Many women experience irregular periods in the lead-up to menopause, but these changes can vary. “I enjoy not having many, if any, periods, but never knowing for sure if one will start or not can be frustrating,” said one woman surveyed by ThisIsMenopause.

As your body enters the menopausal transition, called perimenopause, hormone changes can affect your menstrual cycle. You may notice spotting instead of a full period — or you may have heavier bleeding. Your cycles may also become either more spaced apart or closer together.

As one woman shared, these changes can disrupt daily life: “Due to both hot flashes and unpredictable bleeding, I don’t go out as often.”

Below, we’ll explain how periods can change during perimenopause and what is and isn’t normal.

How Do Periods Change During Perimenopause?

As your body prepares for menopause, your ovaries make less estrogen. This hormone works with progesterone to regulate your menstrual cycles. When these hormone levels shift, the balance between estrogen and progesterone changes, which can affect your periods.

Irregular periods are a common symptom of perimenopause. Some women may notice irregular bleeding on its own or along with other symptoms like mood swings, night sweats, and vaginal dryness.

In perimenopause, “irregular bleeding” can refer to several different situations.

Spotting

“I think I’m starting to not have a period — only light spotting occasionally now. I haven’t had a real one for two months,” one woman shared.

Changing hormone levels can affect how your body signals when to have a period. As a result, your body may shed the uterine lining at unexpected times or hold on to it longer than usual. This can lead to spotting or irregular bleeding. Lower estrogen levels can also make the uterine lining thinner, which may cause lighter bleeding.

Bleeding during perimenopause can be lighter or heavier than usual, according to the American College of Obstetricians and Gynecologists. Hormone fluctuations, particularly in the early part of perimenopause, may cause spotting instead of a regular period. Later in perimenopause, spotting or irregular bleeding may happen after a skipped period.

Spotting can last from three to seven days. The blood may look dark brown or brick red and be darker than usual due to older uterine lining being shed.

When To Talk to Your Doctor

Consult your doctor about spotting during perimenopause, especially if it’s frequent or heavy. Bleeding that stops and starts repeatedly or comes with pain or other symptoms should be evaluated.

If you have postmenopausal bleeding (bleeding after not having a period for 12 months), it’s important to see your healthcare provider.

Heavy Bleeding

“Perimenopause has caused me to bleed more frequently. Sometimes, I have excessive bleeding; other times, spotting,” one woman wrote.

During perimenopause, changes in estrogen and progesterone levels can lead to heavy bleeding. Because these hormones regulate the menstrual cycle, shifts in their levels can affect how much you bleed. You may also have symptoms like abdominal pain, cramps, and fatigue.

Heavy menstrual bleeding can be defined in several ways. You may have heavy periods if your bleeding:

• Lasts longer than one week
• Soaks through at least one pad or tampon an hour for several hours
• Requires you to wake up during the night to change a tampon or pad
• Is double your usual amount of blood loss (typically 5 or more tablespoons compared to 2 to 3 tablespoons)
• Causes you to use two or more pads or tampons at once
• Leads to passing quarter-size or larger blood clots several times

Heavy bleeding is common as you get closer to menopause.

When To Talk to Your Doctor

Your period shouldn’t interfere with your daily life. Talk with your doctor if heavy bleeding affects your quality of life. Any bleeding after menopause, heavy or not, needs to be evaluated by a healthcare provider.

Heavy bleeding can sometimes require urgent medical care. If you have heavy bleeding along with anemia symptoms, such as shortness of breath, chest pain, or dizziness, seek immediate care.

Long or Short Cycles

Hormone changes can also lead to longer or shorter menstrual cycles. “My period comes, like, every two weeks and lasts seven to 10 days every time,” one woman shared. Another wrote, “I have gone 60 days between periods.”

A typical menstrual cycle ranges from about 21 to 35 days. After ovulation (when the ovaries release an egg), estrogen and progesterone levels drop if the egg isn’t fertilized by sperm. This signals that menstruation should start. Ongoing hormone changes can affect how often your period occurs.

Perimenopause can lead to missed periods, including skipping several in a row. It can also cause loop cycles — menstrual cycles that happen close together. If you have loop cycles, you may start bleeding again only two weeks or so after your last period. After that, you might go several weeks without bleeding before the pattern repeats.

When To Talk to Your Doctor

Talk with your doctor if your period comes 20 days or sooner after your previous one or lasts several days longer than usual. Irregular cycles are often due to perimenopause, but they can also be caused by other health conditions, so it’s important to get checked.

Irregular Periods and Pregnancy

You may start transitioning out of your reproductive years anytime between your mid-30s and mid-50s. The length of perimenopause varies, ranging from a few months to several years. During this time, ovulation and menstruation may become irregular but can still occur. This means pregnancy is possible during perimenopause.

Although irregular periods may lower the odds of getting pregnant, they can increase the chances of an unexpected pregnancy. If you don’t wish to become pregnant, talk with your doctor about birth control options.

Managing Irregular Periods

The best way to manage irregular periods depends on the cause. It’s a good idea to see a healthcare professional for an evaluation. Your provider may recommend tests to rule out other causes of irregular bleeding.

Medications and Treatments

Irregular periods that disrupt daily life are often managed with medications like oral contraceptives (birth control pills). Hormone therapy — estrogen or a combination of estrogen and progesterone — may also be recommended to help regulate hormones.

Other options may help reduce heavy bleeding, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, taken before bleeding starts
• Intrauterine devices (IUDs)
• Nonhormonal options, such as tranexamic acid and iron supplements

Other Treatments

If medications don’t help reduce heavy bleeding, your doctor may suggest procedures such as:

• Hysteroscopy — A procedure that allows a doctor to view the inside of the uterus and remove abnormal growths
• Endometrial ablation — A procedure that destroys the uterine lining in a controlled way
• Surgery — Procedures like hysterectomy (removal of the uterus) or myomectomy (removal of fibroids)

You don’t have to manage disruptive periods on your own. If you’re experiencing irregular periods during perimenopause, talk with your doctor about your treatment options.