Perimenopause and periods: what’s going on?

As we go through perimenopause – the time leading up to menopause – our reproductive systems undergo a transformation. 

Dear Menopause: Leave Me AloneOur hormones are changing and rebalancing during this time, so many women find their periods go a bit haywire before they disappear completely.

This can feel disconcerting, especially if you’ve always had regular periods and have come to know exactly what to expect from your monthly cycle. For some, the thought of no more periods is a blessing – but there can be some tricky times to navigate before you reach that point.

So what can you expect? Well, as with all things menopause it is different for each individual. But you might notice that your periods become unpredictable, lasting a lot longer than before and with a heavier, or lighter, flow than you’re used to.

Can I get pregnant while I’m in perimenopause?

Yes! So it is very important to continue using contraception until after your periods have completely finished. And even then, you will need to consider protection from sexually transmitted diseases.

Did you know that over 20 women a year in the UK over the age of 50 have a termination? It’s a rather startling figure, but unintended pregnancy really does happen in this age group. While it’s true that some women do choose to become pregnant a little later in life, for those who have already completed their families or chosen not to have children, this is a very big issue.

If you miss a period then don’t just assume it’s a sign of menopause – take a pregnancy test. And if you miss a period – or more likely, you miss several – then don’t assume that you’re not still ovulating. If you are taking HRT, it can make the last of your eggs more likely to release.

So yes you can get pregnant while you’re perimenopausal and yes you can get pregnant on HRT. Be warned! So it’s important to take contraception for two years following your last period if you’re under 50 and one year from your last period if you’re over 50.

My periods are so heavy, is there anything I can do?

Heavy periods can blight your life, especially if they drag on for what feels like forever. Your egg release is less reliable, and sometimes you enter what is called an anovulatory cycle, where an egg doesn’t release at all. This can trigger the prolonged, heavy bleeding women frequently complain of during menopause.

The good news is that there’s a fairly simple answer. Having a Mirena coil fitted can help to regulate your bleeding, making it lighter and more predictable. It’s a small, plastic device that’s inserted into your womb and releases progesterone. This acts to thin your womb lining, making it less inclined to receive a fertilised egg so it is also an excellent form of contraception (although please bear in mind it will protect against pregnancy but not sexually transmitted diseases).

The Mirena coil is suitable for most women. If you think you’d like to have one fitted, speak to your GP or practice nurse.

Some women elect to use other types of treatments which can help with regulating their periods and making them lighter. And some types of HRT can help with reducing the heavy and irregular bleeding – again speak to your doctor.

Louise Newson

About Louise Newson

I am a GP and medical writer with a particular interest in the management of the menopause. I have written numerous articles and presented at local and national meetings on topics related to the menopause and its management. To find out more, here's my website. BSc (Hons), MBChB (Hons), MRCP, FRCGP