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How your periods can change in perimenopause

How your period may change during your perimenopause can be unpredictable! Both internal and external factors can play into your individual experience - there is no rule book for you to follow. There are, however, ways for your to keep track and manage your periods moving forward.

Let's be honest - periods do NOT get better with time. That's one of the many myths we're told as teenagers. 'Don't worry - it's the worst when they start'... In fact, many women find their periods get worse with age. Certainly they become more unpredictable as you approach menopause. Both internal and external factors play into each individual experience of the menstrual cycle.


The perimenopause is the time before the full menopause (when your periods will stop for 12 months), during which the regular cycles of your sex hormones will fluctuate. This fluctuation of hormones often causes symptoms including irregular periods. Perimenopause can last up to 10 years. During this time, your hormones are in flux. During this transition, your bleeding pattern will start to change - most commonly becoming less regular with time.

Your periods may also become heavier or lighter at this time. Unfortunately, the end of your cycle can be just as unpredictable as its beginning!

Periods don't always simply 'dry up' as we approach menopause. Heavier periods during this time are also common. Everyone's body will respond in it's own way during perimenopause.

Spotting between periods

Have you ever noticed blood in your underwear between your periods? Not quite enough blood to make a fuss, but it is definitely there? This is most likely spotting.

If you notice that you are spotting regularly between your periods this can be a sign of hormonal imbalance, infection, endometriosis or rarely a more serious illness. Spotting becomes more common when your body is experiencing unpredictable changes in hormone levels - i.e. perimenopause.

If you're spotting it's something to keep an eye on. If it's happening regularly you should be checked by a doctor.If is accompanied by other abnormal symptoms such as bleeding after sex then you should not delay seeking medical advice. If you are concerned about your spotting, make sure that you are up to date on your cervical smears. For more information on cervical screening, visit the NHS website.

Abnormally heavy periods or 'Menorrhagia'

Heavy periods can have a huge impact on women's lives. In fact, it's one of the most common reasons that women will visit their GP. 1 in 3 women today would say that they struggle with heavy periods.

Note that those who experience heavier periods as teens, are most likely to experience them during their perimenopause as well.

When your bleeding is heavier, it may last longer than normal. Bleeding is considered heavy if:

  • You are leaking through your tampon, pad or clothes
  • You require double protection
  • Have a period that last long than 7 days
  • Requires frequent changing of your tampon or pad.

If you're suffering from very heavy periods you will be losing about 80 mL of blood over the same time period - twice as much as the blood lost in an average period.

A single heavy period can often occur when you have a menstrual cycle without ovulation. This is common when you are approaching menopause. So you may have a couple of normal periods, then experience a longer gap before your next period - this period then being heavier than normal. This can happen repeatedly in the perimenopause.

When you are having normal periods, your body will have a balance between oestrogen and progesterone - your reproductive hormones that are responsible for regulating the buildup of your endometrium (uterine lining). Very heavy periods can happen when your body has an excess of oestrogen. Your oestrogen levels will be higher than your progesterone, causing these two hormones to be out of balance. As a result, you shed more blood with each cycle.

If EVERY period is heavy then it is slightly more likely that you have another cause for your heavy periods, and you should discuss this with your doctor, as you might need blood tests and an examination. There is no need to suffer in silence!

Some signs you might be experiencing abnormally heavy periods:

  • Constantly changing your tampons or pads, including waking in the night to do so
  • Passing large clots as part of your cycle
  • Periods lasting much longer than normal
  • Constant lower back or abdominal pain
  • Feeling fatigued, weak or dizzy (which could be caused by low iron levels)

The NHS has a good tool to help you identify if you're having very heavy periods here. There are many reasons for heavy periods


  • Fibroids: enlargements in the wall of your uterus. These can thicken your endometrium lining, causing you to shed more blood.
  • Endometriosis: When tissue that is meant to line the uterus gets trapped outside the uterus. This can cause heavy periods and a lot of pain.
  • Adenomyosis: a condition where the cells of the lining of the womb (endometrium) are found in the muscle wall of the womb. Around one in 10 women will have adenomyosis.
  • PCOS: A hormonal imbalance where you tend to produce more oestrogen and less progesterone. This may cause heavy bleeding, however, is NOT always the reason behind more blood shed.
  • Endometrial polyps: These are benign growths around your uterus which can cause heavier bleeding.
  • Pelvic Inflammatory disease: This is when there’s an infection in your reproductive organs. This can cause many complications - one of which being heavy periods.
  • Endometrial hyperplasia: where the lining of the womb thickens excessively, this can be a pre cancerous state and can be detected by ultrasound and biopsy of the lining of the womb.
  • Endometrial and Womb Cancer: They can cause your endometrial lining to thicken, and result in more blood shed. As you age, your risk will automatically increase.
  • Thyroid disease can also affect your periods.

Some of these reasons are more worrying than others.

Periods are a sensitive topic for many. Having Menorrhagia is not usually a sign of serious illness, but can cause anaemia and make you tired. It is completely normal to feel worried about your periods. If you find, however, that they last more than 7 days and are irregularly heavy, then you should discuss it with your doctor as you may need further medical investigation.

Other things you can do to monitor your periods:

  1. Consider keeping a period diary: This can ensure that both you and your doctor are keeping track of your bleeding patterns. By keeping track of your bleeding, you may notice heavier blood shed earlier on. The quicker you manage your heavy periods, the easier they will be to handle.
  2. Period tracking App: Similar to a period diary, this will allow you to keep track of your periods. This will make it a lot easier to diagnose anything abnormal, as well as provide a medical history on your period cycles.
  3. Try to assess your blood loss. If you have an idea of how much blood you should be losing, you can compare this with your own blood loss. Try keeping track of the number of times you change your tampon or pad in one day. This should help you gage whether or not you're losing too much blood in one cycle.


  1. nhs.uk. 2018. Heavy Periods. [online]
    Available at: https://www.nhs.uk/conditions/heavy-periods/ [Accessed 21 June 2020].
  2. Women's Health Concern. n.d. Heavy Periods | Women's Health Concern. [online]
    Available at: https://www.womens-health-concern.org/help-and-advice/factsheets/heavy-periods/ [Accessed 23 June 2020].
  3. Royal College of Obstetricians & Gynaecologists. 2014. Heavy Menstrual Bleeding Affects Many Women. [online]
    Available at: https://www.rcog.org.uk/en/blog/heavy-menstrual-bleeding-affects-many-women/ [Accessed 21 June 2020].