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, which if severe, you might want to seek medical advice for. Among those symptoms are changes in your menstrual period.
Characteristics of Perimenopause Periods and Bleeding
During perimenopause, you may notice 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. 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 menstrual cycle may not run like clockwork anymore. This can mean less frequent periods, including skipped months.
These infrequencies will increase as perimenopause progresses. This is part of the reason why doctors wait a full 12 months before confirming that you have passed into menopause.
Spotting or Lighter Periods
Due to fluctuating hormones, you might experience very light periods or spotting between periods.
Considering periods become irregular at this stage, it can be easy to mistake the stage you’re in for menopause. It’s worth tracking your periods 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 periods become infrequent, 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, you may be at risk of anemia, or it might be a symptom of something else. So monitor your cycle and determine if you need to seek medical advice. Learn more about heavy bleeding here.
Can You Still Get Pregnant?
Even as your menstrual cycle becomes 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 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: Night sweats are hot flashes that occur while sleeping. They can have the added complication of disrupting sleep and causing 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. During perimenopause this process can begin, resulting in dryness.
- Changes in sexual desire or satisfaction: Some women report changes in sexual desire and arousal due to fluctuating hormones.
- Sleep troubles: Apart from night sweats, general sleep can become unpredictable during perimenopause and beyond.
- 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 increase the risk of osteoporosis — a disease that causes fragile bones in women.
- 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.
- Cardiovascular disease: Cholesterol levels can change during perimenopause creating greater risk of cardiovascular disease or CVD (especially when combined with other risk factors). 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 oestrogen that occur in the years before the menopause. As oestrogen 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.”
If you’re finding these changes difficult to tolerate or you’re feeling uncertain about what’s happening, it’s definitely worth chatting with your doctor.
There are a range of treatments you and she 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 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 Gynaecologists, “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.
If your symptoms are more severe and making lifestyle changes does not impact them, you and your doctor can explore other courses of action. These might include hormone replacement therapy (HRT) and even surgical options, including hysterectomy.
What’s Next? Symptoms of Menopause
Menopause happens when your menstrual cycle comes to a complete end. Given the irregularity of perimenopausal bleeding and periods, it can be difficult to judge when you’ve reached menopause.
In medical terms, once you’ve gone 12 months without a period, your doctor will consider you’ve reached menopause. This usually happens between the ages of 45 and 55. At this stage, you are no longer fertile, so birth control is no longer required to prevent pregnancy.
When to Seek Medical Advice
If you experience anxiety due to any changes you’re experiencing, or you’re uncertain whether your symptoms are medically concerning or not, it’s definitely worth seeking medical advice and reassurance.
It’s worth noting that perimenopause can manifest differently for every individual. Some people may breeze through it with aplomb. Others may really feel debilitated by these symptoms.
Generally, you should definitely seek medical advice if you experience any of the following bleeding symptoms:
- Very heavy bleeding: Keep track of how often you need to change your pad or tampon to determine if bleeding is heavy. If it requires you to change your pad or tampon every hour or you notice clots larger than the size of a quarter, you should definitely see your doctor.
- Prolonged abnormal bleeding: If your menstrual periods last longer than 7 days, there may also be cause apart from perimenopausal changes. A lot of blood loss can also put you at risk of anemia.
- Abnormal bleeding happening frequently: If you’re bleeding (not just spotting) more frequently than every three weeks, you should seek medical advice.
Perimenopause can be a challenging time for many women. As you approach the end of your reproductive years there may be at gamut of emotion to work through.
On top of this, there are physical changes to adjust to. If you experience symptoms that interfere with your life quality, it’s always worth seeing a doctor.
However, for the most part, it’s worth understanding that many of these changes are completely normal and expected at this stage of life.