Perimenopause and your Menstruation

Written By
Women Like Me Team
Last updated
January 20, 2024

Insights into how your menstruation changes in Peri-menopause

As women age, our bodies undergo many physical changes, including changes to our menstrual cycles which is primarily due to reproductive aging aka Menopause transition. While your body is preparing for menopause at which point your reproductive system shuts down, you will go through a transitional period known as perimenopause, and it can last anywhere between one to over 10 years. During this time, many women experience changes to their menstrual flow and cycle. In this article, we'll explore how a woman's menstruation and flow can change during perimenopause, what is considered normal and when it may be time to go see a doctor.

Your period flow may stay regular for a while, but if you’re like many women, it might also seem to take on a mind of its own. Most women start perimenopause in their 40's, but for some, skipped cycles and period irregularities (like a heavier flow, which affects nearly 1/3 of those in perimenopause) may begin in their late 30s. This can be  normal, and often not cause for concern—but you do want to stay aware.

Let’s look at some of the ways perimenopause may change your flow and when it may be time to call the doc.

Go with the flow

Perimenopause is the transitional period leading up to menopause, which is the cessation of menstruation for 12 consecutive months. During perimenopause, the body's hormone levels fluctuate, which can lead to a range of physical and emotional symptoms. These symptoms can vary in severity and duration, and may include hot flashes, mood changes, and changes to your menstrual cycle.

How Menstruation and Flow Change in Perimenopause

During perimenopause, many women experience changes to their menstrual cycle and flow. These changes can include:

  • Irregular periods: As hormone levels fluctuate, periods may become irregular, with cycles lasting longer or shorter than usual. Some women may skip periods altogether.
  • Changes in flow: Menstrual flow may become lighter or heavier than usual, and may last for a shorter or longer duration.
  • Changes in symptoms: Women may experience new or different symptoms during their periods, such as cramping, bloating, or mood changes.

When you should see a Doctor

While some changes to the menstrual cycle and flow are normal during perimenopause, others may be a cause for concern. Women should see a doctor if they experience:

  • Very heavy bleeding: If menstrual flow is very heavy and lasts longer than usual, or if there are large clots present, it may be a sign of a medical issue that requires treatment.
  • Bleeding between periods: Any bleeding between periods should be evaluated by a doctor to rule out underlying conditions such as fibroids or polyps.
  • Postmenopausal bleeding: If a woman has gone 12 months without a period and experiences bleeding, she should see a doctor to rule out serious conditions such as endometrial cancer.

Managing Menstrual Changes in Perimenopause

While changes to the menstrual cycle and flow can be frustrating, there are ways to manage symptoms during perimenopause. These may include:

  • Tracking cycles: Keeping track of periods and symptoms can help women better understand their menstrual cycle and identify any changes that may require medical attention.
  • Birth control (Hormone therapy): Hormone therapy, which involves taking hormones such as estrogen and progesterone, that can help regulate periods and manage symptoms during perimenopause.
  • Absorbent underwear: Many women prefer wearing absorbent underwear (aka period underwear) (in addition to tampons or pads) as an extra safety measure when their flow becomes unpredictable.

Key takeaway

Most changes in your period or flow during your 40s are likely due to perimenopause, and changes in frequency, severity and duration are completely normal. But even though it is very common it may still feel unsettling, especially if your cycle has been running like clockwork until now. Having said that - you know your body better than anyone and when something feels not right (i.e. excessive bleeding, or less than three weeks between periods) please seek medical attention. By working with a healthcare provider, women can manage their symptoms and maintain their overall health and well-being during perimenopause.


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