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

Last updated 05.29.2024 | by Dr. Karen Pike | 17 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Perimenopause is the precursor to menopause, a time when your hormones fluctuate and your body prepares for the end of your reproductive cycle.  And one of the first perimenopause symptoms most women notice is irregular or unpredictable periods. 

Many women don’t realize they’re in perimenopause until other symptoms, such as hot flashes, mood swings, or weight gain, arrive. But it’s important to be aware of this early sign of perimenopause, so you can feel more informed and better prepared for other changes that may come.

As a medical writer specializing in women’s health issues, I knew that my own suddenly irregular period meant I was probably entering this phase of my life. But many women I’ve spoken with say that perimenopause took them by surprise, and they were caught off guard when their periods changed without warning.

So, have you noticed the length of your menstrual cycle is a little off lately? Are you beginning to wonder if your irregular periods could be the first sign of perimenopause? A change in your cycle doesn’t always mean you’re entering perimenopause, even if you arein your early to mid-40s. There are various reasons that can cause irregular periods or occasional periods, so try not to jump to conclusions too soon. 

That being said, it’s important to understand these changes in your body and identify the reason behind them. So, in this post, I’ll explain the link between irregular periods and perimenopause. I’ll also look at some other potential reasons for a change in your cycle. Plus, I’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 experience the end of menses 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 female reproductive hormones. As a result, you will likely notice a variety of symptoms closely associated with climacteric, including hot flashes, trouble sleeping, mood disturbances, and abnormal uterine bleeding resulting in changes to your menstrual cycle.

How Might Perimenopause Change my Periods?

The heaviness and duration of your flow, your period’s frequency, and your usual PMS symptoms may all begin to alter. 

During perimenopause, you may have irregular or missed periods. This is also one of the first symptoms I noticed in myself, and after a couple of negative pregnancy tests, I began to suspect perimenopause was on the way. 

Fluctuating levels of estrogen and progesterone are the reasons behind these changes. 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, it can affect menstruation in a way that 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 pad
  • contains clots larger than an inch (2.5 cm)
  • lasts longer than a week

If your periods are heavier than usual, fluctuating hormones levels 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 skipped your 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 have irregular periods and notice that their menstrual cycles become shorter. For years, my period usually would arrive promptly every 28 days, but after perimenopause began, suddenly, it was showing up every 20 days. 

But it wasn’t just my period cycle that became shorter. My period itself didn’t last as long. I found that I was only bleeding for two days, and my flow became much lighter than it ever had been before.

This change is due to a dip in estrogen. Less estrogen means the endometriumbecomes thinner, and periods become lighter.

So, it’s important to track your period before and during perimenopause, so you can identify any changes.

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. Period between 2 to 7 days is common and it becomes fewer as women age. 

Other causes of a shorter-than-usual menstrual cycle

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

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 approachcessation of menses, 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 menses 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 ovary syndrome (PCOS), weight loss, anorexia, and endometrial polyps.

Missed Periods

Absent 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 that last for only two days, space out and become very 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 the cessation of menses and it’s called menopause.

Other causes 

Amenorrhoea is 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

Spotting refers to a small amount of bleeding that isn’t heavy enough to require a 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 changes in the body, such as those that 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 endometrium.

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, and cause irregular bleeding. 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 period, 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 periods can be caused due to perimenopause, don’t panic. There are plenty of ways to make this transitional time easier.

Here are some practical tips that may be helpful for you to adjust to an unpredictable cycle:

1. Track Your Periods

When I first went through an irregular menstrual cycle, I used a calendar to track my monthly cycle. But recording details about my flow on the kitchen wall calendar wasn’t ideal, so I soon switched to a period tracking app. 

These apps don’t just allow you to track when your period arrives. They also ask you to report any new symptoms like PMS, cramping, and mood swings, and 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 mightcome and what to expect from it. Plus, you’ll know for sure once you’ve officially entered climacteric (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 prevent serious underlying medical conditions and 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, which means until cessation of menses. 

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 to deal with cramping or pain. Or if you’re bleeding during or after intercourse
  • You have postmenopausal bleeding (bleeding after one year with no periods)

Natural Remedies For Irregular Periods During Perimenopause

Well, ladies, periods can be a rollercoaster ride. But when they become downright irregular, missing their usual times, or showing up unexpectedly, it can be a source of worry. This irregularity could be a sign of perimenopause, the transitional phase leading up to menopause. However, there are other possibilities, too.

Before diving into more management techniques, let’s explore some natural remedies that might help our cycles get back into a predictable rhythm. But remember, consulting a doctor is always crucial to rule out any underlying medical conditions.

Here are some natural remedies and methods that can help with perimenopausal irregularities:

Evening Primrose Oil: This oil, extracted from the seeds of a flowering plant, has been used for centuries to address menstrual issues. Research offers a glimmer of hope. Studies have found some evidence that evening primrose oil might help regulate periods and reduce premenstrual syndrome (PMS) symptoms.

For a few months, I tried evening primrose oil to see if it would bring some order to my increasingly irregular cycle. While I can’t definitively say it regulated my periods completely, I did notice a slight decrease in the intensity of my PMS cramps. It’s worth considering but remember, it can take several months to see any effects, and consistency is key.

Chasteberry (Vitex Agnus Castus): This herb is known for its potential to regulate hormones, particularly progesterone, which can become imbalanced during perimenopause.

Black Cohosh: Another popular herb, black cohosh, has shown its effects in reducing hot flashes, a common perimenopausal symptom. While research on its impact on periods is limited, some women say that it helps regulate their cycles.

Soy: Soy products like tofu, tempeh, and edamame contain plant-based compounds called isoflavones. These isoflavones mimic the effects of estrogen to a certain extent, potentially offering some relief from perimenopausal symptoms. Aim to incorporate 1-2 servings of soy products daily into your diet.

Flaxseed: These tiny nutrients are packed with lignans, plant compounds that have weak estrogenic and anti-estrogenic properties. Studies suggest they might help regulate menstrual cycles. Try grinding them fresh and adding them to smoothies, yogurt, or even baking them into muffins.

Omega-3 Feast: These healthy fats, found in fatty fish like salmon and tuna, have anti-inflammatory properties that may benefit hormonal health. Aim for at least two servings of fish per week.

Acupuncture: This ancient Chinese practice involves inserting thin needles at specific points on the body. Studies have shown acupuncture can be effective in reducing hot flashes and night sweats, both common perimenopausal companions. There’s also some emerging evidence suggesting it might help regulate menstrual cycles, though more research is needed.

Stress Management: Did you know chronic stress can disrupt your hormones, including those involved in menstruation? Techniques like meditation, yoga, or deep breathing can be powerful tools for managing stress and potentially improving menstrual regularity. Find what works for you and incorporate it into your daily routine.

Exercise: Regular exercise offers a plethora of benefits, and perimenopause is no exception. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. Not only can exercise help manage weight gain, a common concern during perimenopause, but it can also improve sleep quality and potentially regulate your menstrual cycle.

Balanced Diet: What you eat directly impacts your hormones. Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean protein. Limit processed foods, sugary drinks, and unhealthy fats. Maintaining a healthy weight can also help regulate your periods.

Sleep: Perimenopause can disrupt your sleep patterns, leading to fatigue and worsening other symptoms. Aim for 7-8 hours of quality sleep each night. Create a relaxing bedtime routine, establish a regular sleep schedule, and make sure your bedroom is cool, dark, and quiet.

These natural remedies are not a guaranteed solution. They might work for some women but not for others. The key is to find a combination that works best for you.

Be patient, as it may take some time to see results. If your irregular periods persist, consult your doctor to discuss underlying causes and explore other treatment options.

FAQs

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 hitcessation of menses. 
So, don’t worry if you haven’t experienced regular periods for some time. While some women go through the menstrual transition stage 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 then maybe treatment is needed so visit your doctor.
·   Very heavy bleeding, which leaks through a pad or tampon in less than one hour
·   Bleeding that lasts 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 a cessation of menses and haven’t had a period for more than 12 months, you can still get pregnant. No matter how irregular your monthly 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.

Are there any risks associated with using natural remedies for irregular periods?

Natural remedies are generally considered safe, but there can be potential side effects. It’s crucial to talk to your doctor before starting any supplements, especially if you have underlying health conditions or take prescription drugs.

How long should I take natural remedies before seeing results?

Unfortunately, there’s no fixed duration for these remedies to work. It can take several months for natural remedies to show an effect. Consistency is key! Be patient, track your cycle, and consult your doctor if you don’t see any improvement after a reasonable timeframe.

Can natural remedies help with other perimenopausal symptoms besides irregular periods?

Some natural remedies, like evening primrose oil, may also offer relief from PMS symptoms like cramps and mood swings. However, research is ongoing. Discuss your specific concerns with your doctor to see if these remedies could be beneficial for your overall perimenopausal experience.

Are there any alternative therapies that might help with perimenopausal irregularity?

Yes! Acupuncture and acupressure are traditional Chinese medicine practices that some women find helpful in managing menstrual irregularities. There’s also limited research on the potential benefits of massage therapy for hormonal balance. Discuss these options with your doctor to see if they might be a good fit for you.

Conclusion

If you’ve noticed that your periods have become irregular for months in a row, you could be entering perimenopause. But there are also numerous other possible causes. So, if in doubt, it’s best to speak to your doctor.

If your symptomsare 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.

Reference:

Author

  • Dr. Karen Pike

    Dr. Pike is a senior physician administrator and board-certified emergency room doctor actively working in northern California. She received her undergraduate degree at Dartmouth College, where she graduated Phi Beta Kappa and played collegiate soccer. She attended Georgetown University for medical school and performed her residency in emergency medicine at Stanford University. She was part of the first-ever, women-majority emergency medicine program in United States. Dr. Pike is also the primary medical consultant for “Grey’s Anatomy,” a role she has held since the pilot episode when she partnered with Shonda Rhimes as the show’s original medical consultant. At her hospital, she was the second woman Chief of Staff. Today serves as the Director of the Emergency Department. Whether in leadership or direct patient care, her dedication to excellence in communication, quality, and collaboration is unwavering.