Perimenopause is a transitional stage in a woman’s reproductive life. It usually begins during your mid-to-late 40s, though it can start earlier. During this time, your ovaries begin to produce less estrogen.
Although “the change” is usually associated with hot flashes, it can cause everything from headaches and breast tenderness to changes in your menstrual period.
These symptoms usually last for about four years before your period stops completely. Your body will transition from perimenopause to menopause after 12 months without any bleeding or spotting.
Keep reading to learn more about what you can expect during perimenopause and how it may affect your monthly period.
Perimenopause can make your once-regular periods suddenly irregular.
Before perimenopause, your estrogen and progesterone levels rise and fall in a consistent pattern during your menstrual cycle. When you’re in perimenopause, hormone changes become more erratic. This can lead to unpredictable bleeding patterns.
During perimenopause, your periods may be:
- Irregular. Rather than having a period once every 28 days, you might get them less or more often.
- Closer together or further apart. The length of time between periods can vary from month to month. Some months you might get periods back to back. In other months, you might go more than four weeks without getting a period.
- Absent. Some months you might not get a period at all. You might think you’re in menopause, but it’s not official until you’ve been period-free for 12 months.
- Heavy. You may bleed a lot, soaking through your pads.
- Light. Your bleeding might be so light that you barely need to use a panty liner. Sometimes the spotting is so faint that it doesn’t even look like a period.
- Short or long. The duration of your periods can change, too. You might bleed for just a day or two or for more than a week at a time.
In the years leading up to menopause, your ovaries stop ovulating regularly. As ovulation becomes infrequent, the hormones produced by the ovaries — estrogen and progesterone — also begin to fluctuate and decline. These hormones are typically responsible for regulating the menstrual cycle.
As these hormonal changes take place, it can have an effect on more than just your period. You may also experience:
- breast tenderness
- weight gain
- difficulty concentrating
- muscle aches
- urinary tract infections
- changes in mood
- decreased sex drive
While it’s difficult to estimate how long these symptoms will last, they can be expected to continue well into menopause. This can be anywhere from a few months to as many as twelve years from when symptoms first begin.
When you’re in perimenopause, it’s normal for your periods to be irregular and to come closer together. But sometimes these abnormal bleeding patterns can signal an underlying problem.
See your doctor if:
- bleeding is unusually heavy for you or you soak through one or more pads or tampons in an hour
- you get your period more often than every three weeks
- your periods last longer than usual
- you bleed during sex or between periods
Although abnormal bleeding in perimenopause is usually due to hormone fluctuations, it could also be a sign of:
- Polyps. These are growths that form in the inner lining of the uterus or cervix. They’re usually noncancerous, but they can sometimes turn into cancer.
- Fibroids. These are also growths in the uterus. They vary in size from tiny seeds to masses large enough to stretch the uterus out of shape. Fibroids usually aren’t cancerous.
- Endometrial atrophy. This is thinning of the endometrium (lining of your uterus). This thinning can sometimes cause bleeding.
- Endometrial hyperplasia. This is thickening of the uterine lining.
- Uterine cancer. This is cancer that starts in the uterus.
Your doctor will do an exam to check for causes of abnormal perimenopausal bleeding. You might need one or more of these tests:
- Pelvic ultrasound. For this test, your doctor uses sound waves to create a picture of your uterus, cervix, and other pelvic organs. The ultrasound device can be inserted in your vagina (transvaginal ultrasound) or placed over your lower belly (abdominal ultrasound).
- Endometrial biopsy. Your doctor will use a small tube to remove a sample of tissue from your uterine lining. That sample goes to a lab to be tested.
- Hysteroscopy. Your doctor will place a thin tube that has a camera on the end through your vagina into your uterus. This allows your doctor to see the inside of your uterus and to take a biopsy if needed.
- Sonohysterography. Your doctor will inject fluid into your uterus through a tube, while an ultrasound takes pictures.
Which treatment your doctor recommends depends on the cause of your abnormal bleeding and how much it’s affecting your quality of life.
If the bleeding is due to hormones and it doesn’t interfere with your daily life, wearing a thicker pad or tampon and carrying around an extra pair of underpants may be enough to get you through this perimenopausal phase.
Hormone therapies, including birth control pills or an intrauterine device (IUD) may also help. This can help both to lighten your periods and to keep them regular by preventing your uterine lining from thickening too much.
Growths like fibroids or polyps may need treatment if they’re causing symptoms. Polyps can be removed with hysteroscopy. There are a few procedures that can remove fibroids:
- Uterine artery embolization. Your doctor injects medicine into the arteries that supply blood to the uterus. The medicine cuts off blood flow to the fibroids, causing them to shrink.
- Myolysis. Your doctor uses an electric current or laser to destroy the fibroids and cut off their blood supply. This procedure can also be done using intense cold (cryomyolysis).
- Myomectomy. With this procedure, your doctor removes the fibroids but leaves your uterus intact. It can be performed using small incisions (laparoscopic surgery) or with robotic surgery.
- Hysterectomy. With this procedure, your doctor will remove the entire uterus. It’s the most invasive procedure for fibroids. Once you have a hysterectomy, you won’t be able to get pregnant.
You can treat endometrial atrophy by taking the hormone progestin. It comes as a pill, vaginal cream, shot, or IUD. The form you take depends on your age and the type of hyperplasia you have. Your doctor can also remove thickened areas of your uterus with hysteroscopy or a procedure called dilation and curettage (D and C).
The main treatment for uterine cancer is to have a hysterectomy. Radiation, chemotherapy, or hormone therapy can also be used.
As you progress through the perimenopausal stage and into menopause, your periods should occur less and less frequently. Once menopause has begun, there shouldn’t be any bleeding at all.
If you’re experiencing any unexpected bleeding or other menstrual changes, talk with your doctor. They can determine whether these changes are tied to perimenopause or if they’re a sign of another underlying condition.
Also keep your doctor informed about any other perimenopause symptoms you may be experiencing. The more they know, the more beneficial your care plan will be.