Perimenopause Periods Explained: Spotting, Heavy Bleeds, and More

What Is Perimenopause?

Perimenopause, or menopausal transition, represents a time during which newly arising symptoms can present complex issues which can be hard to manage. You may experience symptoms including hot flashes, mood swings, sleep issues, changing bleeding patterns and changes in sexual desires. The effect of these symptoms on the quality of your life can be significant, even before you enter menopause.

Timeline of Perimenopause:

Perimenopause normally starts in late 30s or 40s and can last anywhere between few months to over a decade.

Symptoms and Changes:

Irregular periods are one of the main signs of perimenopause, but they may differ from woman to woman. Some women notice lighter, irregular periods, while some may struggle with heavy, prolonged bleeding.

Hormonal changes during your perimenopause can also cause symptoms like hot flashes, mood swings, and sleep disturbances, which often come with menstrual irregularities.

Spotting and Irregular Bleeding During Perimenopause

What exactly is spotting? If you notice spots of blood in your underwear, which is light and won’t require pads or tampons, then it can be spotting.

Spotting can range from very light to light in intensity. It can differ from person to person.

Why Does Spotting Happen?

Due to changes in hormone levels in your body, the normal cycle of your menstrual cycle, which includes uterine lining shedding, can get disturbed. Lack of progesterone can cause irregular shedding and spotting.

Potential Causes:

• Hormonal imbalances
• Endometrial atrophy (thinning of the uterine lining)
• Uterine fibroids or polyps

When Should You Be Concerned:

Spotting can be benign, so monitoring any unusual symptoms is necessary.

You should seek medical advice if your spotting is:

• Persistent and unrelated to periods.
• If you are also suffering from pelvic pain.
• Heavy or occurs after sexual activity.

Heavy Periods (Menorrhagia) in Perimenopause

During perimenopause, you may suffer from menorrhagia, which is excessively heavy menstrual bleeding. This can be a challenging and exhausting experience.

What Defines Heavy Bleeding?

Heavy periods have the following characteristics :

• Pads or tampons are soaked completely every hour.
• Passing large clots.
• Prolonged bleeding that lasts more than seven days.

Why Are Your Periods Heavier (Menorrhagia) During Perimenopause?

Hormonal imbalances during perimenopause disturb your ovulation. Without ovulation, production of the hormone progesterone declines, leaving the hormone estrogen unopposed. This leads to an excessive thickening of your uterine lining, which can result in heavier periods.

Other Factors:

• Uterine fibroids (non-cancerous growths in the uterus).
• Polyps (small tissue growths in the uterine lining).
• Adenomyosis (thickening of the uterine walls).

Skipped Periods and Irregular Cycles

During perimenopause, one of the most common complaints is the increasing occurrence of irregular menstrual cycles. Skipped periods or extended cycles are widespread due to changing hormone levels.

Why Does This Happen?

Your body undergoes many changes throughout your lifetime. During menopause, your body faces changes in ovulation patterns, menstrual cycles, and hormones. As your ovulation becomes less consistent, hormones’ regular rise and fall are disturbed. This causes irregular cycles, and period cycles can be very uncertain.

What to Expect:

Your menstrual cycles can range anywhere between 21 days and over 35 days.

Many women can have long gaps between periods, which a very heavy one may follow.

Others can have a very scanty flow, which may last for a day or two only. 

Other Menstrual Changes in Perimenopause

Perimenopause causes irregularity and can change the nature of your periods in the following ways.

1. Shorter or Longer Periods:

Changes in your hormones can cause changes in your periods. It can sometimes last for a day or stretch beyond the usual period at other times.

2. Lighter or Heavier Bleeding:

You may notice changes in your period flow; it can suddenly become lighter or heavier.

3. Changes in Duration or Intensity:

Your periods can begin with spotting, become heavier, and reduce slowly and irregularly.

Some of your cycles can be so light that they resemble spotting, while others can be very heavy.

Understanding the Root Cause of Changes

The changes in hormone levels during perimenopause—especially the decline in levels of estrogen and progesterone—are responsible for menstrual changes.

Estrogen?

It stimulates the growth of the uterine lining. When it’s unbalanced, it can lead to heavy or prolonged bleeding.

Progesterone?

It manages the uterine lining. Any change in it can cause irregular periods, spotting or skipped periods.

Going Through Perimenopause with Awareness….

Each woman’s menopausal phase is different, and the changes in your menstrual cycles can vary. Paying attention to your body and seeking professional guidance can help ensure a smoother transition through this phase.

When to Seek Medical Advice: Spotting Red Flags

Menopause and perimenopause is a natural phase which every woman goes through. 

Most of the menstrual changes and symptoms during the menopause and perimenopause periods are normal, but some specific symptoms may need immediate medical attention.

When Should You Call Your Doctor?

• If you experience heavy bleeding that soaks through multiple pads or tampons in a short period.
• If your periods last longer than seven days.
• If you notice spotting after menopause or sexual activity.
• If you experience severe lower abdominal pain and cramps.
• If you notice unexplained weight gain, persistent fatigue, or bloating.

Medical attention given at the proper time can help to address underlying conditions you may have and also prevent any further complications like anaemia.

Medical Options for Managing Perimenopausal Periods

Most of the symptoms of perimenopause are very common. Still, some of the symptoms can be debilitating and cause you physical and mental distress, affecting your daily life and routine. If proper care and attention are not given, it can lead to future complications for you. Medical treatments can provide you relief if you suffer from severe symptoms.

Hormonal Treatments:

• Birth Control Pills or Hormonal IUDs: They help to manage your cycles and reduce heavy bleeding and perimenopausal symptoms.
• Hormone Replacement Therapy (HRT): It balances your declining estrogen and progesterone levels, easing your menstrual irregularities.

Non-Hormonal Medications:

• Tranexamic Acid: It reduces tissue activity in your uterus and hence decreases heavy bleeding, too.
• NSAIDs: It reduces inflammation in your body, thus relieving pain and reducing bleeding.

Advanced Interventions:

• Endometrial Ablation: It removes your uterine lining to decrease or stop bleeding.
• Uterine Artery Embolization: It shrinks any fibroids that can cause heavy periods.

Discuss available options with your doctor to make sure what is the best treatment for you.

Natural Remedies for Managing Period Symptoms

Several remedies can help manage your perimenopausal symptoms. They are as follows:

Herbal Remedies:

• Black Cohosh and Red Clover: It helps to reduce symptoms like hot flashes and menstrual irregularities.
• Chasteberry:  It maintains hormonal balance and reduces discomfort during periods.

Acupuncture:

It stimulates hormone regulation and improves blood flow to reduce menstrual discomfort.

Supplements:

• Magnesium and Vitamin E: It relieves cramps and reduces inflammation.
• Omega-3 Fatty Acids: It supports hormonal balance and reduces period-related inflammation.

You can also check out this blog, to know how to manage your heavy periods.

Lifestyle Changes

A healthy lifestyle is beneficial to decrease your issues related to perimenopause.

Diet:

• Your diet should be high in fibre, healthy fats, and antioxidants.
• Add flaxseeds, leafy greens, berries and fatty fish to your diet.
• You can also add supplements to your routine under professional guidance according to your needs.

Exercise:

• Regular physical activity is very important as it can help manage your hormones.
• It elevates your mood and reduces the intensity of your symptoms.
• A mix of cardio, strength training, and yoga exercises can be very helpful.

Managing Stress :

• Stress can affect your hormonal and period cycles.
• Practices like meditation and deep breathing help calm and clear your mind.

Sleep:

• Poor sleep can affect the production and functioning of your hormones, which can cause an increase in symptoms that affect your daily lives.

Stick to a sleep schedule and do practices that calm your mind before sleeping.  

Wrapping Up

If you understand menopause and perimenopause’s effects, it can help you effectively take control.

While it may cause challenges, you can manage your symptoms by making lifestyle changes, medical options, and adding natural remedies.

Remember, every woman’s journey is different—listen to your body and seek support when needed.