What To Expect: Perimenopause Periods

You’ve probably heard of menopause. But are you familiar with perimenopause?

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If not, here’s a quick primer. While menopause is defined as 12 consecutive months without a menstrual period, perimenopause is the five to seven years before your period stops completely.

During this time, you may experience changes in your menstrual cycle due to your ovaries producing less hormones. These irregularities can include:

Longer cycles.
Shorter cycles.
Missed periods.
Spotting between periods.
Heaving bleeding.

It’s a complicated process that differs from person to person. And it can be challenging to keep track of when you may have your period, leaving you frustrated and concerned about the changes your body is going through.

Ob/Gyn Sharon Sutherland, MD, explains how your period will change during perimenopause and what other symptoms you may experience.

Can you be perimenopausal and still have periods?

Yes. Typically, the first sign that you’re in perimenopause is irregular periods.

Most people enter perimenopause in their mid-40s. But some people may begin perimenopause in their mid-30s or as late as their mid-50s.

Because the levels of estrogen and progesterone go up and down in your body during perimenopause, when you have your menstrual cycle will vary.

Perimenopause is the amount of time when your menstrual cycles are unpredictable. And it’s a natural progression that signals that your body is preparing to enter menopause.

On average, most people will be in perimenopause for about four years — although for some, it can only last a few months. Once you’ve gone 12 straight months without having a period, you’re in menopause.

What are periods like during perimenopause?

The short answer? All over the place. Your menstrual cycle may be longer one month and then shorter the next.

“The root cause is the fact that ovulation becomes less reliable,” says Dr. Sutherland. “You’re not ovulating routinely every month, and that’s when your period starts to change.”

You may even miss a period for a month or two and then have it monthly for a while. And the flow of your periods can change between being normal, lighter and heavier.

How long are menstrual cycles during perimenopause?

There isn’t a one-size-fits-all answer. The length of each period can vary. A typical menstrual cycle lasts three to five days. Maybe you have a short period (two days or fewer) or your periods become longer (eight days or more).

And when you have a period will change as well.

“The timing between the beginning of one period to the beginning of the next will likely vary,” says Dr. Sutherland. “Some people have double periods every month, and then they just suddenly stop. But for most people, the periods will start to space out. So, maybe they’ll have a period every two to three months, maybe eventually it’ll go to six months.”

It’s possible that you can go from having 12 periods a year to eight periods a year, then four periods a year. Over time, you will just get them less frequently.

Are PMS symptoms more severe during perimenopause?

They can be, says Dr. Sutherland.

Due to hormonal fluctuations, you may experience symptoms like you did during your teenage years. And you may also start experiencing some menopause-like symptoms.

Symptoms can include:

Cramps.
Breast tenderness.
Headaches.
Fatigue.
Hot flashes.
Vaginal dryness.
The need to urinate more frequently.
Trouble sleeping.
Changes in mood, like irritability, depression and mood swings.

But in some cases, symptoms may be absent.

“If you aren’t ovulating, sometimes, you may not have the typical PMS symptoms like breast tenderness or cramping,” notes Dr. Sutherland. “So, you may not necessarily have warning that your period is coming, you just suddenly start to bleed.”

But there are things you can do at home to help reduce symptoms related to perimenopause. For example:

Eat a well-balanced diet.
Exercise, including weight-bearing activities like walking, hiking and strength training.
Quit smoking.
Improve your sleep hygiene.
Limit alcohol and caffeine.
Maintain a healthy weight.
Practice stress management techniques like meditation and deep breathing.

When to see a doctor

While changes to your menstrual cycle are to be expected when you’re in perimenopause, that doesn’t mean you shouldn’t talk to a doctor about any symptoms that may be concerning.

Other conditions, like uterine fibroids, and pregnancy and birth control pills can cause abnormal bleeding. It’s time to see your doctor if you notice the following: