Perimenopause Periods: What to Expect…

Whether you’re approaching perimenopause or already in the throes of these changes, you may wonder what to expect, what’s considered “normal,” and when you should seek medical advice.

One of the biggest questions is what to expect from your monthly menstrual cycle. Many of us might expect a gradual wane, but the reality can be more turbulent than that.

Let’s try to explain...

What Is Perimenopause

The time before menopause is known as perimenopause. It can last anywhere between 1 and 10 years. Perimenopause means “around menopause.”

This is a transitional time for the body (like puberty) and refers to the time your body is making a transition from fertility to menopause, which marks the end of your reproductive years. Perimenopause is sometimes called the menopausal transition.

According to the Mayo Clinic, “You may notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. But some women notice changes as early as their mid-30s.”

From a hormonal standpoint, perimenopause is characterized by irregular estrogen and progesterone levels. These changes to your hormone levels can cause many symptoms. If you experience perimenopausal symptoms that are severe (such as mood swings or hot flashes), you might want to ask your healthcare provider for advice. Among those symptoms are changes in your menstrual period.

Perimenopausal Symptoms and Characteristics

When perimenopause occurs, a common symptom is changes to your periods. Some of these changes can be extreme opposites of each other, from lighter periods to heavier periods. This is caused by the extreme fluctuation of your hormone levels. 

Some women may experience all of these changes, others will just experience some perimenopausal symptoms. Below are some of the possibilities. If it reads like perimenopause is a bit of a rollercoaster ride, that’s not surprising—many feel that way!

Less Frequent or Irregular Periods

Because you will start ovulating less as you approach menopause, your entire cycle may not run like clockwork anymore. This can mean less frequent, irregular periods—including skipped months.

These perimenopause symptoms will increase as perimenopause progresses. This is part of the reason why a healthcare provider will wait a full 12 months before confirming that you have passed into menopause.

Spotting or Lighter Periods During Your Menstrual Cycle

Due to hormonal changes, perimenopausal symptoms include very light periods or spotting between periods.  

Considering irregular periods are common at this stage, it can be easy to mistake perimenopausal symptoms for menopause. It’s worth tracking your menstrual cycles and any irregular bleeding in a journal or app so you and your doctor can understand what stage you’re in. 

Longer Periods or Heavy Bleeding

As irregular periods become more common, sometimes the lining of the uterus has more time to become thicker. This means that when your uterus sheds its lining, there will be a longer and heavier period. 

If periods become excessively heavy, health risks could include anemia. But abnormal uterine bleeding might be a symptom of something else. So, monitor your cycle and determine if you need to talk to a healthcare provider. Learn more about heavy bleeding here.

Can You Still Get Pregnant?

Even as your menstrual cycles become less regular, it is important to know that you’re still ovulating (even if it’s infrequent). As long as you’re ovulating and having periods, you can become pregnant.

If you want to avoid pregnancy, use birth control until you've entered menopause (i.e., you’ve had no periods for 12 months).

Other Symptoms of Perimenopause

Other common symptoms of perimenopause include:

Hot Flashes

Hot flashes are commonly associated with menopause. According to the Mayo Clinic, “The cause of hot flashes isn't known, but it's likely related to several factors. These include changes in reproductive hormones and in your body's thermostat (hypothalamus), which becomes more sensitive to slight changes in body temperature.”

Night Sweats

Hot flashes that occur while sleeping are called night sweats. Nighttime hot flashes can have the added complication of causing sleep problems such as insomnia.

Vaginal Dryness

Vaginal or endometrial atrophy occurs in some women after menopause. The body produces less estrogen after menopause, which can lead to the thinning, drying, and inflammation of the vaginal walls. This process can begin during early perimenopause, resulting in dryness and a change in sexual function.

Changes in Sexual Desire or Satisfaction

Some women report changes in sexual desire and arousal due to fluctuating hormones.

Sleep Problems

Apart from night sweats, general sleep can become unpredictable during perimenopause and the menopausal transition.

Bone Loss

The hormone estrogen can protect your bones. With declining estrogen levels, your bone density may decrease as you start to lose bone more quickly than you replace it. For some, this can lead to an increased risk of osteoporosis—a disease that causes fragile bones in women—as you reach menopause. 

Bladder Problems

Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

Heart Disease

As estrogen levels drop during perimenopause, cholesterol levels can change, creating greater risk of cardiovascular disease, or CVD (especially when combined with other risk factors and family history). According to the US Cardiology Review, “CVD is traditionally thought of as being a problem of middle-aged men, but in fact CVD affects just as many women as men—if not more—albeit on average a decade later. This delay is thought to be due to the protective effects of estrogen that occur in the years before the menopause. As estrogen levels drop, often from the mid-40s onwards, the protective effect is lost and changes occur that lead to an increased risk of heart disease in the ensuing years.”

Symptom Relief

If you’re finding these changes difficult to tolerate or you’re feeling uncertain about what’s happening, it’s definitely worth chatting with a healthcare provider to discuss managing symptoms.

There are a range of treatments you can explore together. The majority of women would prefer to manage these changes through lifestyle, and your doctor will certainly recommend ways to adjust your lifestyle to mitigate the symptoms of perimenopause.

These changes might include:

• Healthy diet: Of course, a healthy diet has many benefits for your body, but some of the symptoms of perimenopause and menopause are more severe when you don’t maintain a healthy lifestyle. Dairy products and dark leafy greens are rich in vitamin D and calcium, which can help with other symptoms. 
• Regular exercise, including strength training: Staying fit and flexible can mitigate some of the symptoms associated with this time of life. Strength training in particular can help maintain strong bones, which can help offset the decrease in estrogen and its effect on bone density for women.
• Stop smoking: Smoking can increase the risk of many diseases, including cardiovascular disease. 
• Less alcohol: Alcohol consumption can worsen the effects of hot flashes or night sweats, so abstaining or drinking less can help bring relief to those symptoms.
• Vaginal lubricants: These can help with vaginal dryness.
• Leakproof underwear: If you’re experiencing irregular cycles, spotting between periods, or bladder control issues, leakproof underwear can provide you with extra reassurance and confidence.
• Supplements: According to the American College of Obstetricians and Gynecologists, “Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness.” Always talk to your doctor about taking new supplements, including over-the-counter supplements.

Written by Jane Flanagan — Updated on April 5, 2022.

We hope you found this post informative — but remember: we’re not doctors and this post is not medical advice! While all posts are fact-checked and well researched, we always recommend you chat with your doctor about any questions or concerns you might have regarding a medical condition. We’re here to support and educate, but never with the aim of disregarding professional medical advice you’ve been given. Phew, now that that’s out of the way, you can go on living unapologetically free.