Menopause refers to the end of your menstrual cycle. Once you’ve gone 12 months without a period, you’ve reached menopause. This usually happens between the ages of 45 and 55.

The time period before menopause is called perimenopause.

Perimenopause symptoms can last anywhere from 1 to 10 years. During this time, the hormones estrogen and progesterone are in flux. Your levels will fluctuate from month to month. These shifts can be erratic, affecting ovulation and the rest of your cycle. You may notice anything from irregular periods to different bleeding patterns to missed periods.

Other symptoms of perimenopause include:

  • hot flashes
  • night sweats
  • sleep troubles
  • memory issues
  • difficulty urinating
  • vaginal dryness
  • changes in sexual desire or satisfaction

Keep reading for more on what to expect from your periods, as well as what you can do to manage your symptoms.

If you notice some blood on your underwear between periods that doesn’t require the use of a pad or tampon, it’s likely spotting. Spotting usually results from your body’s changing hormones and endometrium buildup.

Many women spot before their period starts or as it ends. Mid-cycle spotting around ovulation is also common.

If you’re regularly spotting every two weeks, it may be a sign of hormonal imbalance. You may want to speak with your healthcare provider.

What you can do

Consider keeping a diary to track your periods. Include information such as: when they start, how long they last, how heavy they are, and any in-between spotting. You can also log this information in an app, like Eve.

Worried about leaks and stains? Consider wearing panty liners. Disposable panty liners are available at most corner drug stores. They come in a variety of lengths and materials. You can even buy reusable liners, like Lunapads, that are made of fabric and can be washed over and over again.

When your estrogen levels are high in comparison to your progesterone levels, your uterine lining builds. This results in heavier bleeding during your period as your lining sheds.

A skipped period can also cause the lining to build up, creating heavy bleeding.

Bleeding is considered heavy if it:

  • soaks through one tampon or pad an hour for several hours
  • requires double protection — such as a tampon and pad — to control flow
  • causes you to change your pad or tampon during sleep
  • lasts longer than seven days

When bleeding is heavy, it may last longer, disrupting your everyday life. You may find it uncomfortable to exercise or carry on with your normal tasks. Heavy bleeding can also cause fatigue and increase your risk for other health concerns, like anemia.

What you can do

As you may know, taking ibuprofen (Advil) during your period can help with menstrual cramps. If you take it when you’re bleeding heavily, it may also reduce your flow by up to 30 percent. Try taking 200 milligrams every four to six hours during the day.

If cramps and pain continue, talk to your healthcare provider about hormonal approaches to treatment. Some women have a medical or family history that discourages the use of hormones in the perimenopausal period.

The colors you see in your menstrual flow can range from bright red to dark brown, especially toward the end of your period. Brown or dark blood is a sign of old blood exiting the body.

Women in perimenopause may also see brown spotting or discharge at other times throughout the month.

You may also notice changes in discharge texture. Your discharge may be thin and watery, or it may be clumpy and thick.

What you can do

If you’re concerned about your flow, you may want to schedule an appointment to see your doctor. The variation in color is usually due to the amount of time it takes for the blood and tissue to cycle out of the body, but it can sometimes be a sign of another underlying condition. If there is a foul order to the vagina discharge, this may be a sign of an infection. See your healthcare provider.

When your estrogen levels are low, your uterine lining is thinner. Bleeding, as a result, may be lighter and last fewer days. Short cycles are more common in the earlier stages of perimenopause.

For example, you may have a period that’s two or three days shorter than normal. Your whole cycle may also last two or three weeks instead of the standard four. It isn’t uncommon to feel like your period just ended when the next one comes.

What you can do

If you’re worried about short, unpredictable cycles, consider leakage protection like liners, pads, or period underwear like THINX.

Pass on tampons and menstrual cups unless you have a flow. Insertion can be difficult or uncomfortable without this lubrication. You’re also more likely to forget to change your tampon or cup, increasing your risk for complications.

In the later stages of perimenopause, your cycles may become much longer and farther apart. Longer cycles are defined as those longer than 36 days. They’re related to anovulatory cycles, or cycles in which you do not ovulate.

One study suggests that women who experience anovulatory cycles may have lighter bleeding than women who experience ovulatory cycles.

What you can do

If you’re dealing with longer cycles, it may be time to invest in a good menstrual cup or a cycle set of blood-wicking underwear. Or you may use pads or tampons to help you avoid leakage.

Your fluctuating hormones may also be to blame for a missed cycle. In fact, your cycles may become so far apart that can’t recall the last time you bled. After you’ve missed 12 consecutive cycles, you’ve reached menopause.

But if your cycles are still making an appearance — however delayed — ovulation is still occurring. This means you can still have a period, and you can still get pregnant.

What you can do

Missed cycles every so often usually aren’t cause for concern. But if you’ve missed a few consecutive cycles, you may want to take a pregnancy test to determine whether your symptoms are tied to perimenopause.

Other early signs of pregnancy include:

  • nausea
  • breast tenderness
  • frequent urination
  • smell sensitivity
  • heartburn

You can also make an appointment with your doctor in place of a home test. Your doctor can run blood tests to determine whether you’re experiencing symptoms of perimenopause, menopause, or pregnancy.

If you aren’t pregnant and don’t want to conceive, use birth control every time you have sex. Fertility doesn’t end until you’ve completely reached menopause. Use condoms as well to prevent sexually transmitted disease.

Between long cycles, short cycles, spotting, and heavy bleeding, your cycles during perimenopause may be generally irregular. They may not settle into any discernible pattern, especially as you get closer to menopause. This can be unsettling and frustrating.

What you can do

Try your best to remember that the changes you’re experiencing are a part of a bigger transition. Just as it began, the process will eventually end when you stop ovulating and reach menopause.

In the meantime:

  • Consider wearing black underwear or investing in period underwear to reduce your risk of ruined clothing.
  • Consider wearing disposable or reusable pantry liners to protect from irregular leaks, spotting, and otherwise unexpected bleeding.
  • Track your periods as best you can via an app, like Eve, or a calendar.
  • Take notes about abnormal bleeding, pain, discomfort, or other symptoms you’re experiencing.

In some cases, irregular bleeding may be a sign of another underlying condition.

See your doctor if you’re experiencing:

  • extremely heavy bleeding that requires you to change your pad or tampon every hour
  • bleeding that lasts longer than seven days
  • bleeding — not spotting — that happens more frequently than every three weeks

At your appointment, your doctor will ask about your medical history and about any symptoms you’ve had. From there, they may give you a pelvic exam and order tests, such as a blood test, ultrasound, or biopsy, to rule out more serious issues.