Perimenopause periods: changes and care

Periods can become irregular during perimenopause. They may come earlier or later than expected, or skip a month. Tell your GP about any changes, even if you think they are part of this stage. You can be in perimenopause and also have a bleeding problem that needs checking.

From perimenopause to the final period

Perimenopause is the time leading up to menopause. Hormone levels change, and periods may become irregular. The US Office on Women’s Health says it usually begins in the mid- to late 40s. It can also begin earlier or later than that.

Menopause means 12 months without a period when you are not using hormonal contraception. The NHS says it usually happens between 45 and 55, but it can happen earlier.

You only know which period was your last one when you look back. If you have a long gap, note it and talk about it with your GP. A gap on its own doesn’t prove your periods have stopped. See a GP if you think you have menopause symptoms before 45.

Bleeding that needs checking

Heavy periods that disrupt your day

Heavy periods can happen as menopause gets closer. But there are other possible causes, and treatment may help. Book a GP appointment if the bleeding is affecting your life or has been heavy for a while. Signs of heavy periods include needing to change a pad or tampon every one to two hours. Bleeding for more than seven days and leaking through to clothes or bedding are signs too.

You don’t need to measure how much blood you lose to explain the problem. Mention cancelled plans, times you had to stop work, or extra changes of clothes. There’s more on heavy periods and when to get help.

Bleeding between periods or after sex

Book a GP or sexual health appointment for bleeding between periods or after sex. It should always be checked, even though it is not usually serious. Don’t assume perimenopause is the reason.

Write down when the bleeding happened and whether it came after sex. For help describing it, read about spotting between periods.

Any bleeding after 12 months without a period

After menopause, even one small bleed needs a GP check. That includes spotting, or pink or brown discharge. Book the appointment after that first time, however light it is.

Postmenopausal bleeding has several possible causes. It is often not serious. It still needs checking, because cancer is one possible cause. Tell the clinician about any HRT or other medicines you take.

Urgent and emergency symptoms

Get urgent help if you recently missed a period and you also have unusual vaginal bleeding with tummy or pelvic pain. In the UK, get an urgent GP appointment or contact NHS 111. This mix of symptoms can be a sign of an ectopic pregnancy. Elsewhere, contact your local urgent medical service.

Get emergency care for pelvic pain that is severe or getting worse. The same goes for pelvic pain with faintness, trouble breathing or heavy vaginal bleeding. In the UK, call 999 or go to A&E. Elsewhere, use your local emergency number or emergency department. Don’t wait just because you were told before that you’re in perimenopause.

Describe the timing, flow and other symptoms

Perimenopause periods don’t follow one set pattern. Cycles may get shorter or longer, you may skip months, and bleeding may change in length or heaviness.

Change you might notice	How to describe it
Periods coming closer together	Write down the start dates, with a note such as “more frequent”.
Longer gaps or skipped periods	Note the last bleeding you remember, and say if you’re unsure of the date.
Heavier or lighter flow	Describe changes in the products you use, any leaks, or how it differs from your usual flow.
Bleeding for more or fewer days	Log bleeding days separately from the gap between the start of one period and the next.

Use whichever prompts help you put the change into words. For example, “The gaps are longer, but the bleeding is heavier when it comes” is clearer than “My periods are irregular”.

Note bleeding between periods too. If you’re not sure whether it was a period or spotting, write down what you saw. Then take that note to the clinician.

Common symptoms of perimenopause include hot flushes, night sweats, poor sleep, mood changes, and trouble with memory or concentration. Vaginal dryness can happen too. Some people barely notice any effects. For others, daily life gets much harder.

Describe the effects that matter most to you. You might say, “I wake in the night and struggle the next morning.” Or: “The bleeding is the main problem. I haven’t noticed other changes.” Start with those concerns, even if you only have a few symptoms.

Clinicians use age and symptoms to assess menopause and perimenopause. There is no routine test for everyone. A cycle record can help with that assessment, but it can’t make the diagnosis.

Contraception while periods are changing

You can still get pregnant during perimenopause. If you want to avoid pregnancy, follow the NHS advice on when to stop contraception:

• Keep using it for one year after your last period if you are 50 or over.
• Keep using it for two years after your last period if you are 40 to 49.

The US Office on Women’s Health gives general advice to keep using it for a year after the last period. This guide follows the NHS advice above, which gives different advice for each age group.

Hormonal contraception can change or stop your bleeding. That makes your last period harder to spot. Before you stop, ask your GP how the advice applies to your method. HRT does not work as contraception. You can still get pregnant while taking it. A predicted period date is not a reason to stop contraception either.

Getting treatment while periods continue

You can ask for help with symptoms while you still have periods. Treatment for menopause symptoms includes HRT and other options if HRT isn’t right for you or you don’t want it. The choice depends on your symptoms and medical history. Talk through the benefits and risks with your GP.

Before your appointment, note how the bleeding has changed, what it gets in the way of, and any medicines or herbal remedies you take. When preparing appointment notes, pick the question you most want answered. It might be “What needs investigating?” or “What could help with the bleeding?”

Ask how a treatment you’re offered should help, when it will be reviewed, and who to contact if the bleeding changes before then.