The lead-up to menopause is called perimenopause. Changing hormone levels during this time can alter the frequency, symptoms, and regularity of a person's periods.
How do periods change during perimenopause?
Menstrual cycle changes will vary between individuals.
Each person's experience of perimenopause is different, and changes to the menstrual cycle vary between individuals.
When people are approaching menopause, hormonal shifts cause their bodies to ovulate less frequently. When the ovary does not release an egg, the uterus lining does not shed, and the person does not have a period.
The most common shift in the menstrual cycle is that a person begins to have fewer monthly periods.
Because ovulation is not occurring cyclically during perimenopause, the body produces smaller amounts of a hormone called progesterone. This can cause the lining of the uterus to build up for longer than usual, which makes periods less frequent and heavier.
Because of these hormonal fluctuations, people may notice the following changes in their periods during perimenopause:
- Less frequent periods. This occurs because people are ovulating less often.
- Longer, heavier periods. This happens because the lining of the uterus has time to grow thicker and takes longer to shed.
- Lighter periods. People may experience lighter periods when their estrogen levels are low. This is because estrogen increases the thickness of the uterus lining.
- Irregular periods. People may have irregular periods, spotting between periods, or both, when the uterus lining grows thicker than usual.
- Changing menstrual symptoms. People may also notice an increase or decrease in their menstrual cramps and other symptoms.
The time between monthly periods can also vary greatly. Some people's periods may change unpredictably from month to month. For example, their period may be heavy one month and absent the next.
In general, people experience lighter and less frequent periods as they go through perimenopause. If someone experiences, longer, heavier, and more frequent periods they should see their doctor to discuss possible reasons for this.
Over time, perimenopause will cause a person's periods to become less frequent and eventually to stop altogether. Typically, doctors consider the transition into menopause as complete when an individual has gone 1 year without a period.
After 1 year, people should talk to their doctor about any vaginal bleeding.
Managing periods during perimenopause
If people notice that their menstrual symptoms are becoming more uncomfortable during perimenopause, they can try:
- taking over-the-counter pain relievers or specific medicines for period symptoms
- exercising to reduce bloating and help with cramps
- practicing meditation to help relieve stress, pain, or mood swings
- applying heat to the back or stomach to help with cramps and muscle pain
People who experience irregular or painful periods might find relief from using hormonal birth control.
Many people report other symptoms during perimenopause, including mood swings, hot flashes, vaginal dryness, and exhaustion. Doctors often prescribe hormone replacement therapy (HRT) to help manage these symptoms.
Hormones can help with many symptoms, but people should note that they can carry health risks, including an increased risk of:
The risk is usually small and depends on the person's overall health and the specific treatment used. So, always discuss the benefits and risks with a doctor.
The American College of Obstetricians and Gynecologists noted that certain herbs, including soy and black cohosh, may help with some perimenopause symptoms. Always talk to a doctor before trying new remedies, including these supplements, which are available over-the-counter.
Some people believe that soy helps perimenopause symptoms because it mimics estrogen.
According to a 2017 study, eating a diet rich in soy products may help people regulate their hormones. The researchers found that certain soy supplements can reduce the number of menopause symptoms a person experiences.
Because most people still have periods during perimenopause, it is still possible to get pregnant during this time. Those who already use hormonal birth control should continue taking it if they want to avoid pregnancy.
Dairy products can help to prevent osteoporosis.
Some dietary changes can help a person stay healthy during this transition.
Diet tips include:
- Eating a varied, nutritious, and healthful diet. Many people find that their metabolism slows down during this stage of life, causing more weight gain than usual.
- Including calcium and vitamin D in the diet to prevent osteoporosis and broken bones. Dairy products and dark leafy greens are rich in these nutrients. Some people also choose to take a supplement.
- Drinking plenty of water to avoid dehydration. This may also help with dry skin and vaginal dryness.
Other causes for period changes
The regular monthly period is not the only reason why people may bleed.
Because a person's periods are often irregular during perimenopause, they should pay extra attention for any abnormal symptoms — particularly as some uterus-related conditions are more common during and after perimenopause.
People may bleed because of:
- Endometrial atrophy. Low estrogen in perimenopause and menopause can cause the tissue of the uterus to get very thin, which can cause irregular bleeding.
- Uterine polyps. These are benign growths that can grow inside the uterus and cervix. Polyps do not always cause symptoms, but some people notice bleeding after sex.
- Endometrial hyperplasia. Hormonal shifts can cause the lining of the uterus to thicken in perimenopause. When the body has too much estrogen without enough progesterone, this thickness may cause bleeding. Bleeding is its most common symptom. Endometrial hyperplasia is treatable but can increase a person's risk of cancer.
- Uterine Cancer. Uterine cancer happens when abnormal or atypical cells progress into cancer. Though rare, it generally presents with heavy bleeding or postmenopausal bleeding.
When to see a doctor
Perimenopause is not a disease and does not require treatment. It can, however, increase people's risk of developing certain diseases. Moreover, the menstrual cycle can change for reasons other than perimenopause.
Anyone experiencing changes in their menstrual cycle should see a doctor for a diagnosis.
People going through perimenopause should see a doctor if:
- they experience side effects associated with hormone treatments
- they bleed after 1 year without a period
- they experience bleeding that is very heavy, very painful, or that soaks through more than a pad or tampon an hour
- hormone therapy stops helping with perimenopause symptoms
- they experience pain or bleeding during or after sex
The transition to menopause is different for everyone, both physically and psychologically.
People should discuss their symptoms with a healthcare provider they trust.
Support from loved ones, support groups, or a therapist can help with the emotional side effects of perimenopause.
Though dealing with the changes can be difficult, this new stage in life can be a time of growth and reflection that offers new purpose and meaning.