Irregular Periods: Is it Perimenopause and How to Manage it?

Last updated 08.14.2023 | by Sabrina Johnson | 11 Minutes Read

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Have you noticed your menstrual cycle has been a little off lately? Are you beginning to wonder if your irregular periods could be the first sign of perimenopause?

Perimenopause is the precursor to menopause, a time when your hormones fluctuate and your once regular period may suddenly become unpredictable. The heaviness and duration of your flow, your period’s frequency, and your usual PMS symptoms may all begin to alter.

But a change in your menstrual cycle doesn’t always mean you’re entering perimenopause, even if you are in your early to mid-40s. There are various reasons your period could be irregular, so try not to jump to conclusions too soon.

If you’re concerned, the best thing you can do is seek advice from your doctor. They can help you discover the cause of your irregular periods and decide what, if anything, you should do next.

That said, in this article, we’ll be exploring the link between irregular periods and perimenopause. We’ll also look at some other potential reasons for a change in your cycle. Plus, we’ll share some helpful advice on how to best manage irregular periods and other perimenopause symptoms.

What is Perimenopause?

As we mentioned above, perimenopause is the precursor to menopause. It’s the transition between your fully fertile years to the date of your final period.

Most women begin perimenopause during their mid-40s, but it’s not unusual for symptoms to show themselves earlier.

How long this transition lasts can vary widely. A small minority of women barely notice their perimenopausal phase. Instead, their periods stop, and they enter menopause seemingly out of nowhere. However, the vast majority of us will experience perimenopause symptoms for several years before we officially enter menopause.

Perimenopause symptoms last an average of four to eight years. During this time your body begins to lower its production of reproductive hormones. As a result, you will likely notice a variety of symptoms closely associated with menopause, including hot flashes, trouble sleeping, mood disturbances, and changes to your menstrual cycle.

How Might Perimenopause Change my Periods?

One of the most common symptoms of perimenopause is irregular or missed periods. This is due to fluctuating levels of estrogen and progesterone. These reproductive hormones control ovulation as well as the rest of your monthly cycle. When their levels shift, so does your period.

These shifts are happening all the time. So, there may be some months when you completely skip your period. In other months, your period may be much longer and heavier than usual.

Here are some common menstrual changes that can occur during perimenopause.

An Abnormally Heavy Flow

A heavy menstrual flow (known as menorrhagia) is defined as bleeding which:

  • requires you to change your pad or tampon every hour for several hours in a row
  • requires two pads, or a pad and a tampon, to effectively control the flow
  • requires you to wake up during the night to change your tampon and/or pad
  • contains clots larger than an inch (2.5 cm)
  • lasts longer than a week

If your periods are heavier than usual, fluctuating hormones due to perimenopause could be to blame. A high ratio of estrogen to progesterone causes the lining of the uterus to build, resulting in increased flow. If you have recently missed a period, this can also contribute to excess bleeding.

Other causes of a heavy menstrual flow

If your period has suddenly become heavier than normal, several other potential causes may need to be ruled out. These include endometriosis, uterine polyps or fibroids, pregnancy complications, and pelvic inflammatory disease.

A Shorter-than-Usual Cycle

During the early phases of perimenopause, many women notice that their menstrual cycles become shorter. For example, a period that used to come every 28 days may start to arrive every 20 days.

It’s not just your menstrual cycle that can become shorter. If your body’s estrogen levels have dipped, the lining of the uterus is thinner than normal. This can result in a lighter period that lasts just a couple of days.

Any cycle that lasts less than 21 days is considered to be short. That being said, every woman has a different range of normal. The most important thing to consider is how the change relates to your usual cycle. This is just one reason why tracking your periods is so important.

Other causes of a shorter-than-usual menstrual cycle

A shorter-than-usual menstrual cycle is a common sign of early perimenopause. However, there are plenty of other potential conditions which could be to blame. These include an underactive or overactive thyroid, stress, weight gain or weight loss, ectopic pregnancy, certain medications (for example, non-steroidal anti-inflammatories (NSAIDs) and steroid medication), and polycystic ovarian syndrome (PCOS).

A Longer-than-Usual Cycle

According to the US Office on Women’s Health, a normal menstrual cycle lasts between 24 and 38 days. Anything outside of this window is considered to be abnormal.

However, a longer-than-usual cycle is a common phenomenon for women in a perimenopausal phase. As you approach menopause, your periods are likely to become less frequent until they eventually stop completely.

For example, during the later phases of perimenopause, you may notice that a period that used to come every 28 days is now arriving every 45 days.

Other causes of a longer-than-usual menstrual cycle

A longer-than-usual menstrual cycle is a normal part of the later stages of perimenopause. That being said, there are several other potential causes. These include hypothyroidism, uterine fibroids, polycystic ovarian syndrome (PCOS), weight loss, anorexia, and endometrial polyps.

Missed Periods

Missed periods are another common symptom of perimenopause. Fluctuations in estrogen and progesterone mean that it’s perfectly normal to skip an entire cycle. During this time, most women will begin to notice their periods space out and become less frequent.

For example, last year, you may have had 12 periods. This year, perhaps only 8, and next year, you may only have 4 or 5. Eventually, you’ll notice that you haven’t had a period at all in the last 12 months. This is the point when you’ve officially reached menopause.

Other causes of missed periods

Missed periods are one of the most common signs of perimenopause, but of course, there are other potential reasons behind your missing monthly cycle. The most obvious is pregnancy. Other causes include stress, being underweight or overweight, certain blood pressure medications, antidepressants, and antipsychotics.


Spotting refers to a small amount of bleeding that isn’t heavy enough to require a tampon or sanitary pad. It can occur at any time during your cycle that isn’t your expected period.

Other causes of spotting between periods

Spotting is a relatively common phenomenon that most women will experience from time to time.

The cause is usually related to hormonal shifts in the body, such as those which take place during perimenopause. However, it is not necessarily a sign of perimenopause. Another cause could be implantation bleeding, an early sign of pregnancy that occurs when a fertilized egg becomes implanted into the lining of the uterus.

Some underlying health conditions may also trigger spotting. These include polycystic ovarian syndrome (PCOS), uterine fibroids, pelvic inflammatory disease, and certain types of cancer.

In most cases, occasional spotting isn’t a concern. However, if you notice spotting on a regular basis (every two weeks or more), it’s best to contact your doctor.

Irregular Periods? Rule out Other Causes

As you can see, perimenopause can play havoc with your periods, making them irregular and unpredictable. But there are also multiple other potential reasons for shorter or longer cycles, a heavier flow, and spotting.

If you’re concerned about changes to your menstrual cycle, the best course of action is to visit your doctor. They can run diagnostic tests to determine if your symptoms are due to perimenopause or something else.

7 tips for Managing Irregular Periods During Perimenopause

7 tips for managing irregular periods during perimenopause

If you’ve discovered that your irregular menstrual cycle is due to perimenopause, don’t panic. There are plenty of ways to make this transitional time easier.

Here are some practical tips to help you adjust to an unpredictable cycle:

1. Track Your Periods

Use a calendar or a period tracking app to record your monthly cycles. Make a note of any new symptoms, such as PMS cramping and mood swings, and record how heavy or light your flow is.

Collecting this information can help you make sense of any patterns that may be emerging. It can also help you to predict when your period might come and what to expect from it. Plus, you’ll know for sure once you’ve officially entered menopause (12 months after your last period).

2. Switch to Black Underwear

An unpredictable cycle means you’re more likely to get caught out without proper period protection. Switching to black underwear might not save you from an embarrassing situation, but it can eliminate the risk of stains in your panties.

3. Use Specially Designed Period Underwear or Pantyliners

For extra security, consider investing in period-proof underwear. Another option is to use daily panty liners. That way, spotting or surprise bleeding doesn’t have to ruin your day.

4. Use Pain Relief Medication

If your periods have become more painful, over-the-counter pain relief and prescription pain relief can help. Talk to your doctor to find a suitable option for you.

For a natural alternative, try thyme oil, thyme capsules, or sip a cup of thyme tea. A study published in the Caspian Journal of Internal Medicine has found that thyme can be as effective as ibuprofen at reducing the pain of menstrual cramps.

5. Keep Moving

Exercise is integral to your well-being during perimenopause. It can help to reduce cramps, bloating and boost your mood if you’re feeling low.

6. Continue to Use Protection

During perimenopause, your fertility is gradually waning. But that doesn’t mean it’s gone completely.

Even if your periods are irregular, you may still be ovulating, and there’s still a chance you can become pregnant. So, it’s important to continue using contraception until 12 months after your last period, when menopause has been reached.

7. Talk to Your Doctor

Your doctor may prescribe birth control pills to eradicate irregular or painful periods. If you’re suffering from other bothersome perimenopause symptoms, such as hot flashes, mood swings, and fatigue, they may also be able to offer hormone replacement therapy (HRT) to help combat these symptoms.

Additionally, if you are going through perimenopause, always speak to your doctor if

  • You have very heavy or painful bleeding
  • You have pain or bleeding during or after intercourse
  • You have postmenopausal bleeding (bleeding after one year with no periods)


How long should irregular periods last during perimenopause?

Irregular periods are one of the first symptoms of perimenopause, and they can last until you officially hit menopause.
So, don’t worry if your periods have been irregular for some time. While some women go through perimenopause fairly quickly, the average duration is around 4 years. During this time, your periods are unlikely to remain as predictable and stable as they once were.

When should I worry about irregular periods during perimenopause?

Irregular periods are one of the most commonly reported symptoms that women experience during perimenopause. So, if you are a woman in your early 40s or above and have no other concerning symptoms, irregular periods are par for the course.
However, if you notice any of the following symptoms, visit your doctor.
·   Very heavy bleeding, which leaks through a pad or tampon in less than one hour
·   Bleeding that last for more than 7 days
·   Periods that occur every 3 weeks or less

Am I still able to conceive if I have irregular periods and have started perimenopause?

Yes. Until you reach menopause and haven’t had a period for more than 12 months, you can still get pregnant. No matter how irregular your periods are, their presence indicates you could still be ovulating.
However, conceiving naturally does become less likely once you enter the perimenopausal phase, as your fertility is in decline.


If you’ve noticed that your periods have become irregular, you could be entering perimenopause. But there are also numerous other potential causes. So, if in doubt, it’s best to speak to your doctor. If your symptoms are due to perimenopause, there’s plenty of support out there to help you navigate this transitional time. Try to see these changes for what they are; a brand new stage in your life and an opportunity for learning and growth.



  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.