What Is Your Period Telling You About Perimenopause?

Are your periods all over the show?

During perimenopause, you might find that your period is getting lighter, or even really, really heavy. 

You may see that your cycle is starting to become less regular. 

Whatever the change, often there are big clues as to the stage you're in in perimenopause, or that there may be other things going on.

Let's jump in and find out what your period is telling you about where you're at in this journey of perimenopause, or if there's something else happening for you.

Quick Snapshot Of What the Perimenopause Is

Before we start, let's be clear about what perimenopause means:

Perimenopause is the lead up/transition to menopause when the ovaries start to wind down. Menopause is a point in time marked by 1 year without a period.

Perimenopause can really vary in length for women, anything from 2-12 years and on average is between 4-6 years. The average age to reach menopause is 51 years of age. So most women start perimenopause in their 40’s but it can start in your late 30’s too.

There are four different stages of the perimenopause transition - see the diagram below.

The Four Phases of Perimenopause

Credit Author

As you can see from this chart, your period is likely to be different at different  the stages of perimenopause

Cycles are still regular but could be shorter in length, maybe between 21-26 days.

You are likely to be in STAGE 1: Very Early Perimenopause (lasts 2 - 5 years on average) 

• Likely to have less progesterone and more oestrogen.
• Symptoms might be heavier periods, increased period pain, migraines, sleep disturbances.

Cycles are starting to be irregular and vary in length up to seven days

You are likely to be in STAGE 2: Early Menopause Transition (2 - 3 years on average)

• Likely to have less progesterone and more oestrogen. Oestrogen is starting to fluctuate and when it drops it goes lower than you are used to.
• Symptoms might be more hot flashes and night sweats.

You start to miss cycles or have your first cycle that is longer than 60 days.

You're likely to be in STAGE 3: Late Menopause Transition (you might be 4 years away from menopause)

• Symptoms could increase: hot flashes/night sweats and heavier periods. Breast pain should ease if you have any.

You're starting to miss cycles with longer gaps e.g. 6 months in between

You're likely to be in STAGE 4: Late Perimenopause (the twelve months from your final period)

This is the start of your body getting used to low oestrogen and you should start to feel less of the symptoms associated with the wild fluctuating oestrogen levels like migraines and mood symptoms. 

What is a normal cycle?

A normal menstrual cycle lasts between 21-35 days with average bleeding days of 7, within those 7 days total menstrual blood loss is between 10-60ml in total. 

How can you measure? With many women using the cups nowadays some of us can measure that way. If you are unsure read the signs of heavy bleeding below.

What is heavy menstrual bleeding in Perimenopause?

Over 80ml is heavy menstrual bleeding also called menorrhagia.

Menorrhagia can be caused by other causes, so if you feel you are having heavy bleeding it’s a good time to check in with your health professional.

There's a good article here all about it.

Perimenopausal heavy menstrual bleeding is really common, 1 in 5 women will experience this. It can be bloody hard to live through.

Signs that your period is too heavy:

• Soaking through your pad, period undies or tampon in less than an hour.
• Needing a double up pad plus tampon.
• Walking up in night to change a pad, period undies or tampon
• Bleeding for more than seven days.
• Clots larger than 20 cent piece.
• Restricting your activities due to heavy flow.
• Symptoms of iron deficiency - fatigue, hair loss and shortness of breath.

In perimenopause you will see the length of your period change, as well as the length of your bleeding days and you might get light spotting in between.

What Causes Periods to Get Heavier in Perimenopause?

Perimenopause is a time of wild and fluctuating estrogen where you might see higher estrogen that is usually paired with very low or nearly non existent progesterone. This combination can cause heavy bleeding. 

In the diagram above it shows you what oestrogen and progesterone are up to during perimenopause.

In perimenopause your ovaries are starting to slow down and not perform as well, some cycles you might not experience ovulation.

During these cycles the bleeds are heavier.  You might have some periods that are totally normal and then the next two are super heavy. It can be a frustrating time as there is no 'normal' anymore.

Iron Deficiency in Perimenopause

If you are experiencing heavy periods or very heavy periods you might be deficient in iron.

Signs and symptoms are

• Fatigue
• Hair loss
• Breathlessness and
• Easy bruising.

Through your peri years it’s important to check your iron levels.  The last thing you're going to need is more symptoms when all that's needed is an iron supplement or infusion.

 

Treatments for Menorrhagia (heavy menstrual bleeding) in Perimenopause

The most common treatments for Menorrhagia/heavy bleeding in perimenopause are hormonal IUDs and the pill.

With the IUD it can reduce the heavy bleeding between 90 - 96 percent and compared to other birth control options it also allows natural ovulatory cycling and the production of progesterone which is beneficial for your long term health.

Find out the pros and cons of all options and decide what will work best for you taking into consideration any possible side effects.

Heavy Periods in Perimenopause: A Quick Summary

Heavy periods through perimenopause is common and really hard to deal with. It can help to know that they're not going to last forever and you're absolutely not alone.

If perimenopausal heavy bleeding is restricting your activities, check out your treatment options with your GP and remember to get your iron levels checked. Don’t live with iron deficiency fatigue on top of your peri fatigue.

If you're finding perimenopause challenging and keen to join a community of other women going through peri, feel free to join our private SheBANG! PeriSisterhood group here (all welcome).

 

 

 

Resources

Hormone Repair manual, Lara Briden ND

The M Word, How to Thrive in Menopause, Dr Ginni Mansberg