Perimenopause Periods: 6 Changes to Expect and How to Track Them

Perimenopause is the transition stage before menopause, where your reproductive organs gradually stop producing eggs. Perimenopause can last anywhere from a couple of months to multiple years (the average duration is two to four years), during which the levels of estrogen and progesterone, the two sex hormones crucial to reproductive and sexual health, fluctuate. The imbalance of these hormones leads to mood changes and hot flashes and can also impact your menstrual cycle, including your periods.

Understanding how perimenopause periods change can help you feel more in control during this transition. Research shows that tracking hormonal patterns alongside period changes provides valuable insights that can guide treatment decisions and improve quality of life during perimenopause.

What happens to your period during perimenopause?

During perimenopause, your levels of estrogen and progesterone fluctuate and start to decline. These changes lead to changes in your cycle, and often, your period. Eventually, at the end of perimenopause, your period will stop. 

As hormones start fluctuating during perimenopause, it can affect the length of periods and menstrual flow. Your period can encounter many changes during perimenopause, from longer or shorter cycles to heavier or lighter flows and missed periods.

>>MORE: What Are The First Signs of Perimenopause?

The Hormone Story Behind Period Changes

Your perimenopause periods reflect the complex dance between estrogen and progesterone. In early perimenopause, progesterone typically drops first while estrogen remains normal or even elevated, creating "estrogen dominance." This imbalance directly affects your periods:

• Low progesterone: Can cause shorter cycles and breakthrough bleeding
• High estrogen relative to progesterone: Often leads to heavier periods and longer cycles
• Fluctuating both hormones: Results in unpredictable patterns month to month

Understanding these hormone dynamics helps explain why your periods might be completely different from one month to the next.

When do perimenopause periods start? 

Perimenopause can begin as early as your mid-30s but most often occurs in your 40s. Some women may start to experience symptoms of perimenopause earlier, while others might not notice any changes or symptoms until much later. The duration of perimenopause can vary as well, lasting anywhere from a few years to over a decade before reaching menopause. 

Irregular periods are a good indication that perimenopause has begun. They are likely the first symptom you’ll experience, potentially along with hot flashes, vaginal dryness, or mood changes.

Stages of Perimenopause and Your Periods

It's important to understand that perimenopause periods change predictably through different stages:

Early Perimenopause:

• Cycles may shorten to 21 to 27 days
• Flow often remains regular but timing changes
• You're still ovulating most months

Mid Perimenopause:

• Cycles become increasingly unpredictable
• Mix of short and long cycles
• More anovulatory cycles (cycles without ovulation)

Late Perimenopause:

• Cycles lengthen significantly (60+ days)
• More missed periods
• Approaching the final 12 months without a period

6 Types of Period Changes During Perimenopause

So, what changes to your perimenopause periods can you expect? Here are six different types of perimenopause periods.

1 Shorter cycles

When estrogen levels are low, your uterine lining is thinner. This can result in a lighter and shorter period cycle. 

Shorter cycles are more likely to occur in the earlier stages of perimenopause. You may also experience two periods in one month because of these shorter cycles, and the next period can happen as quickly as three weeks after your previous cycle.

What to know: If your cycles shorten to less than 21 days consistently, considering sharing with your healthcare provider as this may indicate other concerns beyond perimenopause.

2 Longer cycles

Longer cycles (more than 38 days) are more common in the later stages of perimenopause. Higher levels of estrogen than progesterone can cause your cycle to get longer and further apart. Estrogen builds up the uterine lining and your body may take more time to shed it during menstruation.

What to know: Cycles over 60 days are common in late perimenopause. However, you can still ovulate during these long cycles, so pregnancy is still possible.

3 Missed periods

With your estrogen and progesterone levels thrown off, these imbalances can also lead to missed periods. Menopause begins after 12 consecutive months without a menstrual period. Even if your cycle occurs after an extended time, ovulation is still taking place and you can still get pregnant.

>>MORE: Perimenopause vs. Menopause: What's the Difference?

4 Brown or dark blood

Bright red blood is blood that quickly leaves the body. Brown or dark blood is a sign of old blood leaving the body. This blood has a brown and dark color because it stays in the uterus longer and becomes oxidized. It’s common during perimenopause to have brown or dark blood as a result of fluctuating hormones.

5 Spotting

You may notice spotting between periods. Spotting is light vaginal bleeding that doesn't require a pad or tampon. The varying hormone levels and the buildup of the endometrium or uterine lining can cause unpredictable period spotting before or after your period usually occurs. 

Tracking your bleeding patterns can help to anticipate spotting, or you can wear panty liners to avoid leaks and stains.

6 Heavy bleeding

You may experience heavier bleeding during perimenopause. Estrogen and progesterone levels are in flux, and when estrogen levels are higher than progesterone levels, it builds up your uterine lining. This can result in heavier bleeding when your body sheds its uterine lining during menstruation. A missed period can also cause the uterine lining to thicken and lead to heavier bleeding.

Heavy bleeding is defined as losing more than 80ml of blood per cycle, or needing to change your pad or tampon every 1 to 2 hours.Signs of heavy bleeding are when your period blood soaks through a tampon or pad quickly or when it requires multiple menstrual products (both a tampon and pad) to manage the flow. It may disrupt your sleep because you need to change your pad or tampon.

While a common symptom of perimenopause, too much heavy bleeding can be a sign of other health concerns like anemia or endometrial cancer. If you experience this, it's important to tracking the frequency and amount can help your healthcare provider determine if intervention is needed.

When Perimenopause Periods Need Medical Attention

Add after "Heavy bleeding":

While perimenopause periods vary widely, certain patterns warrant medical evaluation:

• Bleeding that lasts longer than 7 days
• Periods occurring more frequently than every 21 days
• Bleeding between periods that isn't light spotting
• Bleeding after intercourse
• Any bleeding after 12 months without a period
• Soaking through protection every hour for several hours
• Passing blood clots larger than a quarter

These symptoms could indicate conditions requiring treatment, from hormonal imbalances to structural issues.

Managing Perimenopause Periods: Practical Strategies

Track Your Patterns: Monitoring your perimenopause periods helps you and your healthcare provider understand your unique transition. Track:

• Cycle length (first day of one period to first day of next)
• Flow intensity (light, medium, heavy, very heavy)
• Number of days bleeding
• Associated symptoms (cramps, mood changes, hot flashes)
• Any spotting between periods

Be Prepared: Since perimenopause periods are unpredictable:

• Keep period supplies in multiple locations (work, car, gym bag)
• Consider period underwear for unexpected spotting
• Use overnight pads for heavy flow days
• Set calendar reminders based on your tracking patterns

Nutritional Support: Certain nutrients can help manage perimenopause periods:

• Iron rich foods to prevent anemia from heavy bleeding
• Vitamin B6 to support hormone balance
• Magnesium to reduce cramping
• Omega 3 fatty acids to reduce inflammation

Consider Hormone Testing: Understanding your hormone levels can explain period changes and guide treatment. Testing progesterone and estrogen at specific cycle points (when possible) provides insights into whether hormone support might help regulate your periods.

Perimenopause Periods, The Bottom Line

Remember that every woman's experience with perimenopause periods is unique. What's normal for you might be different from your friends or family members. The key is understanding your own patterns, tracking changes, and maintaining open communication with your healthcare provider. With the right information and support, you can navigate this transition with confidence.

Frequently Asked Questions About Perimenopause Period

Can I still get pregnant if my periods are irregular during perimenopause?

Yes. As long as you're having periods, even irregular ones, you may still be ovulating. Pregnancy is possible until you've gone 12 full months without any period. If you don't want to become pregnant, continue using contraception throughout perimenopause.

Why are my periods suddenly so heavy in my 40s?‍

Heavy perimenopause periods often result from estrogen dominance. When progesterone drops but estrogen remains high, your uterine lining builds up more than usual, causing heavier bleeding when it sheds. This is common in perimenopause but should be evaluated if it affects your daily life.

Is it normal to have two periods in one month during perimenopause?

Yes, this can happen, especially in early perimenopause when cycles shorten. You might have a 21 day cycle, meaning you could have a period at the beginning and end of the same calendar month. Track these patterns to distinguish between short cycles and abnormal bleeding.

How long do irregular periods last before menopause?

Irregular perimenopause periods typically last 4 to 8 years before your final period, though this varies greatly. Some women experience irregularity for just a few months, while others have irregular periods for over a decade before reaching menopause.

Should I still see my gynecologist if my periods are just "weird" but not painful?

Yes. Annual visits remain important during perimenopause. Your provider can help determine if your "weird" periods are typical perimenopause changes or something requiring attention. They can also discuss management options to improve your quality of life.