Let's talk about perimenopause and periods. Even for women who've long had a cycle that comes like clockwork each month, periods can start to change drastically as hormone levels shift and the body prepares to stop ovulating.
In other words, one of the hallmark symptoms of perimenopause is period changes – specifically, menstrual cycle irregularity. But you don't have to go through this weird phase in the dark. We talked with Dr. Brooke Faught, DNP, to learn more about the common period changes that happen during perimenopause, how long they last, her top tip for managing the unpredictability, and when to discuss period changes with your healthcare provider.
Why Do Perimenopause Period Changes Happen?
Thinking about the definition of perimenopause can help us understand why periods start to become less regular during this time. "Perimenopause is the time beginning in the late child-bearing years leading up to the actual point of menopause, or the discontinuation of periods," Dr. Faught explains.
As a woman nears menopause, her ovaries begin to function less efficiently compared to her 20s or 30s. "Ovulation is the regulator of menstrual cycles, and when ovulation does not occur or becomes irregular, it leads to a disruption in consistent monthly periods," says Dr. Faught.
When Do Periods Change in Perimenopause, On Average?
"The average age of menopause – the moment in time when you’ve gone 12 consecutive months without a period – is 51, but every woman's experience with perimenopause varies," Dr. Faught notes. It's not uncommon for a woman to begin noticing changes to her menstrual cycle as early as her late 30s. On the other hand, irregular periods can continue through much of a woman's 50s, she explains.
What Can You Expect from Your Period During Perimenopause?
"Perimenopause menstrual changes are like snowflakes," Dr. Faught says. In other words, every woman's experience will be unique. That said, there are some common themes that most of us will notice.
During perimenopause, many women notice that their periods become less consistent and predictable. "Cycles can become shorter or longer, and sometimes heavier or sometimes lighter," explains Dr. Faught. It's also normal to go a month or two (or more) without having a period at all, or even to have two periods in one month, she notes.
If you typically deal with symptoms of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), these can become exaggerated and last for more of your cycle. "PMS and PMDD are due to hormonal fluctuations experienced just prior to the onset of a period," Dr. Faught explains. "So, with regard to perimenopause, the changes to ovulation lead to more erratic hormonal fluctuations, which explains most of the common perimenopausal symptoms. I describe perimenopause as 'PMS on steroids.'"
Do Period Changes Become More Noticeable as You Get Closer to Menopause?
A woman may notice that her periods become more irregular as ovary function continues to decline. But that's not always the case. "Some women menstruate normally until their very last period and then it [their period] simply never returns," says Dr. Faught.
And because perimenopause symptoms can persist for years, changing periods don't necessarily indicate that menopause is right around the corner, Dr. Faught notes. In fact, if you're still getting a period, it'll be at least another 12 months until you've officially reached menopause. "Menopause is really a one-day event, it's the one-year anniversary of the last menstrual period," she says.
What About Birth Control – Do Women Still Need to Use It Once Their Periods Start Changing?
Yes. Women who are sexually active should use a reliable form of birth control until they've gone 12 full months without a menstrual period, Dr. Faught says. In fact, birth control in perimenopause may be even more important compared to when a woman's periods were more regular. "While fertility declines throughout the later childbearing years, the potential for pregnancy still exists. And with irregular periods, natural family planning methods become more difficult," Dr. Faught explains.
Is There Anything That Can Make It Easier to Cope with Period Changes During Perimenopause?
One of the simplest things you can do is track your periods using an app or calendar. It won't make your periods more regular, of course, but it can help you stay on top of what's happening with your cycle. "You never know when your last period will be your last period," says Dr. Faught. Tracking the dates can help you determine when you've officially reached menopause, she says.
If irregular bleeding becomes bothersome or intrusive, talk with your healthcare provider. "There are remedies and treatments available, however, I caution against trying over-the-counter products without appropriate healthcare provider guidance," Dr. Faught says.
When Should You Bring Up Period Changes with Your Healthcare Provider?
Though it's normal to experience period changes and unpredictability during perimenopause, very heavy bleeding or clotting raises a red flag. "Having to change your pad or tampon more than once an hour warrants medical evaluation," Dr. Faught says. You should also let your provider know if you experience period or perimenopause symptoms that are intrusive or impact your daily functioning. "These should be addressed rather than simply be tolerated, as there may be treatment options available to help minimize symptoms," she says.
After a woman has gone a full year without a period and has officially reached menopause, subsequent bleeding or spotting should be brought up to her practitioner. "Any vaginal bleeding after menopause is considered a concerning finding that warrants evaluation with a woman's healthcare provider," says Dr. Faught.