Perimenopause periods: changes and care

Periods can become irregular during perimenopause, arriving earlier or later than expected, or skipping a month. Tell your GP about changes even if you think they are part of the transition. Perimenopause and a bleeding problem that needs checking can happen at the same time.

From perimenopause to the final period

Perimenopause is the transition towards menopause, when hormone levels change and periods may become irregular. It usually begins in the mid- to late 40s, according to the US Office on Women’s Health, though it can begin outside that age range.

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

You only know which period was your final one afterwards. Record and discuss a long gap; it doesn’t prove that periods have finished. 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 approaches, but there are other possible causes and treatment may help. Arrange a GP appointment if bleeding is affecting your life or has been heavy for some time. Signs of heavy periods include needing a pad or tampon change every one to two hours, bleeding longer than seven days, and leaking through clothes or bedding.

You do not need to measure blood loss to explain the problem. Mention cancelled plans, interrupted work or extra changes of clothes. There’s more detail on heavy periods and when to get help.

Bleeding between periods or after sex

Arrange a GP or sexual health appointment for bleeding between periods or after sex. These changes should always be checked, even though they are not usually serious. Do not assume they are explained by perimenopause.

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

Any bleeding after 12 months without a period

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

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

Urgent and emergency symptoms

A recently missed period together with unusual vaginal bleeding and abdominal or pelvic pain needs urgent assessment. In the UK, get an urgent GP appointment or contact NHS 111, because this combination can indicate an ectopic pregnancy. Elsewhere, contact your local urgent medical service.

For pelvic pain that is severe or worsening, or pelvic pain with faintness, difficulty breathing or heavy vaginal bleeding, seek emergency care. Call 999 or go to A&E in the UK, or use your local emergency number or emergency department. Don’t delay because you’ve previously been told you’re in perimenopause.

Describe the timing, flow and other symptoms

There is no single pattern that perimenopause periods must follow. Cycles may get shorter or longer, months may be skipped, and bleeding may change in length or heaviness.

Change you might notice	How to describe it
Periods coming closer together	Write the start dates alongside a description such as “more frequent”.
Longer gaps or skipped periods	Note the last bleeding you remember and any uncertainty about the date.
Heavier or lighter flow	Describe product changes, leaks or a difference from your usual flow.
Bleeding for more or fewer days	Record bleeding days separately from the gap between period starts.

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

Keep a note of bleeding between periods too. If you are unsure whether something was a period or spotting, write what you saw and take that description to the clinician.

Common symptoms of perimenopause include hot flushes, night sweats, disturbed sleep, mood changes and difficulty with memory or concentration. Vaginal dryness can also occur. Some people are barely affected, while others find daily life much harder.

Describe the effect that matters to you. You might say, “I wake in the night and struggle through the following morning”, or “The bleeding is the main problem; I haven’t noticed other changes”. Start with those concerns, even if you have only a few symptoms.

Clinicians use age and symptoms to assess menopause and perimenopause; there is no routine test for everyone. A cycle record can support that assessment, but cannot make the diagnosis.

Contraception while periods are changing

Pregnancy remains possible during perimenopause. If you want to avoid it, follow the NHS advice on when to stop contraception:

• Continue for one year after your final period if you are 50 or over.
• Continue for two years after your final period if you are aged 40 to 49.

The US Office on Women’s Health gives general advice to continue for a year after the last period. This guide uses the NHS advice above, which distinguishes between those age groups.

Hormonal contraception can change or stop bleeding, making the final period harder to identify. Ask your GP how the advice applies to your method before stopping. HRT does not provide contraception: pregnancy is still possible while taking it. A predicted period date is not a reason to stop contraception either.

Getting treatment while periods continue

You can ask about symptoms while periods are still happening. Treatment for menopause symptoms includes HRT and alternatives if HRT is unsuitable or you do not want it. The choice depends on your symptoms and medical history; discuss benefits and risks with your GP.

Before the appointment, note the bleeding change, what it interrupts, and any medicines or herbal remedies you take. When preparing appointment notes, choose the question you most want answered: “What needs investigating?” or “What could help with the bleeding?”

Ask what improvement to expect from a proposed treatment, when it will be reviewed, and who to contact if the bleeding changes before then.