One of the first and most common signs of perimenopause is irregular periods (1). Learn what causes irregular periods during perimenopause and how to manage these changes.

Causes of Irregular Periods During Perimenopause

During the reproductive years, menstrual cycles are usually regular and may last between 24 and 38 days. However, with the onset of perimenopause (the years leading up to menopause), irregular periods occur. (2)

In a normal menstrual cycle, the hormones estrogen and progesterone follow a regular pattern, leading to ovulation in the mid-cycle. If pregnancy doesn’t occur, menstruation usually starts approximately two weeks later. (2)

During perimenopause, the ovaries produce less estrogen, resulting in inconsistent egg release, leading to irregular periods with some months experiencing ovulation and others without (2).

During perimenopause, you may observe the following irregularities in your menstrual periods (3, 4):

• Less frequent periods. This happens due to less ovulation.

• Longer, heavier periods. This may occur due to the increased thickness of the uterine lining, which takes more time to shed during the menstrual cycle.

• Lighter and shorter periods. Estrogen causes the uterine lining to thicken. Lower estrogen levels can cause lighter and shorter periods.

• Spotting. The uterine lining may grow thicker than usual and cause spotting—some bleeding in between menstrual cycles.

• Irregularity or unpredictable patterns. This can include long cycles, short cycles, heavy bleeding, and spotting.

The most common change in the menstrual cycle is a decrease in the frequency of monthly periods. You may also observe changes in menstrual cramps and other menstrual-related symptoms. Eventually, the periods stop altogether. Menopause is typically recognized when menstrual periods have been absent for a continuous duration of one year. (3)

How to Manage Irregular Periods

Perimenopause is not only marked by irregular periods but also potential changes in mood due to hormonal fluctuations. The unpredictability of irregular periods and other perimenopause symptoms can heighten stress. Here are some tips to effectively manage irregular periods (3, 4):

• Track your periods and your symptoms. Keep a journal of your periods or use a period-tracking app. Note when periods start, how long they last, how light or heavy they are, and if there is any spotting or other symptoms.

• Consider period underwear. Period underwear looks like regular underwear but has a hidden layer to absorb menstrual blood and to prevent leaks.

• Exercise regularly. Exercise offers numerous physical and mental health benefits and can also help reduce bloating and cramps.

• Practice stress-relieving techniques. Activities like meditation, yoga, and deep breathing can help relieve stress or mood swings.

• Take over-the-counter pain medications for menstrual cramps. Ibuprofen offers dual benefits, relieving cramps and potentially reducing menstrual flow, making it a valuable consideration if you experience heavy bleeding during your periods.

• Consider hormonal birth control. Hormonal birth control can offer relief if you’re experiencing irregular or painful periods. Consult your doctor to determine if this option is suitable for you.

• Continue using contraception. Missed cycles are common during this time. If you’re sexually active, it’s important to remember that you’re still fertile until you’ve fully reached menopause. 

When to See Your Doctor

Always discuss any changes in your menstrual cycles with your doctor. While irregular periods are common during perimenopause, it’s crucial to rule out other underlying conditions. See your doctor if you experience any of these symptoms (4):

• Heavy bleeding that requires changing your pad or tampon every hour or two.

• Bleeding for more than seven days.

• Bleeding (not spotting) occurs more frequently than every three weeks.

• Severe cramps or pains.

• A foul odor in vaginal discharge may indicate an infection.

• Pain or bleeding during and after sex.

• Bleeding happens after one year without periods.

Written By: Johna Burdeos

Resources

1. My Periods Have Changed. Is Menopause Around the Corner? The American College of Obstetricians and Gynecologists. Accessed 8/5/2023.

2. Perimenopausal Bleeding and Bleeding After Menopause. The American College of Obstetricians and Gynecologists. Accessed 8/5/2023.

3. How Does Perimenopause Affect Periods? Medical News Today. Accessed 8/5/2023.

4. How Perimenopause Can Affect Your Periods and What You Can Do. Healthline. Accessed 8/5/2023.