Irregular periods are a hallmark of perimenopause and often one of the first symptoms that women notice. These irregularities can manifest as changes in the timing of periods (for example, late one month, early the next), variations in the duration of menstruation, or fluctuations in flow (ranging from spotting to heavy bleeding). In short, perimenopause makes periods unpredictable, which can be anxiety-provoking for many women.
Cycle length is influenced by ovulation, which is regulated by estrogen and progesterone. During perimenopause, hormone levels fluctuate, leading to inconsistent ovulation and, consequently, irregular cycle lengths. These hormone imbalances can also affect the thickening of the uterine lining, meaning that when your period does occur, it may be exceptionally heavy or light.
While irregular periods are an inevitable part of the perimenopausal transition (eventually leading to menopause), it’s important to recognise that abnormal periods can also signal other underlying conditions. It is essential for your doctor to explore all possibilities before attributing irregular periods solely to perimenopause.
What is a normal period?
- Cycle length: Typically, between 21 and 35 days (from the first day of one period to the first day of the next).
- Bleeding duration: Usually 3-5 days.
- Blood volume: Less than 80ml per period (easily measured with a menstrual cup).
What are signs of an abnormal period?
- Having to change tampons or pads every 1-2 hours during the day.
- Needing to change tampons or pads overnight.
- Experiencing “flooding” or leaking through clothes.
- Passing clots larger than a 20-cent coin.
- Pain that does not respond to over-the-counter medications.
- Pain severe enough to interfere with daily activities.
If you experience any of these symptoms, it’s important to discuss them with your doctor.
Managing Irregular Periods:
- Rule out other potential causes of irregular periods that may need treatment. Conditions such as PCOS, thyroid dysfunction, fibroids, endometriosis, and even cancer should be considered and investigated
- If your periods are causing distress or interfering with your quality of life, there are several treatment options available to help regulate them:
- Hormonal contraceptives: Options like oral contraceptives or IUDs can help manage cycle regularity- it is also important to remember that while you are ovulating you still have a chance of falling pregnant, so this has the added benefit of preventing pregnancy (if that is of concern). Hormonal contraceptives can also mute other perimenopause symptoms.
- Menopausal hormone therapy: Cyclical menopausal hormone therapy (MHT) can reduce heavy bleeding as is effective at treating other symptoms, such as hot flashes. However, as your body continues to experience fluctuations in the natural production of these hormones, breakthrough bleeding may still occur. MHT will not prevent pregnancy.
- Hormonal contraceptives: Options like oral contraceptives or IUDs can help manage cycle regularity- it is also important to remember that while you are ovulating you still have a chance of falling pregnant, so this has the added benefit of preventing pregnancy (if that is of concern). Hormonal contraceptives can also mute other perimenopause symptoms.
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