I often joke that during perimenopause, it’s almost as your period becomes more intense and problematic so when menopause finally comes, you’re ready for it to end. I’ve had patients describe liken their periods to a flood or a “gusher” so some of the period changes can be quite disruptive.
In fact, the only consistent symptom of perimenopause is a change in menstruation. These changes can vary in intensity and duration, but understanding what constitutes “normal” helps you decide if something needs to be medically tested or treated and better navigate this phase of life. So let’s discuss what normal really looks like during perimenopause.
Normal Period Changes During Perimenopause
- Irregular Cycles: One of the hallmark signs of perimenopause is a change in the regularity of menstrual cycles. Periods may come more frequently, or they may become spaced further apart. Generally speaking, women in earlier perimenopause tend to have shorter cycles. They may have had consistent 30 day cycles for decades and now their cycles are 22 days apart. Once you get closer to late perimenopause, periods tend to space out, often going months without bleeding. These changes are completely normal and expected in perimenopause.
- Changes in Flow: As estrogen levels fluctuate, the amount of menstrual bleeding can also change. Some women may experience heavier periods, while others may have lighter flows. Heavy periods, known as menorrhagia, can occur when the lining of the uterus grows thicker due to elevated estrogen levels. Though this could also be due to fibroids, which commonly grow during perimenopause due to the fluctuation of hormones. This variability in flow is typically a natural part of perimenopause, but excessively heavy bleeding or prolonged periods should be assessed by a healthcare provider as excessive bleeding can lead to anemia. Usually lighter flow is seen in late perimenopause whereas heavier flow generally occurs in early to mid-perimenopause.
- Shorter or Longer Periods: In addition to changes in frequency and flow, the duration of periods may change. Some women experience shorter periods, while others may find that their periods last longer than before. A normal period lasts between 3 to 7 days, but during perimenopause, some women may notice that their periods extend beyond this range. A common theme is longer periods in early to mid-perimenopause but then they tend to shorten as you get closer to late perimenopause.
- Missed Periods: A common sign of perimenopause is the occasional missed period. As the body approaches menopause, ovulation becomes less predictable, leading to missed periods or irregular intervals between them. This can sometimes be mistaken for pregnancy, especially if there are other symptoms such as nausea or fatigue. However, missed periods are usually part of the perimenopausal transition and occur with more frequency as you get closer to late-perimenopause.
|
Symptom |
Early/Mid-Perimenopause | Late-perimenopause |
| Cycle length | shorter (<25 days) | longer, can go months between periods |
| Period flow | heavier | lighter |
| Period length | longer | shorter |
| Missed periods | infrequent but can occur | occurs regularly |
Coping with Period Changes
Though menstrual changes during perimenopause are often part of a natural process, they can still be disruptive. Here are some strategies for managing symptoms:
- Track Your Periods: Keeping a record of your cycle, including frequency, flow, and duration, can help you and your healthcare provider identify any unusual patterns. It’s so easy to forget all the details of your period when you’re trying to go about your day-to-day life so tracking is an easy way to have objective data as to what’s going on.
- Get Tested: If the changes are getting too disruptive, one step in getting a better understanding what’s going on is getting hormone testing. As we’ve discussed previously, hypothyroidism can mimic a lot of perimenopause symptoms, including period changes so it can sometimes exacerbate the problem.
- DIM: Diindolylmethane (DIM) is a natural compound found in cruciferous vegetables such as broccoli, cauliflower, and cabbage. Estrogen dominance is a common occurrence in perimenopause. As you get closer to your period officially ending, ovulation occurs less frequently until it stops completely. This is normal but without ovulation, you don’t make high levels of progesterone. With estrogen still present but low levels of progesterone, this leads to a state called estrogen dominance that can cause frequent, heavy, and painful periods. DIM helps your body metabolize and remove excess estrogen, which can help alleviate some of those symptoms.
- Yarrow (Achillea millefolium): Herbs can be an important component of navigating perimenopause. Yarrow is a styptic herb meaning is helps to slow the flow of bleeding. It can be taken to help shorten a long period or help reduce the amount of bleeding during a period. I’ve had someone women go from heavy 3 week-long periods back to a manageable 5 day period thanks to Yarrow. Thankfully Yarrow is generally safe but those with allergies to other plants in the Asteraceae family may need to be careful.
When to Seek Medical Advice
While many changes in menstruation during perimenopause are normal, there are certain symptoms that warrant medical attention:
- Heavy bleeding: Soaking through one or more pads or tampons in an hour, or experiencing periods lasting more than 7 days, should be evaluated by a healthcare provider.
- Severe pain: Intense cramping or pelvic pain, particularly if it is new or different from typical menstrual discomfort, should be assessed.
These symptoms could signal conditions such as fibroids, polyps, endometrial hyperplasia, or even cancer, so it is important to get an evaluation if these symptoms arise.
Menstrual changes during perimenopause are a normal and expected part of the transition to menopause. Although the variations in cycle length, flow, and duration can be unsettling, most are short-term and a natural part of the process. By understanding what’s normal and knowing when to seek help, you can navigate this transition with more confidence, assured that your body is functioning as it should, even during this challenging time.