From Regular to Random: How Your Period Changes Before Menopause

Perimenopause symptoms: the role of irregular periods

The menopausal transition is typically marked by a variety of uncomfortable symptoms, including irregular periods. Other perimenopausal symptoms, such as hot flashes and vaginal dryness, can begin in the early menopause transition, even before you notice cycle irregularities.

A change in menstrual patterns is one of the earliest signs that your final period is approaching. Your menstrual cycles during perimenopause may become more irregular, with changes to the frequency, duration, and volume of menstrual bleeding.

That said, not everyone experiences dramatic changes—about 12–25% of perimenopausal women report little to no alteration in their bleeding patterns before they reach menopause.

What is a normal period during the menopausal transition?

This is a trick question! There is no “normal” when it comes to perimenopausal bleeding. 

By the age of 47, most women notice a significant shift from their ‘normal’ menstrual cycle. According to the International Federation of Gynecology and Obstetrics, a normal cycle lasts 24-38 days from period to period, and menstrual bleeding lasts 8 days or fewer.

Menstrual flow changes during perimenopause can include:

• Heavy periods - could be heavier or lighter bleeding than before

• More or fewer days of bleeding

• Menstrual cycles that last longer or shorter than before

• Spotting between periods

• You may skip periods

• Irregular cycle lengths (with variations of 7+ days)

• Anovulatory cycles in which ovulation doesn’t occur

How your cycle changes during perimenopause 

The Stages of Reproductive Aging Workshop (STRAW) criteria are the gold standard for characterizing female reproductive age, particularly throughout the menopause transition. 

According to the STRAW criteria, early perimenopause features increasing variability in cycle length; while your cycles may become longer or shorter, shorter cycles (<21 days) are more common. 

During late perimenopause, cycles tend to become longer (>36 days, and sometimes longer than 60 days). Your periods—the days when you’re actually bleeding—may last longer as well.

More than 19 million users of the Flo period tracking app logged data that reflected these patterns. The data confirmed that shorter cycles are more common during the early perimenopause years, while cycles get longer as you approach your final menstrual period.

However, it’s not just bleeding patterns that shift: other symptoms change, too. Older users of the app logged more headaches, backaches, stress, and sleep disturbances. In contrast, these users reported menstrual cramps and acne less frequently: a silver lining of sorts!

Menstrual experiences can also differ based on race, ethnicity, and body weight. For instance, Chinese and Japanese women, and people with obesity, generally have longer menstrual cycle lengths during perimenopause.

When the flow goes rogue: What’s really going on?

The outward shifts in menstrual patterns—such as irregular cycles—are a reflection of underlying hormonal changes happening internally. 

Estrogen and progesterone are the main hormones that regulate the menstrual cycle. These hormones affect how the uterine lining develops and when it sheds. 

In the perimenopausal period, hormone levels fluctuate - the ovaries begin producing less and less estrogen and progesterone. Declining estrogen levels contribute to irregular bleeding and confusing symptoms. 

How might menstrual irregularity impact my daily life? 

Menstrual changes can be confusing, disruptive, and negatively impact quality of life. Unpredictable bleeding may cause you anxiety and inconvenience, and may complicate contraception or family planning. 

Prolonged or heavy bleeding is also plain annoying! Add in symptoms like hot flashes, night sweats or mood swings, and it can significantly affect your daily comfort and quality of life.

That said, not everyone views these changes as problematic. Surveys show that many women do not consider menstrual changes during menopause to be disruptive. Ultimately, every experience is unique.

What you can do about perimenopause period changes

Understanding what’s happening can help you navigate this transition phase with more clarity and confidence. Some general recommendations for overall well-being and peace of mind during this time of change include:

• Keep a menstrual diary or use an app to track any missed periods or changes in cycle length, flow, and associated symptoms.

• Discuss new or unusual symptoms with your healthcare provider to rule out other conditions that can cause abnormal bleeding.

• Ask your healthcare provider about hormone therapy and non-hormonal treatments for symptom management.

• Plan for the unexpected: carry menstrual products with you, even if you think you’re past needing them.

Why should you track your menstrual bleeding?

Your menstrual cycle can reflect many aspects of your health, and it may even help identify medical conditions such as bleeding disorders, infertility, and even some cancers (e.g., endometrial cancer). Your menstrual cycle is also influenced by lifestyle and environmental factors.

Tracking changes can help differentiate between normal menopause symptoms and signs of other conditions. Knowing your medical history or family history may also help.

While changes in your menstrual cycle are to be expected in the menopause transition period, abnormal uterine bleeding can occur due to other medical conditions such as uterine fibroids or polyps, polycystic ovary syndrome or endometrial hyperplasia.

Is bleeding after menopause always cancer?

In short, no—so first step: don’t panic. 

That said, don’t ignore it. Any vaginal bleeding in postmenopausal women is considered abnormal. If you’re experiencing vaginal bleeding after 12 months of no periods, reach out to your provider to see if a physical exam or additional testing is warranted.

Accurate records support better conversations with your healthcare provider, help identify symptom patterns, and ultimately, help you better care for yourself. 

Questions you may want to ask your healthcare provider

Since there’s no single “normal” during the menopause transition, tracking empowers you to speak up about what you're experiencing. Here are a few helpful questions to ask your healthcare provider:

• Are my menstrual cycle changes normal, or could they indicate another health issue? What symptoms should I be worried about?

• How long will these irregular periods last?

• I have had really heavy menstrual bleeding for a few months - am I at increased risk of excessive blood loss? Are there lifestyle changes or treatment options that could help with my symptoms?

• Should I still be using birth control or birth control pills?

Open dialogue and mindful tracking are essential tools for navigating this life stage with confidence and health. Amissa is here to support you during this transition, empowering you with personalised data. 

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.