Perimenopause and Periods

 While perimenopause is different for everyone, the majority of women will start experiencing cycle changes during their 40’s.

Understanding that normal cycle changes occur during perimenopause can help women prepare for the unpredictability associated with this transitional phase.

The hormonal changes associated with perimenopause cause less frequent ovulation, with the most common shift in the menstrual cycle being that a woman begins to have fewer monthly periods. Because ovulation may not occur every month during perimenopause, the body produces smaller quantities of the hormone progesterone, which can cause a longer build up of the uterine lining, leading to less frequent and heavier periods.

The consistency between monthly periods may also vary greatly, with some women changing unpredictably from month to month, experiencing fluctuations such as heavy periods one month, to no period the next. Generally, women experience lighter and less frequent periods as they enter menopause, which eventually causes a woman’s periods to stop altogether.

To help understand these hormonal fluctuations, we’ve put together a list of the most common perimenopausal period changes to help you prepare for the change.

1. Menstrual cycle colour (brown or dark blood)

Menstrual blood flow normally changes during a cycle, starting with bright red and changing to dark brown at the end of your period. Bright red blood indicates fresh blood and brown or dark blood is generally a sign of old blood, that has stayed in the uterus long enough to react with oxygen and oxidize.

Hormonal changes can also affect the colour and texture of the menstrual flow, making it either thin and watery, or thick and clumpy. 

Tips:

While period colour variation is normal during a cycle, due to the amount of time it takes for blood and tissue to pass out of the body, it may also be a sign of other underlying conditions. If vaginal discharge has a foul smell, it could be a sign of an infection. If in doubt, discuss this with a trusted healthcare provider.

2. Heavy bleeding

When estrogen levels are high, or if a cycle is missed, the uterine lining builds up, resulting in heavier bleeding.

Heavy bleeding during a cycle can cause physical discomfort (cramps), fatigue, and impact on everyday life. In extreme cases it can also increase the risk of developing anaemia.

What heavy bleeding looks like:

• Changing tampons or pads (soaked through) every hour for several hours in a row

• Using double protection of tampons and pads to stem flow

• Need to change tampon or pad during the night

• Bleeding lasts for more than eight days

Tips:

If you are experiencing heavy blood flow, talk to a trusted healthcare provider as soon as possible, about different approaches to support symptoms.

3. Shorter cycles

When estrogen levels are low, the uterine lining is generally thinner, resulting in shorter and lighter periods. Shorter cycles are are often common in the early stages of perimenopause, varying in both period length (2-3days) and cycle length (2-3 weeks).

Tips:

Use of tampons and menstrual cups may be difficult and uncomfortable with a lighter flow, as there is less lubrication. Keep pads or panty liners to hand to ensure you don’t get caught out.

4. Longer cycles

Towards the end stages of perimenopause, cycles may become longer (more than 36 days) and further apart. They are related to anovulatory cycles, in which ovulation does not occur.

Tips: 

Again, keep tampons, pads or panty liners to hand to ensure you don’t get caught out. Tracking your periods is a great way to identify and prepare for any cycle changes (I.e. cycle length, how light or heavy they are, and any spotting). We recommend using an app like Kindara to keep track of your cycle.

5. Spotting

Small amounts of blood in your underwear between periods that does not require a pad or tampon is likely due to spotting, which is normally caused by changing hormones and endometrium buildup. It is not uncommon for women to spot before and after their periods, and around mid-cycle with ovulation.

If spotting is occurring more frequently, it may be a sign of hormonal imbalance. If concerned, you may wish to discuss this with a trusted healthcare provider.

Tips:

Tracking your periods is a great way to identify and prepare for any cycle changes. If you are concerned about staining from spotting, consider wearing panty liners to prevent this.

6. Missed cycles

As perimenopause progresses, fluctuating hormones can also cause missed cycles. After 12 consecutive months without a period, you’ve reached menopause.

If cycles are still infrequently occurring, ovulation is still occurring. It is important to remember that if you are still getting a period, you can still get pregnant.

Tips:

While missed cycles are not of concern during this phase, they can make it hard to know if or when a period will come. Track your period and also keep tampons, pads, or panty liners on hand to ensure you don’t get caught out.

7. When to seek assistance and advice

If you are experiencing symptoms that are causing physical discomfort, or impacting on your daily life, we encourage you to seek professional advice about ways best to support you. Any abnormal symptoms or concerns should be discussed with your health care professional.

If you are experiencing any of the following, we advise you to speak with a trusted healthcare professional as soon as possible:

• Changing tampons or pads (soaked through) every hour for several hours in a row

• Bleeding that lasts for more than eight days

• Bleeding that occurs more frequently than every three weeks

What Next?

If you are experiencing discomfort caused by perimenopausal period symptoms and would like advice and support, contact us today to find out how we can support you through the perimenopausal phase.

The Holland Clinic is experienced in supporting female hormones, so if you want to feel vital again, contact us today to book your initial consultation on (03) 9388 8950