What happens to periods in perimenopause?
They usually change before they stop. They may come more or less often, heavier or lighter. But the NHS asks you to report bleeding more than before, between periods, after sex or after menopause.
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How do periods change in perimenopause?
A change in your periods is usually one of the first signs. The NHS says they may come more often or less often, and bleeding may get heavier or lighter. In time, they stop.
Perimenopause is the run-up to menopause, when periods become irregular. Menopause is when you haven’t had a period for 12 months and you’re not on hormonal contraception.
It usually happens between 45 and 55, but it can come earlier.
Periods change, then stop. 12 months without one is menopause.
- 1
Your usual cycle
Periods come in your normal pattern.
- 2
Perimenopause
Periods come more or less often, and get heavier or lighter.
- 3
Menopause
No period for 12 months, if you’re not on hormonal contraception.
- 4
After menopause
Any bleeding from the vagina needs a GP check.
Aged 45 or over and otherwise healthy? NICE says doctors can spot perimenopause without a lab test. They look for hot flushes or night sweats that started recently, plus any change in your cycle.
More in perimenopause blood tests.
Start a period diary today. Note the day each period starts, how many days it lasts and how heavy it is. Your GP can then see the pattern.
Is a long or heavy period normal in perimenopause?
It can be. The NHS says periods can be heavy when you’re approaching menopause, and heavy periods may be normal for you.
But if you still have periods and you’re bleeding more, not less, than before, the NHS says contact your GP.
- 7 days or belowNot long by the NHS measure. Check the other signs too.
- Above 7 daysMore than 7 days. The NHS says this may mean heavy periods.
Source: NHS
The NHS says you may have heavy periods if you:
- change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than recommended
- need 2 types of period product together, such as a pad and a tampon
- have periods lasting more than 7 days
- pass clots bigger than about 2.5cm, the size of a 10p coin
- bleed through to your clothes or bedding
- avoid daily activities like exercise, or take time off work, because of your periods
- feel tired or short of breath a lot
Tired a lot? Your GP may offer blood tests to check for conditions such as iron deficiency anaemia, which is caused by a lack of iron. See blood tests for heavy periods and periods and iron.
If heavy periods affect your life, a GP can help. Options include an IUS (hormonal coil), the combined pill or tranexamic acid, a medicine that helps cut the bleeding. The combined pill is not recommended at 50 or over.
Never stop or change a prescribed medicine without your prescriber.
Is a late period normal in perimenopause?
Often, yes. Periods coming less often is one of the usual changes.
But a late period can also mean you’re pregnant. The NHS says it’s possible to get pregnant during perimenopause.
- Below 12 monthsNot menopause yet. Keep using contraception.
- 12 months or aboveMenopause, if you’re not on hormonal contraception. Aged 40 to 49? Keep contraception to 2 years. Any bleeding: see a GP.
So keep using contraception after your last period. The NHS says you need it for 2 years if you’re 40 to 49, or 1 year if you’re 50 or over.
Under 40? Ask your GP.
Late, and had sex without contraception? Most pregnancy tests work from the first day of a missed period.
Not sure when it’s due? Test at least 21 days after you last had sex without contraception.
Still ovulating, which means releasing an egg? The NHS doesn’t list signs, but says you can still get pregnant. So keep using contraception.
What if I’m on HRT or contraception?
Then your bleeding may not tell you much. The NHS says hormonal contraception can make it harder to tell if you’ve reached perimenopause or menopause.
| What you take | What it can do to your bleeding |
|---|---|
| Progestogen-only pill, IUS (hormonal coil), implant or injection | Can make periods irregular or stop them. |
| Combined pill | A monthly bleed like a period, for as long as you take it. Not recommended at 50 or over. |
| HRT (hormone replacement therapy) | Can make periods more regular. Irregular bleeding or spotting should settle within 6 months. |
Source: NHS
If you have a womb, NICE says bleeding is common in the first 6 months of whole-body HRT, such as tablets or patches. It’s also common within 3 months of changing the dose or type. Outside those times, get medical help promptly.
Ask your GP which contraception suits you now. Never stop or change a prescribed medicine without your prescriber. See HRT and blood tests.
Is period pain part of perimenopause?
The NHS doesn’t list period pain as a perimenopause symptom.
Six things the NHS says can help ease period pain
- Have a warm bath or shower.
- Put a heat pad, or a hot water bottle wrapped in a tea towel, on your tummy.
- Massage your tummy and back.
- Try gentle exercise like yoga, swimming, walking or cycling.
- Take painkillers like paracetamol or ibuprofen.
- Cut down on alcohol and don’t smoke. These may also help.
Source: NHS: period pain
Period or pelvic pain severe or worse than usual, and painkillers haven’t helped? Ask for an urgent GP appointment or contact NHS 111.
If you have period pain, the NHS says see a GP if:
- your periods become more painful, heavier or irregular
- period pain stops you doing your usual daily activities
- you have pain during sex, or when peeing or pooing
- you’re bleeding between periods
- you notice a change in how much you pee or poo
- you have a swollen tummy
- you’ve lost your appetite
- you’re losing weight without trying
When to speak to a GP
Contact your GP if:
- You still have periods but you’re bleeding more, not less, than before.
- You haven’t had a period for 12 months or more and you have any bleeding from the vagina. That includes once, a small amount, spotting, pink or brown discharge, no other symptoms, or not being sure it’s blood.
- Heavy periods affect your life or have gone on for some time. Or you have severe period pain, bleeding between periods or after sex, or heavy periods with pain when peeing, pooing or having sex. These are on the NHS heavy periods list.
- You’re on HRT and still get irregular or heavier bleeding or spotting after 6 months, or more than 3 months after changing the dose or type.
- You have a fast heartbeat (palpitations), or want to know your options for perimenopause symptoms.
Period or pelvic pain severe or worse than usual, and painkillers haven’t helped? Ask for an urgent GP appointment or contact NHS 111.
Bleeding after menopause is not usually serious, but it can be a sign of cancer. Cancer may be easier to treat if it’s found early.
Your GP should refer you to hospital or a special clinic. You should not have to wait more than 2 weeks to see a specialist.
See also perimenopause symptoms and irregular periods.