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

  • Samantha Evans

    Great advice about the perimenopause, so many women don’t even realise this exists. I’m perimenopausal but don’t have periods as I had an endometrial ablation ( removal of endometrial wall) 5 years ago for painful periods, the best thing I ever did, no more periods! However I have other symptoms such as occasional chest pain, joint aches and itchy skin and rashes on my face, all of which were dismissed by my GP but confirmed by a variety of menopause experts as peroimenopausal and menopausal symptoms. I experience vagina dryness and have been using YES organic sexual lubricants which have transformed our sex life. Getting good advice about the perimenopause is essential so thank you Henpicked

    • Deborah

      Thank you Samantha. Sitting here shaking my head though – too many women tell us that they’ve had these symptoms dismissed by GPs and it’s not on. Personally in the last few months I’ve started getting rashes on my neck and jewellery is irritating or making me itch when it didn’t before. Necklaces, bracelets and earrings often abandoned after an hour or so.

      We’re doing all we can this year to raise awareness, and hopefully this will help get more momentum:

      Hope to meet you one of these days! And thanks for commenting.

      • Samantha Evans

        Thank you Deborah, It would be great to meet. We have to keep raising awareness of these issues that so many women face and the way in which they are often dismissed by HCPs especially GPs. Henpicked, Jo Divine, LouiseNewson, Debbie Danzebrink and many other people are offering excellent advice but many women aren’t even aware of it. There is often poor or outdated advice on NHS websites being recommended by HCPs too. GPs cannot be expected to know everything but when you raise a query about a symptom or even tell your GP about YES lubricants or in my case, the work I have been doing with a leading gynaecologist and womens health physiotherapist based in the gynae department at our local hopsital to help women enjoy better sexual intimacy and pleasure, it would be good to get some kind of response. Having just turned 49 yesterday I’m on a mission along with so many great people to get the best advice and treatment for women whatever their age and whoever they are.

        • Deborah

          Belated happy birthday Samantha. Followed you on Radio Gorgeous on Monday – love your podcast! Would be great to meet up and discuss more what we can do. Henpicked is running an event next Tuesday (with Louise and other menopause experts). First of many and we’re also looking at GP training and more events for women over 40 (we did 2 sell outs last year).

          Will DM you my telephone number, would be fab to discuss!