Your period's late. Five days now. Or is it six? Last month it came early, you're sure of that. The month before? You honestly can't remember. This month you bled through your jeans at work. Stood there in the meeting room trying to position your bag just so, hoping nobody noticed.
It's 2:47am and you're Googling "perimenopause heavy bleeding cancer" for the fourth time this week. Your GP said "probably just perimenopause" like that explained everything. It didn't. You're tracking everything on the app but the numbers blur together.
We see you. We know you're trying to find a pattern that simply isn't there. You're probably wondering if something's seriously wrong, whether you should be worried about the flooding, and why your friend Sarah's periods just stopped while yours have become this unpredictable nightmare.
What Actually Happens to Your Periods During Perimenopause
Perimenopause is when your ovaries start winding down. They gradually start to produce less estrogen and progesterone and you don’t release an egg as regularly until eventually you stop releasing eggs all together. This usually shows up as changes to your periods.
By irregular we mean that they can be unpredictable and all over the place.
Your cycle might shrink from 28 days to 24 days for three months. Then suddenly stretch to 38 days. Then you skip one entirely. Then have two in one month. It's not a gentle glide from regular to stopped. It's a rollercoaster that lasts years.
Your periods can be shorter or longer. Heavier or lighter. You might spot between them. You might have no period for three months then the heaviest one you've ever experienced.
There is huge variability between how periods are affected. We know you're sitting there thinking "but which one am I going to get?" Possibly all of them. At different times. With no warning.
Can Your Periods Stay Regular During Perimenopause?
Yes.
You can have textbook-perfect 28-day cycles while experiencing hot flushes, night sweats, brain fog, anxiety and every other perimenopause symptom going. Hot flushes happen even when your cycle's still predictable.
We've noticed women with continuing regular periods often doubt they're in perimenopause. They think "it can't be perimenopause because my periods haven't changed." Then they feel dismissed when they mention other symptoms to healthcare providers who focus solely on menstrual patterns.
Diagnosis is based on symptoms and cycle changes combined. If you're experiencing hot flushes alongside any changes in your cycle, that's perimenopause. But even with clockwork periods, the other symptoms still count.
Your ovaries might be managing to pop out eggs on schedule for now, but everything else? Chaos. The decline in estrogen isn't linear. It spikes and crashes like a faulty thermostat before finally giving up.
Some women maintain regular cycles right until their periods stop for good. They're the minority, but they exist.
Why Periods Change (or Don't) in Perimenopause
Your menstrual cycle depends on precise hormone timing. During your reproductive years, estrogen and progesterone rise and fall in a fairly predictable pattern.
Your brain sends FSH (a hormone signal) to your ovaries. This makes an egg mature. The follicle around that egg produces estrogen, thickening your womb lining. When you ovulate, progesterone production starts. Progesterone stops the lining growth and prepares it to shed if you don't get pregnant.
During perimenopause, your ovaries become less responsive. Sometimes they ignore the signal entirely. No egg means no progesterone surge. But estrogen might still be produced, continuing to thicken your womb lining without the "stop" signal.
When you finally have a period, there's more lining to shed.
Other times, estrogen levels spike higher than they've ever been, then crash. Your body is figuring out how to wind down a system that's run for decades.
The Different Types of Period Changes You Might Notice
32% of women aged 40-45 experience heavy menstrual bleeding at some point. You're not imagining it getting worse.
Closer together: Your cycle shrinks to 24 days, even 21 days. You feel like you're bleeding more often than not. This often happens in early perimenopause when estrogen's still being produced but everything's wonky.
Further apart: Cycles stretch to 35 days, 40 days, longer. You might go two or three months without a period. Then it returns. This typically happens later as your ovaries produce less estrogen overall.
Heavier bleeding: Soaking through a pad every hour or two. Passing clots the size of 50p pieces. Bleeding through clothes and bedding. This happens when estrogen builds up your womb lining without progesterone to regulate it.
Lighter bleeding: Your period's basically spotting. Lasts two days instead of five. You barely need protection.
Longer periods: Instead of five days, you're bleeding for seven, ten, even two weeks. Often caused by cycles where no egg gets released.
Spotting between periods: Light bleeding or brown discharge between your regular periods. Happens mid-cycle or just before your period starts properly.
The vanishing act: Your period doesn't show up for months. Then returns unexpectedly.
And honestly? You might experience several of these over the course of perimenopause. Your body doesn't pick one and stick with it.
Heavy Bleeding: When It's Normal and When to Worry
Heavy bleeding is extremely common in perimenopause. It happens because of those hormonal fluctuations. Without regular ovulation, estrogen builds up your womb lining without progesterone to regulate it. When you finally shed that lining, there's more of it.
But see a specialist if you're experiencing:
Soaking through one or more pads every hour for several hours. Needing to double up on protection regularly. Bleeding for more than seven days. Bleeding more frequently than every three weeks. Passing clots larger than a 50p piece. Bleeding so heavy you're missing work or avoiding leaving the house.
Also see someone if you have bleeding between periods, bleeding after sex, or any bleeding after you've gone 12 months without a period.
These don't automatically mean something sinister. They might indicate fibroids, polyps, or other benign conditions common during perimenopause.
Heavy bleeding can cause iron deficiency anemia. You feel exhausted, breathless, pale. Your menopause specialist can test for this and prescribe iron if needed.
When Your Periods Just... Stop Turning Up
Skipped periods are normal. Completely normal.
You might skip one month. Have a period. Skip two months. Have three periods in quick succession. There's no pattern.
NICE confirms menopause when you've gone 12 consecutive months without a period. But getting there is rarely straightforward.
Around 10-20% of women have another period after going a year without one. Then the 12-month clock starts again. Honestly.
Can you still get pregnant during perimenopause?
Yes. As long as you're having periods, even irregular ones, you're still ovulating occasionally. If you don't want pregnancy, continue contraception until you've been period-free for 12 months (if over 50) or 24 months (if under 50).
Time and again, we see that the unpredictability itself becomes the problem. You don't know whether to carry tampons. Can't predict when it might arrive.
When to See a Menopause Specialist About Your Periods
Menopause specialists have specific training in hormone health that many GPs don't. Our specialists at Voy Menopause understand perimenopause complexities and offer more tailored treatment.
See a menopause specialist if:
- Your bleeding is very heavy (as described earlier)
- It's lasting longer than seven days
- It's happening more than every three weeks
- You're bleeding between periods (more than light spotting)
- You have any bleeding after 12 months without a period
Also see someone if period changes significantly affect your quality of life. Missing work because of flooding. Avoiding social situations. Feeling exhausted constantly. Anxiety about when your next period might arrive.
Treatment options exist. HRT can regulate your cycle and reduce heavy bleeding by providing consistent hormone levels. The Mirena coil releases progestogen locally and significantly reduces heavy bleeding. Tranexamic acid is non-hormonal and reduces blood flow during periods.
Sometimes changing your HRT regimen helps if you're already taking it. Increasing progesterone, switching from sequential to continuous combined HRT, or adjusting doses can make a difference.
If you can't access a menopause specialist directly, ask your GP for a referral. Check the British Menopause Society website for accredited specialists in your area.
You don't have to just tolerate it.
¹- NHS. Menopause - Symptoms. https://www.nhs.uk/conditions/menopause/symptoms/
²- NICE. Quality statement 1: Diagnosing perimenopause and menopause. https://www.nice.org.uk/guidance/qs143/chapter/quality-statement-1-diagnosing-perimenopause-and-menopause
³- NICE. Menopause: identification and management - Context. https://www.nice.org.uk/guidance/ng23/chapter/context
⁴- NICE. Menopause: identification and management - Recommendations. https://www.nice.org.uk/guidance/ng23/chapter/recommendations
⁵- NICE. Menopause: identification and management. https://www.nice.org.uk/guidance/ng23
⁶- British Menopause Society. Tool for clinicians - What is the menopause. https://thebms.org.uk/wp-content/uploads/2023/08/17-BMS-TfC-What-is-the-menopause-AUGUST2023-A.pdf
⁷- PMC. The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years. https://pmc.ncbi.nlm.nih.gov/articles/PMC3489035/
⁸- ACOG. Perimenopausal Bleeding and Bleeding After Menopause. https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause
