periods have stopped. However, both types can cause some unpredictable bleeding, especially in the first 3 months of using them. If this happens, you may need some more tests, or to have your HRT type or dose changed.
If you normally have a regular cycle, are sexually active and miss a period, consider taking a pregnancy test to make sure your irregular periods are due to perimenopause and not pregnancy.
Your health questions answered
Is ovulation bleeding a sign of menopause?
Answered by: Dr Roger HendersonOvulation bleeding is light bleeding or spotting that happens when you ovulate, usually in the middle of your period cycle. As you approach menopause, you’re less likely to ovulate, as your egg reserves reduce and eventually disappear. So, although ovulation bleeding isn’t usually a sign of menopause, any changes in your periods – including bleeding more frequently or in the middle of your cycle – can be. Mid-cycle bleeding can have lots of different causes, so it’s best to get it checked out by a doctor, especially if you’re already menopausal (your periods have stopped altogether) and you’re bleeding or even spotting.
Key takeaways
- the hormonal changes that occur during the perimenopause can cause a wide range of symptoms including changes to your periods
- perimenopause can cause your menstrual cycle to be shorter or longer than normal, or your periods to be heavier or lighter, among other changes
- other medical conditions unrelated to the perimenopause can cause irregular periods too, including pregnancy and PCOS
- sometimes, an abnormal bleeding pattern may be a sign of an underlying issue that needs medical attention
- hormonal medicines like the combined contraceptive pill or HRT can sometimes be used to regulate irregular periods
