How Perimenopause May Affect Your Periods

Perimenopause is the period of time before menopause when the ovaries begin to make less estrogen. This is also when symptoms of menopause typically begin and your periods become more irregular than before. Your period may start earlier or later than normal or be lighter or heavier.

Besides changes to your periods, perimenopause is also accompanied by symptoms like hot flashes, night sweats, and mood swings.

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Period Changes During Perimenopause

Perimenopause is the stage when your menstrual cycle begins to change. Menopause is when a year has gone by and you haven’t had a period.

During this time, hormones (estrogen and progesterone) fluctuate, which directly relates to your periods. Each month can be dramatically different from the month before.

Spotting Between Periods

Spotting is when you bleed between your periods. You may experience this before perimenopause from a change in birth control or other reasons. During perimenopause, your periods will be unpredictable and you may experience spotting.

While spotting is typically nothing to worry about during this time, it’s important to mention any excessive bleeding to your healthcare provider. If your periods are lighter, it’s more likely due to perimenopause.

Sometimes, however, this bleeding is a sign of underlying conditions. Discuss these concerns with a doctor and keep up with gynecological visits and pelvic exams.

Shorter Periods

Each woman experiences their period differently, including the length of their period. Some women notice this shortening of their cycles as the first sign of perimenopause.

During perimenopause, hormone levels change, which leads to a shorter follicular phase as ovulation happens quicker. Shorter and earlier periods are common. You may see your period come between two to three days earlier than expected.

Longer Periods

Some people can experience longer periods. Longer cycles are characterized by bleeding longer than 38 days. They can be attributed to the level of estrogen in relation to progesterone during perimenopause.

If the estrogen levels are higher than progesterone levels, bleeding can be heavier or last longer. You may experience long periods or a combination of long and short periods.

Missed Periods

A woman’s period can change from month to month during the perimenopause phase and can even be skipped altogether. Some women will experience a skipped period followed by an especially heavy period.

Unfortunately, there’s no knowing what to expect. About one in 10 women stop menstruating quickly, without lasting irregularity.

Heavier Periods

Heavy bleeding is also called menorrhagia and is characterized by 80 mL or more blood lost during your period. You can assume you’re experiencing heavy periods if you’re bleeding through your tampon or pad quickly.

When your estrogen levels are higher than your progesterone levels, the uterine lining grows and leads to more bleeding.

While heavy periods are a common symptom of perimenopause, they can be dangerous. Losing too much blood can lead to iron deficiency. Also, heavy periods can in rare cases be a sign of endometrial cancer or endometrial hyperplasia, where the lining of the uterus becomes unusually thick because it has too many cells. It’s important to let your doctor know if you have heavy periods.

Periods That Are Closer Together

Periods close together might mean two periods in one month. This is caused by hormone shifts leading to short cycles. It’s common to have another period as soon as three weeks after a previous one.

Brown or Dark Blood

Blood will appear dark or brown when it’s old blood leaving the body. Blood that quickly leaves the body will appear bright red, which is the typical color of normal periods. Sometimes blood can stay in the uterus longer, and during this time it becomes oxidized. This causes the blood to change color.

This occurs during perimenopause, ovulation, or early pregnancy. During perimenopause, it’s common because of hormonal imbalance. The uterine lining breaks down differently, so blood can be in the uterus longer.

Perimenopause and Pregnancy

Pregnancy is more difficult during perimenopause, but it’s not impossible. The chance of getting pregnant during perimenopause is lower but still possible.

The National Center for Health Statistics reported 840 births of women 50 years and over in 2017. Furthermore, the birth rate for women 45 and older was 0.9 births per 1,000 women. This means if you’re going through perimenopause and if sex with your partner could result in pregnancy previously, birth control is still needed.

What You Can Do

Period changes and physical symptoms related to perimenopause can interfere with daily life. Thankfully, there are ways to cope with these changes and live a more comfortable life during perimenopause.

Since perimenopause symptoms are unpredictable, it’s best to plan. This includes preparing for hot flashes by wearing light clothing, bringing extra tampons or pads with you, and drinking in moderation.

Additional treatments and lifestyle changes include:

  • Keeping up with exercise
  • Quitting smoking
  • Maintaining a healthy weight
  • Using a lubricant or vaginal moisturizer
  • Starting hormone replacement therapy
  • Taking a non-hormonal medication

When to See a Doctor

Speak with your healthcare provider if you’re experiencing any of these:

  • Abnormal length of period
  • Abnormal heaviness of period
  • Spotting
  • Bleeding with intercourse

While these are common during perimenopause and usually not a cause for concern, it’s best to keep your doctor in the loop and notify them of any changes. Anytime you’re unsure or concerned about perimenopause symptoms, speak with your doctor.

Frequently Asked Questions

How long is too long for a period during perimenopause?

Long cycles are common during perimenopause and can be as long as 38 days or more. If you’re experiencing one, speak with your doctor.

How do you get pregnant during perimenopause?

Pregnancy is rare but still possible during perimenopause. Since you haven’t reached menopause yet, ovulation is still happening and there is a small chance of getting pregnant.

How do you know when perimenopause is coming to an end?

Signs of perimenopause ending are an increase in symptoms, such as hot flashes and night sweats, and a decrease in bleeding. If you see fewer periods and more irregularity, this is a sign that you’re near menopause and the end of perimenopause.

Summary

Periods will still happen during perimenopause, but they may be different from what you’ve experienced before. They could be lighter, heavier, shorter, or longer. You may also notice brown or black blood. These are all normal changes that are part of perimenopause. However, if you have heavy bleeding or are concerned about any of these changes, talk to your healthcare provider.

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  2. Centers for Disease Control and Prevention. Births: final data for 2017. National Vital Statistics Reports. 2018;67(8):1–50.