Medically reviewed by Dr. Tamara Neuhaus MD

Irregular Bleeding During Periods and Perimenopause

My periods are off the hook! I blow through a super tampon in two hours. The cramps are worse than they were in puberty. I thought these things were supposed to be petering out, not ramping up. - Brenda, 47

What is it?

Irregular bleeding patterns are very common in perimenopause. Your period may come more or less frequently than it used to, it may be heavier or lighter than normal, and it may last longer or dwindle to just a few days. You also may experience more or less cramping than before. You officially enter menopause after 12 months without a period. If you experience any vaginal bleeding after you reach menopause, you should see your doctor right away, as it could indicate medical issues like polyps, vaginal atrophy, thickened uterine lining, or even cancer. 

Why does it happen?

During perimenopause, your fluctuating hormones can wreak havoc on your body and your brain. In the case of irregular periods, your hormones aren’t cueing your ovaries to produce eggs on the same regular schedule they’ve been sticking to for most of your reproductive life. Some months they produce no egg at all, causing you to skip a period. Others, they produce eggs twice, causing periods that come in quick succession.

What can you do about it?

A good first step is to start tracking your periods: their frequency, length, and quality (e.g.: heavy/light, crampiness). This will give you a good sense of your cycle over time. And it’s valuable information for your doctor as he or she helps you navigate this transition. Plus, you won’t know if any given period will be your last period until you’ve gone a full year without one. And it’s easy to forget when that date was.

Next, you should talk to your gynecologist. Depending on where you are in your peri/menopause transition, they may recommend hormone therapy (HRT) via various types of birth control pills, progestin-containing IUDs or other combinations of estrogen and progesterone. All of these forms of HRT can alleviate cramps and lighten the bleeding. Occasionally, hormones aren’t enough to combat structural problems like fibroids, polyps, etc. In that case, you’ll need to have a bigger conversation with your gynecologist about whether or not you should consider surgery.

As you and your doctor consider how best to treat your heavy, irregular periods, make sure to keep menstrual products with you at all times since you just never know when a period will hit. You might consider wearing reusable cloth panty liners on the daily to prevent any embarrassing moments. They’re not only eco-friendly but also breathable and less irritating to sensitive vaginal tissue.

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At The Cusp, we provide expert menopause care. We are a comprehensive, convenient virtual healthcare service dedicated to help you feel better.