Six Things Every Woman Should Know About Her Periods Before Menopause

When to worry, when to go with the flow
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It seems like only yesterday you were snickering in health class as you learned about feminine hygiene and your impending first period. Now here you are in the prime of life -- and it's already time to think about your last.

By your 40s -- and sometimes earlier, for the 1 to 5 percent of women headed for premature menopause -- important menstrual-cycle changes are already on the way. Here's what to know.

A skipped or heavy period might be your first sign of menopause.

Your menstrual cycle until menopause isn't a now-you-see-it, suddenly-you-won't kind of thing. "The ovary doesn't stop, boom!" says Sandra Carson, a professor of ob-gyn at Brown University and medical director of the Center for Reproduction and Infertility at Women's and Infants Hospital of Rhode Island.

Most women experience gradual menstrual irregularity during the phase known as perimenopause, the three to five years before menopause. Estrogen levels start falling even earlier, as eggs disappear from the ovaries, though we don't notice. Ongoing hormonal shifts finally become obvious in the form of changing periods.

Usually this means lighter and less frequent, but "normal" reactions are surprisingly variable. A woman's periods may turn longer than usual, shorter than usual, space farther apart, or in some months be skipped entirely. Some women begin to have bouts of heavy bleeding. Others spot between periods.

Tracking their timing, length, and nature now can help you notice the changes.

Bleeding changes are normal, but you shouldn't assume they're normal.

Even though the majority of women develop some kind of menstrual irregularity in their 40s as the body closes shop on reproduction, heavy bleeding is one symptom you should always report to your doctor.

At minimum, heavy periods can lead to anemia or disrupt your ability to conduct daily life. (Example: a teacher or a surgeon who must spend hours on her feet without a break.) But heavy bleeding can also flag other treatable conditions that can affect women of any age, including fibroids, polyps, ovarian cysts, an overgrowth of the endometrium (uterine lining), or, rarely, uterine cancer.

"Heavy" periods can feel different from woman to woman.

The medical definition of a heavy period (menorrhagia) is more than 80 ccs (cubic centimeters) of blood, or about three ounces, according to Carson. (Most women lose about six teaspoons of blood per cycle.) But who measures her flow, let alone knows what 80 ccs looks like? And if you're someone who's always had intense periods, what should you look for?

Trust what seems like a change for you. "After you've been menstruating for 30 years, you know when there's a change," Carson says.

Also look for: clotting, using more than one high-absorbency pad at a time, combining a tampon plus a pad, needing to change pads hourly, bleeding steadily for more than seven days. The American College of Obstetrics and Gynecologists also recommends telling your doctor if you're bleeding more often than every three weeks or you bleed after having sex.

More things every woman should know about her periods before menopause

There's no link between menstrual difficulty in your reproductive years and menstrual difficulty in perimenopause.

Good news for women plagued by heavy bleeding, cramping, and bad PMS (dysmenorrhea): Your odds of a rough passage through menopause seem to be about the same as any woman's, says Carson. But there's some evidence that stress worsens both PMS and perimenopausal symptoms.

You can still get pregnant even after you start missing periods.

The number-one mistake women with menstrual irregularity make (after not checking with a doctor about big changes): assuming that being down the road toward menopause means you can't conceive -- or that your odds are so low it's not worth bothering about.

"Your chances of pregnancy are low and your chances of miscarriage are high once your periods become irregular in perimenopause, but you can still get pregnant," says Carson, an ob-gyn and endocrinologist. And every year, thousands of perimenopausal women do.

Some doctors keep healthy women without risk factors (like smoking) on hormonal contraceptives through their early 50s, since that has the same protective effects against menopausal symptoms (such as minimizing abnormal bleeding or hot flashes) as hormone replacement therapy (HRT). Others prefer to transition patients to HRT or alternatives, along with an alternate birth control method. Some advise women to wean off hormonal contraceptives by their late 40s in order to measure levels of FSH (follicle-stimulating hormone), which, when elevated, indicate that the ovaries are failing and heading toward menopause. To get an accurate reading, a woman should not be taking hormonal contraceptives for as long as six weeks before testing.

Women in their 40s who have quit birth control pills may be advised to wait 18 months without a period before considering another form of contraception unnecessary. Another reason to consider contraceptives in perimenopause and beyond: You'll still need protection against sexually-transmitted diseases if you're sexually active and not in a long-term monogamous relationship.

You won't know your last period when you see it.

For such a big deal, the official end of tampons, pads, and birth control always slips by without notice. "There's no test to say you'll go into natural menopause next month or next year," Carson says. "Some tests [such as blood tests to measure FSH] will suggest it will probably occur in the next three to five years, but that's the best we can do."

The average age of menopause is 51, most often occurring between 45 and 55. The extreme -- and rare -- ends of "normal" are the early 40s and as late as 60.

"Menopause itself is defined as the last menstrual period, but you won't know when that was until one year afterward," says Carson. That's because technically, menopause isn't the whole passage commonly referred to, from menstrual irregularity through hot flashes. It's the day menstruation ends -- as noted only by looking back on 12 full months without menstruation. Period.

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

3 days, said...

In reply to @pamichen, I once heard of a very good gynae saying that all women at 45 should accept that they are almost definitely peri-menopausal. Obviously with the possibility of it being sooner for some women as is often the case.. No such thing as peri-menopause?? Ahh what does he know?, he's a man!! Wishing you luck whatever the outcome :)

about 2 months, said...

I am 45,last year I started with hot flashes and my periods stoped. Then the suddenly stopped and I started having regular periods again for about six months. Suddenly this month it has been 15 days since I last had a period. Is this normal.

5 months, said...

I'm 43. I feel like I have been perimenopausal for about 2 years now. my dr. (a male) said there is no such thing as perimenopause and unless I haven't had my period for a year I am not in menopause. ha! anyways...I have been having shorter in between periods and the once in a while late period i the last 6 months. I am now on day 46 between periods. I actually am now concerned of pregnancy even though I did a test last week that said negative. I was only 3 weeks after intercourse that would have impregnated so the test may not have been accurate. i will take another test this week to be sure. I will be happy either way...full on menopause, bring it on. Baby at 43? errrr...yeah, ok...bring it on! Take each day as it comes and make the best of it! :o) you know...I love being a woman!

5 months, said...

Im 30 years old ive had 2 kids one vaginal the 2nd c section and had a tubal ligation its been 4 years since the c section and tubal and my periods are very heavy and golf ball to egg size clots and i will go 4-5 months without having one has anyone else had this problem and found out whats goi g on

10 months, said...

I am 55 and started menstruating at age 10. I feel like it will never end. Seriously.

10 months, said...

I am 52 years old and haven't had a period in 10 months now I have my period again. Should I be concerned?

11 months, said...

I go about 3-4 months nothing - then SURPRISE - really!? now, someone (me) who was always light and about 4 days, super heavy, 7 days so far on this one and clots and YUCK - gag! ruining everything because I am 46 and never had heavy ones! craving lima beans (iron) - feeling lethargic - but as for the hormonal headaches - pierced the daith hopeful and it has worked - have had only 2 headaches, compared to more then half the month and NO more migraines! that has been amazing! May the Lord bless our loved ones as we go on this adventure!

about 1 year, said...

I m 38yrs will turn 39 on 7September. My period is regular but observed the flow is only for 2 days. Is it normal?

over 1 year, said...

I am 44 and for the most part have always had regular periods sometimes heavy in the beginning but usually tapers off after a few days. The past year my periods have gotten extremely heavy and I have been experiencing break through bleeding whenever I have a bowel movement about 4 or 5 days before my period. I have also noticed huge blood clots the past few times I've had my period. All the women in my family including my mom, grandma, and my sister have had to have a hysterectomy due to extremely heavy bleeding and fibroid tumors. My daughter also has issues with polysystic ovary syndrome which causes her to have huge blood clots. I haven't had any hot flashes but I have noticed that my pms has been extremely bad this year, so bad that I feel like I could just choke any person who even looks at me the wrong way. I am not that kinda person, but my period is seriously making me feel crazy . I plan on seeing my Dr. to make sure there isn't anything seriously wrong.

over 1 year, said...

I'm 48 and haven't had my period for a whole.year, during which I have had some pretty serious hot flashes, some of which were accompanied by spiky headaches. Now, a year later, I'm having my period. What gives?

over 1 year, said...

I'm going on 42 on Jan 31, my menstrual cycle has always been regular 7 days long heavy the first 3 and light the next 4. Now they are only 3 days long heavy for very little. Can I still get pregnant?

over 1 year, said...

Good afternoon... I've had heavy periods through most of my life since I was 10 yrs old. Bad cramping, headaches, leg and back pain, etc.. I've had heat flashes for about a year now. Off and on. Periods have become irregular also. But this past November 2016, I completely missed my period. It stopped. I felt a bit of bloatiness and some PMS. I also always felt fatigued. I'm a housewife. Kids are grown. I've had a tubaligation back in 1991.. I'm thinking I'm in the Perimenopause phase, but not sure. I want to go see a Menopausal specialist to get better educated and possibly some information regarding natural meds for it. I'm thinking of doing a pregnancy test just to be safe. My question is... I would like my boyfriend of 6 yrs who is 51 to learn and get educated regarding what I'm experiencing and what to expect and be supportive. What is the best way to do that? I just turned 49 in November.

over 1 year, said...

Hi everyone, I am 58 years old and I am still having my periods, although, I believe I am finally in the "perimenopause" phase. From what I have read online, they say any age past 55 is "rare", but I don't know. My Mom was 57 when she started into menopause and my oldest sister was 56. I don't know if that has any baring on it or not. When I turned 48-49 years old, I started having strange and irregular periods. Mostly over the past years they have been light and lasting 2,3,4 days, Very little cramping, but had a lot of PMS. Hunger and insomnia have been my biggest annoyances, but I deal with it. But, all seem to change last November, 2015, just a few days after Thanksgiving, I started spotting, very, very light off and on, all through the month. Some days, only a small discharge, then nothing.. I would go a few more days and nothing. This went on until July of, 2016. I started my period, which I knew felt different. It was heavier and 2 days into my period, I felt a push and wow! I've never experienced such bleeding and huge clots! I was freakin out! Then, the next day I had another bleeding episode, it wasn't as bad as the first day. So, July ends and so did my period. Then, bam! August was the worse of my life! I thought I was gonna bleed to death, passing huge clots! Every day and these clots and heavy bleeding would start on me at 7:00 pm, then 9:00 pm and some days around 11:00 pm. It was like clockwork! After midnight and into the next day hardly any bleeding or clots, then 7:00 pm and BAM! This lasted 14 days, (the longest I've ever had a period in my life), but I took advil and wild yam capsules. That helped a lot. September and October of 2016 were really good months, Only very light 1-3 days of spotting, no cramping, I felt so good those months.. Now here I am in November having a somewhat heavy period, but nothing like it was in July-August. I've had some clots, but not huge like it was before. That only lasted about 4 days.. Now 4 days later, which is today, I start again, ugh! It's not heavy bleeding, but I have cramping. I hate this so much! I wish it would come to an end soon.. I wish the best for every one that's been having these difficulties. I hope that what I've told about myself will help or reassure anyone that reads it. (I guess I should add, that I am healthy, I don't smoke, or take any kind of meds for anything, I've never taken any contraceptives in my life! I've had 2 kids and one miscarriage when I was 20 years old. I lost my husband to a sudden heart attack about 4 years ago. We were married 38 years, That was a huge traumatic and stress-filled time in my life. I would suppose from all the things I've read, that this could be the cause of my late-onset menopause, but I am only speculating at this)

over 1 year, said...

I didn't get my first period until I was 14. I was very athletic as a child and understand this sometimes prolongs this. I've have several issues with my periods (extremely heavy) and getting pregnant (tubal preg, miscarriages, etc.) my second child was assisted with Clomed, my third child was a surprise. Just this past month, I've gotten my full blown period three times, is this normal in menopause? I've had heat flashes for over 10 years, however I haven't had any this past month.

over 1 year, said...

every since I started my period at age 12 they were always very heavy (clots) then a few years ago during a pap smear I was told I was going through Perimenopause. I will go two to three months without a period and then when I do have one it's very light and last only two to three days, before they always lasted seven to eight days. i'm now on my period and it's very heavy, so I was wondering Before you go into full Menopause do you have a really heavy period?

almost 2 years, said...

Hi... I am turning 47, this year, and I now believe that I have been in perimenopause since age 43, my periods started changing, heavy for awhile, 22 day cycles, then it went to 30 plus cycles, and from 7 days, to 3 days. Getting shorter and lighter, until this may, they just stopped. It's been almost 3 months since a period. Anyone else have similar situation? Also, have menopause symptoms,, sleep issues, and mood swings..