During perimenopause, your levels of the hormones estrogen and progesterone fluctuate. These changes can affect your cycle, leading to irregular or missed periods, and more.

Menopause refers to the end of your menstrual cycle. Once you’ve gone 12 months without a period, you’ve reached menopause.

The average woman goes through menopause at 51 years old. The time period before menopause is called perimenopause.

Perimenopause symptoms occur for 4 years, on average. However, perimenopause can last anywhere from a few months 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 or missed periods to different bleeding patterns.

Other symptoms of perimenopause include:

Here’s what you can expect from perimenopause and what you can do.

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 is usually the result of your body’s changing hormones and the buildup of your endometrium, or uterine lining.

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 2 weeks, it may be a sign of a hormonal imbalance. You may want to speak with your healthcare provider.

What you can do

Consider keeping a journal to track your periods. Include information such as:

  • when they start
  • how long they last
  • how heavy they are
  • whether you have 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 drugstores. They come in a variety of lengths and materials.

You can even buy reusable liners that are made of fabric and can be washed over and over again.

Products to try

If you deal with spotting between periods, using certain products can help you track your symptoms and avoid leaks and stains. Shop for them online:

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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, leading to 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 menstrual flow
  • causes you to interrupt your sleep to change your pad or tampon
  • lasts longer than 7 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, such as anemia.

What you can do

As you may know, taking ibuprofen (Advil, Midol, Motrin) during your period can help with menstrual cramps.

If you take it when you’re bleeding heavily, it may also reduce your flow. Try taking 200 milligrams (mg) every 4 to 6 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 menstrual 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’s a foul odor to the vaginal discharge, it may be a sign of 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 2 or 3 days shorter than normal. Your whole cycle may also last 2 or 3 weeks instead of 4. 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 such as liners, pads, or period underwear like Thinx.

Pass on tampons and menstrual cups unless you have a menstrual 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.

Products to try

If your periods are unpredictable, you can protect yourself from stains with leakage protection products. Shop for them online:

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In the later stages of perimenopause, your cycles may become much longer and farther apart. Longer cycles are defined as those longer than 38 days. They’re related to anovulatory cycles, or cycles in which you don’t ovulate.

A 2008 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. You can also use pads or tampons to help you avoid leakage.

Products to try

If you have a long cycle, a variety of products are available to help you avoid leakage. Shop for them online:

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

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.

Anovulatory cycles can also create delayed or missed periods.

What you can do

Missed cycles every so often usually aren’t cause for concern. 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 symptoms of pregnancy include:

You can also make an appointment with your doctor instead of taking a home test. Your doctor can run 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 and other barrier methods to prevent sexually transmitted infections (STIs).

Products to try

A missed period may actually be a sign of pregnancy, which can be confirmed with an at-home test. Shop for tests and condoms online:

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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 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 stained clothing.
  • Consider wearing disposable or reusable panty liners to protect from irregular leaks, spotting, and otherwise unexpected bleeding.
  • Track your periods as best you can via a calendar or an app.
  • Take notes about abnormal bleeding, pain, discomfort, or other symptoms you’re experiencing.

Products to try

If you’re having irregular periods, certain products can help you avoid leaks and stains and keep track of your symptoms. Shop for them online:

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

See your doctor if you’re also experiencing these symptoms:

  • extremely heavy bleeding that requires you to change your pad or tampon every hour or two
  • bleeding that lasts longer than 7 days
  • bleeding — not spotting — that happens more frequently than every 3 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, a biopsy, or an ultrasound) to rule out more serious issues.