Perimenopause is the time when a woman’s body begins its shift into menopause, and it comes with a number of not-so-fun changes. One of the most surprising is irregular menstrual periods. While menopause is marked by the official end of menstruation after going a full year without a period, what precedes menopause is often several months (or years) of erratic periods that are longer and heavier than usual. Coupled with common perimenopause symptoms like hot flashes and changes in mood, this can make for a confusing and stressful time.
So what can be done about it? First and foremost, equip yourself with information — about perimenopause, in general, and long periods, specifically. Below is a starter kit, plus suggestions for mitigating the unpleasant menstrual symptoms that come with “the change.”
Why do periods change during perimenopause?
Some women begin to experience signs of perimenopause in their 30s, but it’s most common in the 40s. Dr. Jen Gunter, a gynecologist who quite literally wrote the book on menopause, explains the changes this way: “Menopause is puberty in reverse — a transition from one biological phase of ovarian function to another.” Think back to when you first started getting periods as a pre-teen or teenager — you may have experienced irregularities in your cycle, as your body settled into regular periods. In perimenopause, you’re transitioning into another pivotal phase, so you will likely see changes in your cycle as your body prepares you to stop menstruating entirely.
What period changes will I notice during perimenopause?
Perimenopause can last for a few years and is divided into an early phase and a late phase. Here’s how your period may change in each stage:
- Early perimenopause. “During the early phase, a woman is likely to see some of her cycles lengthen by seven or more days — or she may even skip an occasional menstrual period,” says Dr. Gunter. So, if you’re experiencing a longer time than usual in between periods, be aware that this is quite common in early perimenopause.
- Late perimenopause. By the time you’re in late perimenopause, you’ve likely already noticed symptoms and irregularities in your cycle. “The amount of blood lost with each menstrual period often increases during the menopause transition, which comes as a surprise to some women,” Dr. Gunter warns. Some women experience extremely heavy periods during this time. Heavy bleeding can be alarming — and while changes are to be expected, Dr. Gunter suggests you seek medical attention if you soak through two pads an hour in a two-hour timespan.
According to Harvard Women’s Health Watch, “with less progesterone to regulate the growth of the endometrium, the uterine lining may become thicker before it’s shed, resulting in very heavy periods.” As we get older, ovarian hormone production becomes irregular, so there is less progesterone, a decreased number of follicles, a decline in estrogen, and less frequent ovulation.
How can I mitigate changes in my periods during perimenopause?
Skipped periods, long periods, heavy periods — all of these potential changes to your cycle can be unpleasant. So what can be done to help you feel more comfortable? Here are some tricks for calming the rollercoaster of perimenopausal periods:
- Birth control pills. Because birth control pills suppress ovulation, they modulate menstrual flow and regulate periods, even in perimenopause, says Harvard Women’s Health Watch. They note that the pills can be taken until menopause.
- IUDs. An intrauterine device can also be effective in helping with the irregular bleeding that’s common in perimenopause. The Vancouver Clinic notes that “an IUD often decreases and may even stop menstrual bleeding,” meaning it could offer major relief in some cases.
- Hormone therapy. Some menopausal women choose hormone replacement therapy to manage symptoms; and depending on your experience, you may wish to look into HRT during perimenopause. According to the Mayo Clinic, “if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.” But, as in all cases of beginning a new medical treatment, consult with your doctor first to see if this is the right path for you.
- Over-the-counter medication. Drugstore ibuprofen pills like Advil and Motrin can ease the pain of menstrual cramps, but Northwestern Medicine says they may also calm a heavy flow when taken consistently.
- Supplements. There are a variety of supplements that purport to help symptoms of perimenopause. However, they are not regulated by the FDA, and may not work for all women.
- Exercise. The hormonal shifts of perimenopause can have a real impact on your mental health. While exercise won’t regulate your periods, staying active can help you feel more happy and fit.
- Mindfulness. Perimenopause is a stressful time. Mindfulness practices like meditation can help women dealing with irregular periods and other symptoms of perimenopause feel an increased sense of calm and well-being. A study of 1,744 women ages 40 to 65 undertaken by the Mayo Clinic found that participants who had higher “mindfulness scores” had fewer menopausal symptoms. Practicing mindfulness may help you mentally adjust to the changes of perimenopause and beyond.
The Bottom Line on Perimenopause Periods
If you’re early in perimenopause or haven’t yet experienced it, you may not realize just how irregular your periods can get. Whether your perimenopause journey includes long or skipped periods, extra-heavy bleeding, or other varieties of menstrual changes, remember that perimenopause symptoms (like so many feminine health issues) can vary greatly from one woman to the next. If you’re concerned about your periods in perimenopause, consider tracking your cycle and documenting anything that feels off; note when your periods start and end, the heaviness of your flow, and any instances of spotting between periods.
If you’re concerned about changes you’ve noted in your periods, speak with your gynecologist. They can help you understand what you’re going through and provide advice on potential treatment plans. The Office on Women’s Health suggests talking to your doctor if your cycle is longer than 38 days or shorter than 24 days. But no matter what kind of menstrual issues you experience during perimenopause, remember that irregularities are to be expected, and there are a number of ways to mitigate them.
Perimenopause can be hard on your body and your mood — but anticipating the symptoms and figuring out how to deal with them is empowering, and it will get you one step closer to feeling your best.