Perimenopause Periods: What You Need to Know

For many women, one of the first signs of perimenopause is an irregular period, says ob/gyn Mindy Goldman, MD, Midi’s Chief Clinical Officer. “For most women, studies find, cycles become more and more unpredictable," she says. "The stretch between periods can be longer one month, shorter the next, and flow can be heavier this time around, then suddenly lighter. Your period may go missing entirely for months on end, then come roaring back.”

In a lot of ways, this makes sense. Perimenopause is the transition phase prior to menopause when your ovaries begin their great wind down. Hormones that help regulate your menstrual cycle—estrogen and progesterone—begin to fluctuate wildly, which sends your periods on a whack-a-mole adventure. (Will it come “on time” this month? Will it be a tiny drop of blood or a massive flow? Will it be late, prompting a pregnancy test? Who knows!)

All that to say, if you’re concerned about your perimenopause periods, we hear you, and we have something to say about them. Keep reading to learn more about what’s going on, how to manage symptoms, and when to have a chat with a healthcare professional, like a Midi clinician.

What Is Perimenopause?

Perimenopause is—simply put—the time before menopause. It’s the natural and normal period when your body adjusts to the end of your reproductive years. The name comes from “peri,” a Greek word meaning “around,” which makes sense since it happens in the years before your period stops. It’s also sometimes called the menopausal transition. 

This hormonal transition usually begins in your mid-40s, but it can start as early as your 30s or as late as your 50s. Most women spend about four years in perimenopause, though this time can stretch for up to 10 years for some women. The hormonal changes during perimenopause trigger symptoms like hot flashes, low libido, anger and irritability, and, yes, erratic periods. 

When you’ve gone 12 consecutive months without a period, you’ve crossed the threshold of menopause. “Think of menopause not as a stage, but rather a moment,” says Dr. Goldman. “That point in time marks the definite end of your fertility. The average age of menopause is 51, but it may come years later or earlier.” 

Early Signs of Perimenopause Through Period Changes

If you can remember back to when you started your period (fair if you’ve blocked that out!), you might recall that your periods may have given you a lot of trouble then, too. As your body was adapting to the increase in estrogen and progesterone, your periods may have been long, short, heavy, you name it. But then as you went through your 20s and 30s, that most likely evened out and your periods may have become more predictable, especially if you were on birth control. 

As you approach menopause—a time when your hormones are once again shifting, it should come as no surprise that your menstrual cycle will shift again too. More often, your cycle is surprising—it’s long, it’s short, it’s heavy, it’s light, and telltale PMS symptoms may also be different.

One thing to keep in mind: While perimenopause period changes are often the result of fluctuating estrogen, it isn’t the only reason. Some period changes could indicate a health problem, which can be serious. It’s important to pay attention to additional symptoms you may experience at this time, and—of course—talk to a clinician when something doesn’t feel right. (More on this below.)

Common Changes in Perimenopause Periods

It’s hard to know exactly what your periods will do as your body moves through perimenopause, but here are changes to have on your radar:

Irregular Cycles

A typical menstrual cycle is 24 to 38 days. Your cycle may be longer or shorter than that, and this may depend on where you are in the menopausal transition. During early perimenopause, women occasionally skip a cycle and miss their period, and they may also have short cycles (those fewer than 21 days). As you progress through perimenopause, cycles become increasingly erratic and begin to space out. Cycles are often longer (more than 36 days apart)–and you may go without a period for months sometimes. Late-stage perimenopause is typically marked by periods that are more than 60 days apart. 

Changes in Flow

While it may feel as if you’re passing a lot of blood, we typically lose ⅕ to 2.5 ounces total during each period. During the menopausal transition, women are likely to report extra long flows, prolonged perimenopause spotting, and heavy bleeding, research shows. (You can also have lighter periods or no flow at all.)

Increased PMS Symptoms

In the past, maybe the second you got bloated and crampy, you knew your period was coming. But now PMS symptoms may be different, last longer, or be more intense due to fluctuating hormones. Plus, some of these—like moodiness or irritability—are very similar to the symptoms of menopause and may not be as closely tied to where you are in your cycle.

Duration Variations

On average, bleeding sticks around for 4 to 8 days. During perimenopause, however, bleeding days can be shorter or longer. 

Why Period Changes Happen During Perimenopause

If you’re wondering why your period goes on the fritz during this phase, let us explain. As you age, your ovaries do too, and levels of various hormones, including estrogen, decrease. This affects how your uterine lining develops, leading to an irregular cycle.

In the beginning of perimenopause, the follicular phase of your cycle (the time before ovulation when an egg matures in the ovaries) gets shorter, which is why many women notice they have more frequent periods. During the later stage of perimenopause when you march closer to The Big M (menopause), your ovaries may not release an egg at all, which can also cause bleeding at times outside of what you’d consider a normal period. Eventually, ovaries go into retirement—they stop producing reproductive hormones—and your reproductive years have come to an end. At this point, you’ll have no more periods at all. 

It’s not just hormonal changes in perimenopause that can cause periods to go wonky–or missing altogether. Other lifestyle factors like stress, weight changes, diet, or even over-exercise can affect your cycle. And mid-life happens to be a time when some of these, like stress, are at a tipping point.

Tracking Menstrual Changes During Perimenopause

During perimenopause, you may find it helpful to track your periods using an app (or in a note on your phone or good ‘ol pen and paper) if you’re finding it hard to remember when the last one started, how long it lasted, and how heavy it was. Also make note of PMS symptoms: when they start, stop, and generally how you’re feeling. For some women, this can help them spot patterns even if their cycle isn’t like clockwork anymore. 

All that information can be helpful when talking to a healthcare provider, like a Midi clinician, about the symptoms you’re experiencing. Your clinician can help you understand a bit more about what’s going on with your periods and your perimenopause experience in general, and provide a care plan to manage your symptoms. 

Common Symptoms That Accompany Perimenopause Periods

Not only do you have PMS to contend with, you may start to have all sorts of symptoms of perimenopause popping up since estrogen has a hand in so many processes throughout the body. In addition to changing you periods, you may also experience:

• Brain fog
• Low libido
• Sleep changes
• Gastrointestinal symptoms
• Weight gain
• Headaches
• Hot flashes and night sweats
• Fatigue
• Hair changes

Perimenopause Periods vs. Other Health Issues

Perimenopause isn’t the only cause of irregular periods. In fact, up to 30% of women worldwide in reproductive age have abnormal bleeding, which is bleeding that’s unusually long, irregular, frequent/infrequent, or heavy. But cycle changes and irregularities are associated with a host of conditions, including polycystic ovary syndrome (PCOS), type 2 diabetes, thyroid problems, bleeding disorders, fibroids, endometriosis, sexually transmitted infections, and cancer. 

More specifically, PCOS affects as many as 1 in 10 women between ages 15 and 44. One of the most common symptoms of PCOS is an irregular cycle, including frequent periods, missed periods, or periods that have stopped, along with excess hair growth, acne, male-pattern baldness, and weight gain.

Thyroid disease is another very common problem in women (affecting 1 in 8 women at some point in their lives). This butterfly-shaped gland at the base of your neck helps to regulate your cycle. Thus, thyroid problems can cause erratic periods, plus other symptoms like weight gain, moodiness, cold intolerance, among others.

Sexual Health Issues During Perimenopause Periods

Unpredictable periods, heavy flow, more intense PMS symptoms…who wants to have sex with all that going on? If you’re less in the mood, you’re not alone. These changes can impact your sexual function and your desire to have sex. Plus, declining estrogen levels cause vaginal and vulvar tissues to thin out, lose their elasticity, and become drier and prone to irritation and even tearing. As a result, sex can be painful. There are numerous ways to treat vaginal dryness, including vaginal moisturizers and lubricants, vaginal estrogen and hormone replacement therapy (HRT), as well as maintaining intimacy or improving your relationship. 

When to See a Doctor About Perimenopause Periods

Don’t discount the power of your period. Many health experts argue that the menstrual cycle should be considered a “vital sign,” according to a new research review in F&S Reviews. Meaning: Your period is a barometer of your health. That can be tough when you’re told to expect the unexpected when it comes to perimenopause periods. Luckily, you’re not on your own in this.

So, when should you worry about perimenopausal bleeding? During perimenopause when you’re still getting a period, regular checkups and communication with a clinician are key. We’ve long been told to expect miserable periods or that period pain is just part of being a woman, but if you’re experiencing new symptoms or those that disrupt your life (such as you have to call off work due to symptoms or skip dinner with friends), reach out to a healthcare professional to get checked out.

How to Manage Perimenopause Period Symptoms

There are real solutions for managing perimenopausal periods—you don’t have to endure your symptoms and suffer. A clinician can help you develop a care plan that takes into account lifestyle changes, medical treatments, and natural remedies to help you feel your best during the years of perimenopause. 

Lifestyle Changes 

Regular exercise, a balanced diet, and stress management won’t directly treat perimenopausal periods and accompanying PMS, but they can help you deal with them better. In fact, a study in Frontiers in Public Health found that regular physical activity is associated with less severe PMS symptoms and stress.

Rx Solutions

Hormonal birth control can help regulate your period and provide contraception if you need it. Yes, you can still get pregnant in your perimenopausal years since you’re still ovulating (even if it is less regular). In fact, 78% of women ages 40-50 are at risk for unintended pregnancy. Studies have shown that combined hormonal birth control—meaning the types that use estrogen and progesterone to prevent pregnancy (and come in the form of a pill, vaginal ring, or patch)—can relieve many perimenopause symptoms, including:

• Menstrual irregularity
• Heavy menstrual bleeding
• Menstrual pain
• Vasomotor symptoms like hot flashes, heart palpitations, and migraines

There are several hormonal birth control medications, as well as different forms (oral, patch, or ring), so talk to your provider about what makes most sense for you. 

Hormone replacement therapy (HRT), often referred to as menopause hormone therapy or MHT, is another treatment clinicians often recommend during perimenopause to supplement estrogen and progesterone levels. HRT is the most effective treatment for managing menopause symptoms that result from rapid changes in estrogen and progesterone. 

HRT will typically consist of estrogen and progesterone and is a safe and effective solution that addresses perimenopausal symptoms like hot flashes or night sweats, mood swings, and vaginal dryness. HRT can also lessen heavy menstrual bleeding. “While HRT is the gold standard for improving and reducing the severity of most symptoms, it’s not right for every woman, so we collaborate closely with patients to individualize their treatment,” notes Dr. Goldman.

Natural Remedies

Supplements and botanical remedies can also be used alongside HRT or in place of it to treat the variety of symptoms you may experience during perimenopause. Botanical therapies can be an effective alternative to prescription medications. Black cohosh, a flowering plant native to North America, is one of the most studied herbs for management of hot flashes. Other options include Siberian rhubarb and maca, both promising symptom relievers. In addition, other wellness therapies, like acupuncture or cognitive behavioral therapy, can help you manage PMS symptoms.

The Takeaway

• An irregular period is commonly one of the first symptoms of perimenopause, the stage before menopause. Women report that their periods become erratic in several ways: they can become heavier or lighter, cycles longer or shorter, and the duration of bleeding can change too. 
• Changes in periods frequently occur alongside other symptoms of menopause, such as mood changes, sleep disturbances, vaginal dryness, and more. 
• Medications like hormonal birth control or HRT can treat perimenopausal periods. A healthy lifestyle and natural remedies like herbal supplements can promote hormonal health and overall wellbeing. 
• Always discuss any changes in your bleeding patterns with your provider to rule out other serious, health issues.

Frequently Asked Questions (FAQs)

Are periods awful in perimenopause?

Yes and no. Or, more accurately, it depends. Women find that their periods change in a variety of ways during perimenopause, becoming lighter or heavier, more or less frequent, longer or shorter in duration. Periods also tend to change as you get closer to menopause. It’s impossible to say what your experience will be, but there are treatments that can help improve your symptoms throughout the perimenopausal years.

What is the average period cycle for perimenopause?

During early perimenopause, women often have short cycles (those fewer than 21 days). In later perimenopause, cycles begin to space out, becoming longer (more than 36 days apart). As women get closer to menopause, they may not have a period for months.  

How does perimenopause make you feel?

Irregular periods are one of many symptoms of menopause. Other perimenopause symptoms include hot flashes and night sweats, sleep problems, brain fog, fatigue, low libido and vaginal dryness, and more. 

What is the age range for perimenopause?

Typically, perimenopause starts in your mid-40s, though some women enter into this stage as early as their 30s or as late as their 50s.

What are annoying perimenopause symptoms?

There are few perimenopause symptoms that aren’t considered annoying. Dizziness, hair loss, mood changes, breast soreness, joint pain, brittle nails, muscle pain, incontinence, irregular heartbeat, panic attacks, allergies, and more can all occur during the mid-life years and be frustrating and disruptive. Every woman experiences the menopausal transition differently.