Periods in Perimenopause

Let's be honest - periods do NOT get better with time. That's one of the many myths we're told as teenagers. 'Don't worry - it's the worst when they start'... In fact, many women find their periods get worse with age. Indeed, they become more unpredictable as you approach menopause.

Why do periods change during perimenopause?

Perimenopause is the time before the full menopause (when your periods will stop for 12 months), during which the regular cycles of your sex hormones will fluctuate - this can last up to 10 years. As a result, you may notice changes in your body - this is dependent on how your body responds to your hormones (estrogen, progesterone and testosterone) being in flux. During this transition, your bleeding pattern may start to change, and your periods may become irregular. Unfortunately, the end of your cycle can be just as unpredictable as its beginning!

Periods don't always simply 'dry up' as we approach menopause. Heavier periods during this time are also common. Everyone's body will respond in its own way during perimenopause.

Shorter, or more frequent periods in perimenopause

As a result of your perimenopause, your periods may become shorter or more frequent - as we said, the end of your cycle is highly unpredictable. A shorter cycle length can also alternate with longer cycles, and it may become hard to predict when your next period will arrive - It is best to be prepared for the unexpected.

During this transition, your hormones are constantly changing. If you are bleeding more frequently long term, and especially if your periods are heavy, you may be at risk of developing anaemia (low iron). If you notice you are pale or more tired, it might be worth visiting your doctor and a blood test.

Spotting between periods

Have you ever noticed blood in your underwear between your periods? Not quite enough blood to make a fuss, but it is definitely there? This is most likely spotting.

If you notice that you are spotting regularly between your periods, this can be a direct sign of hormonal imbalance (i.e. perimenopause). However, it can also be a sign of infection, endometriosis, or rarely a more serious illness.

If you're spotting, it's something to keep an eye on. If it's happening regularly, you should be checked by a doctor. However, if it is accompanied by other abnormal symptoms, such as bleeding after sex, you should not delay seeking medical advice. If you are concerned about your spotting, make sure that you are up to date on your cervical smears. For more information on cervical screening, visit the NHS website.

Long periods in perimenopause

If you are experiencing heavier bleeding, your periods will likely also be longer. This is also not uncommon during perimenopause - it is simply a result of your changing hormonal balances. Your oestrogen levels may begin to overtake that of your progesterone, causing your uterine lining to build up more than usual and cause your bleed to last longer and appear heavier, as it may take more time for your lining to shed.

Abnormally long periods can be a scary thing, and disruptive to daily activities. If your bleeds are consistently longer and heavier over several cycles, you should remain cautious.

Irregular periods

It is reasonably common for women to experience a long gap between periods during perimenopause. For example, you might have pretty regular periods and then (suddenly) a 6-8 week gap, followed by a heavy period. This is likely due to hormone changes, meaning that your ovaries will not release an egg during that menstrual cycle, and you won't experience a bleed - this is called an anovulatory cycle. When this happens, your womb lining begins to build up. When the lining finally sheds, your bleed will be heavier than usual.

If your bleeding pattern is 'all over the place' and you are unsure which is a period or whether you are just bleeding between periods, it is best to see your doctor. Keeping a diary of your bleeding pattern for a few months and taking it with you to your appointment can be very helpful.

Can periods restart after menopause?

No - they cannot. Menopause is marked by the end of your reproductive cycle, thus the end of your menstruation. Your hormones estrogen and progesterone are depleted at this point. Any vaginal bleed should therefore be considered abnormal and should be discussed with your doctor as a matter of urgency. Most people who have a bleed once they have not had a period for 12 months (post-menopausal bleeding) have local causes, such as vaginal atrophy. It can, however, also be a sign of endometrial (womb) cancer. For more details of symptoms of gynecologicals cancers see the Eve Appeal website. 

Remember - stress, over-exercise, and the contraceptive pill can all potentially stop your period for a little while as well. This does not mean that you have hit your menopause, and your period may begin again. Make sure you note your age when your period stops - menopause will most commonly occur between the ages 45 and 55.

HRT and periods during menopause - Does HRT stop periods?

A commonly asked question is whether you can take HRT if you still have periods. The answer is: Yes - you can. Perimenopause is often the time when your menopausal symptoms are at their worst as your hormones have not yet settled down - HRT may therefore be beneficial during this time. Taking HRT will not stop your periods; instead, our doctors tailor your HRT regime according to your periods.

So, if you choose to take HRT whilst still on your periods, you should be taking it cyclically to fit in with your natural cycle. Cyclical HRT means that you spend some time taking both estrogen and progesterone hormones, and some time taking oestrogen only. This is different to continuous HRT, which you take when you no longer have your period.

There are different types of cyclical HRT - have a read of our article here to learn all about the different types of HRT during menstruation.

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