As perimenopause nears an end and menopause approaches, you may start experiencing erratic menstrual cycles and other symptoms. Perimenopausal bleeding is different to a regular menstrual period.
Heavy, irregular, and unpredictable bleeding is one of the most common perimenopausal symptoms which can have a really negative impact on your social life, relationships, and self-confidence. Thankfully, however, there are some things you can do to get yourself back on track.
In this article, we'll look at all of the signs perimenopause is ending, what causes them, and how to control them and symptoms of late perimenopause. Let's get straight into it.
What is perimenopause?
Perimenopause is the period that leads up to the menopausal transition. A woman still has a menstrual cycle ( the shedding of the uterine lining), is still able to release eggs and get pregnant. Perimenopausal women experience hormonal fluctuations as their ovaries start to slow the production of oestrogen ( estrogen).
When does perimenopause start?
Perimenopause typically lasts around four or five years, usually starting in women aged in their mid to late-40s. It can, however, last a lot longer. Some women spend eight or more years in perimenopause before their bleeding eventually stops and they enter menopause. Some women will experience early menopause, this is when your periods are absent for 12 consecutive months before the age of 45.
What are common perimenopause symptoms?
The most common symptom of perimenopause happen because of wildly fluctuating hormones. Surges in oestrogen, progesterone and testosterone mean the delicate rhythm and balance of her hormones is off balance.
One of the most common symptoms is a change in a woman's menstrual flow. Women start to notice changes to when her period starts, longer bleeding cycles, infrequent periods or women begin to notice they're regularly spotting blood.
Most women report experiencing other perimenopause symptoms which include abnormal bleeding, mood changes, weight gain, hot flashes, night sweats, heart palpitations before period, sleep issues, vaginal dryness, memory problems and brain fog.
What are the signs perimenopause is ending?
The transition from perimenopause to menopause is marked by the absence of a menstrual period for twelve consecutive cycles. Signs perimenopause is ending include much shorter cycles due to hormonal fluctuations.
Most women enter perimenopause around the age of 46 and the average age for a woman to enter menopause is 51. Once a woman has reached menopause her reproductive years are over and she can experience menopausal symptoms for up to ten years.
The transitional window when perimenopause ends and menopause begins can be hard to recognise due to irregular bleeding and the fact that a woman's last period happens with no special markers.
Very Irregular Bleeding
You'll know you're in the later stage of perimenopause when your periods become a lot less frequent. Eventually, you will reach a stage where you miss menstrual periods altogether.
This happens because as hormone levels start to reach low levels, lower estrogen makes it more difficult for your ovaries to release an egg, and it's one of the signs perimenopause is ending and menopause is right around the corner.
Unusually heavy or light periods
As well as your period being less frequent, bleeding patterns can change. Women can notice that menstrual bleeding is unusually heavy or light. According to the NHS, a period is classed as heavy if you need to change a tampon every one to two hours, have to use additional sanitary protection like period underwear, if it lasts for more than a week, or if it interferes with everyday life.
For example if abnormal uterine bleeding means women need to take time off work or avoid exercise. On the other hand, light period bleeding is when a women loses less than 30ml of blood and bleeding is minimal. In perimenopause, spotting instead of a period is common as are irregular leaks and vaginal discharge which can be managed with disposable panty liners.
Painful periods in perimenopause
The painful periods perimenopause can bring with it are due to surges and fluctuations in hormone levels. Prostaglandins are lipids with hormone-like properties and can increase the chances of cramps, and make them worse. The uterus releases more of this hormone as perimenopause progresses. So, you might notice more painful periods, particularly as you get closer to menopause.
Worsening of some symptoms
As oestrogen levels continue to decline in the later stages of perimenopause, the body needs to work harder to overcome some of the symptoms. For this reason, you are likely to notice some symptoms getting worse in the menopause years, like hot flashes, memory problems, anxiety symptoms and difficulty sleeping.
Improvement in other symptoms
The good news is that not all perimenopause symptoms get worse with time. In fact one of the signs perimenopause is ending and you're about to reach menopause is some symptoms improve. Frequent headaches and mood swings, tend to improve for women.
This is all thanks to lower, but more stable oestrogen ( estrogen) levels which can make a woman's life a little easier. When bleeding stops and you are in menopause, other symptoms, however, start to emerge.
Hot flushes are one of the most common symptoms which happen in both perimenopause and menopause. Sometimes more hot flashes happen as the lack of oestrogen interfere with the brain thermostat. Less frequent headaches may be a benefit but increased anxiety, an inability to get a good night's sleep and urinary tract infections.
Can heavy periods cause anaemia?
Heavy periods, especially when they go on for a long time, can result in the body's iron stores becoming too low which can affect a woman's health. This is called iron deficiency anaemia, and with it women notice other symptoms which can include tiredness, weakness, pale skin and shortness of breath.
When to worry about perimenopausal bleeding
Even if your heavy periods are relatively manageable, if they go on for too long, a woman's health might be risk as she can develop anaemia. Feeling really tired, thinning hair and feeling cold are common.
It's therefore worthwhile speaking to your healthcare provider or doctor if this is the case. Low iron levels can be diagnosed with a simple blood test, and it's easy to treat.
How to manage abnormal bleeding
Abnormal uterine bleeding, fluctuating hormones, mood swings, fatigue, flooding and bloating can make a woman's a little challenging. Hard to control bleeding can lead to embarrassment, affect a woman's sex life, her autonomy and can affect her confidence. There are some options that can make all the difference though.
Prescription medications from a healthcare provider
If you're struggling with heavy bleeding , your doctor may be able to prescribe tranexamic acid – a medicine that helps your blood to clot - usually in a pill form . Prescription anti-inflammatories and anti-inflammatory painkillers such as mefenamic acid and naproxen can also help with uncontrollable bleeding.
Eat more iron-rich foods
To prevent iron deficiency anaemia and keep your iron levels up, it's a good idea to include plenty of iron-rich foods in your diet, particularly if you have been suffering from heavy bleeding for an extended time. A common symptom of iron deficiency is fatigue.
Some foods high in iron include liver, beans, nuts, dried fruit, fortified cereals, and red meat. Iron supplements can be bought over the counter but its best to get your levels checked before supplementing. This can be done with a blood test with you healthcare practitioner.
Consider hormone replacement therapy ( hrt )
Hormone replacement therapy (HRT) is another option available to help regulate irregular periods and reduce heavy bleeding. It involves taking hormones regularly to replace the ones lost during perimenopause. Your doctor will be able to advise you on whether this could be a suitable option for you.
Some doctors may recommend the Mirena coil to manage bleeding. Your medical history will be reviewed by your doctor and used to advise you before considering recommending intrauterine devices.
The bottom line
If you're experiencing changes in your menstrual cycle as you approach menopause, you're not alone, it happens to so many women. The average woman will experience heavy, painful, or irregular periods which are common in the late stages of perimenopause. Late perimenopause can see you miss two or three menstrual cycles in a row.
Symptoms can include menstrual migraines as hormone levels rise and fall, night sweats, mood swings and hot flashes and could be a sign that you're nearing the menopause transition. Thankfully, there are ways in which these symptoms can be managed by leading a healthy lifestyle with the right nutrition, over the counter medicine or hormone replacement therapy.
Can perimenopause cause painful periods?
In the perimenopause phase hormone levels fluctuate and can also surge. If oestrogen levels rise and aren't balanced out by progesterone, the uterus releases more prostaglandin, which can increase cramping and make menstrual pain worse.
What are perimenopause periods like?
It's common for bleeding patterns to change during perimenopause. Some women find their cycle gets shorter, while for others it increases by a few days. Some women experience a much heavier period and blood clotting.