Irregular Periods

Often the first sign of perimenopause, irregular periods during this time are typically heavier and more frequent. As you progress into late perimenopause, frequency decreases before stopping altogether at menopause.

The science

Irregular bleeding is common during perimenopause. At first, cycles can be shorter by just a few days (25 vs 28 days, for example) or you may get your period every three weeks.

Dr. Anna Barbieri, MD

Pro tip #1

Before your next annual visit, track your cycle for 1-2 months to share with your doctor. Tracking specific cycle length between periods, duration of your period, and flow can help your doctor better understand where you are in the perimenopause transition, or whether there is potentially something else that should be evaulated. For example, decreased time between cycles (< 28 days) could be an early sign of perimenopause, while increased time between periods often signals late perimenopause.

Most women will experience period changes as they move into perimenopause. Changes can range from irregular cycles, abnormally heavy or prolonged bleeding (menorrhagia), and / or increasingly painful cramps (dysmenorrhea) — and yes, this can happen even if your cycle ran like clockwork before. The culprit? Hormonal changes.

How your hormones play a role

The two primary reproductive hormones for women, estrogen and progesterone, control menstruation along with a slew of other functions in our body. Among other things, estrogen causes the endometrium, or the lining of the uterus to thicken during a typical menstrual cycle. Progesterone balances estrogen by controlling the build-up of the endometrium and preparing the lining for the potential of pregnancy. When hormone levels shift and eventually decline during the menopausal transition, the result is irregular periods. Below is an example of how a woman may experience the transition, but remember: everyone is different and your experience may be different.

Typically, as early perimenopause shifts into late perimenopause and the last menstruation approaches, cycles become more irregular, and scarce due to declining estrogen levels, often absent ovulation, and less growth of the uterine lining. We unfortunately cannot test accurately for when that last period will come, but the average age tends to be around 51. Some women will continue to menstruate well into their 50s.

How heavy is talk-to-your-doctor heavy?

Our bodies, and our cycles, vary tremendously, but here are some benchmarks to consider, especially if this type of bleeding are new and different from your baseline:

Soaking through 1 pad/tampon per hour for 2+ hours
Bleeding for longer than 1 week
Passing blood clots larger than a quarter
Waking up at night to change a pad or tampon

Below are two other reasons you may want to seek additional medical help:

Prolonged, heavy, or painful periods can sometimes be a result of polycystic ovarian syndrome (PCOS), polyps, fibroids, coagulation (blood clotting) problems — in which case you should definitely consult your doctor.
Any and all vaginal bleeding post-menopause is considered abnormal and should be a sign to talk to your doctor. While the cause could very well be harmless (like dryness), it could also be a signal of a more serious medical condition, including uterine cancer. If you have postmenopausal bleeding, you need to call your doctor right away. And if you can, bring notes on the length, duration, and flow of your bleeding to that doctor’s appointment.

Oh, and one more note on irregular periods

They could very well be due to other causes outside of perimenopause and menopause, including anything that can disrupt ovulation: thyroid and prolactin abnormalities, polycystic ovary syndrome (PCOS), adrenal problems, extreme stress, illness, etc.

Periods that suddenly become irregular may require a workup to exclude causes other than perimenopause, especially for women in their early 40s. And remember, while a skipped period at 40 may mean perimenopause (or any of the culprits listed above), it can also mean pregnancy!

What you can do

We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

Dr. Anna Barbieri, MD

Pro tip #2

If you're having heavier bleeding, don't worry if your doctor recommends bloodwork, an ultrasound, or even a uterine biopsy. These are standard steps of a a workup for heavy bleeding and are used to identify potential other hormonal issues (like thyroid), anemia, uterine abnormalities like fibroids or polyps, and even precancerous changes in the uterine lining. Even if something is found, remember that there can be *many* solutions depending on the results.

Pro tip #3

If you’re taking NSAIDs (think Ibuprofen or Naproxen) for heavy menstrual periods and/or cramps, be sure to take them with food since an upset stomach is a potential side effect.

A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

Lifestyle

Nutrition & Diet

There’s unfortunately little to no research around specific foods that help with menopause-related heavy periods and irregular bleeding; however, nutrition can help if your irregular and/or abnormally heavy bleeding is due to other factors, such as obesity.

Holistic Practices

While most alternative therapies haven’t been clinically studied, the techniques below are worth trying if your heavy bleeding comes with a side of bad cramps.

Acupuncture: When extremely thin needles are inserted through your skin at strategic points (don’t worry — it doesn’t hurt!) to reduce pain from cramping
Acupressure: When gentle pressure is used to stimulate certain points on your body (also for cramping)

A practical tip here on absorbent period underwear. These work wonders if you’re concerned about leaking. Products such as Knix and Thinx can absorb up to 4 tampons worth of flow, but feel free to still use pads or tampons for a double layer of menstruation protection.

Supplements & Over-the-Counter Solutions

Research examining the effect of supplements on irregular and/or heavy bleeding is inconsistent and unclear at best, BUT…here comes the good news…there are two natural agents that stand out as having more evidence — although keep in mind that generally speaking, the medical approaches listed further down below are more effective than supplements.

We recommend consulting with your healthcare provider first to make sure a more effective course of action is not warranted and to ensure you’re using something with optimal efficacy and safety (i.e. backed by clinical research) or consulting with Elektra’s providers.

1. Vitex

Also known as chastetree, monk’s pepper, or Abraham’s balm, Vitex is a peppercorn-sized fruit frequently used as an herbal remedy for those experiencing frequent menstruation. By increasing progesterone, it can help with regulation of your cycles. This is an ideal supplement for early perimenopause when periods are beginning to get closer together (i.e. if you’re tracking your cycles, you’ll note the time between cycles is decreasing).

Elektra’s preferred products:

Vitex Elixer
Chasteberry Plus
DIM Vitex

2. Ginger

Ginger is a flowering plant that belongs to the Zingiberaceae family and can be used fresh, dried, powdered, or in oil/juice form as an anti-inflammatory to tame heavy periods and bad cramps. (This is the same ginger we buy at the grocery store!)

Elektra’s preferred products:

Ginger Root Drops
Ginger Root Capsules

Keep in mind that herbal supplements have only been shown to produce effects after several weeks, so a longer commitment is required here.

A note on NSAIDs (i.e. Ibuprofen)

NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly used during early-late perimenopause to regulate heavy menstrual bleeding.

Prescription

Hormonal

Research shows that hormonal treatments can help with irregular periods during perimenopause. They come in a variety of forms, with these being the two frequently prescribed options:

1. Low-dose oral contraceptives

About: Birth control pills that contain a lower dose of estrogen & progestin, which is a synthetic form of progesterone. Also a good option for women who still require contraception in perimenopause.