Six Things Every Woman Should Know About Her Periods Before Menopause

When to worry, when to go with the flow
Portrait of mature woman sitting in countryside

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.

6 days ago, 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.

30 days ago, 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?

3 months ago, 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..

3 months ago, said...

Hi, I started menstruating the spring of 1977. I will be 52 this year and have not missed any periods although I seem to have spotting between periods. I was really hoping that I would see some signs of menopause or perimenopause by this point but I'm beginning to think I'm going to still be menstruating until the day I die! Most everyone I know has either gone through it or has had a hysterectomy. This has been going on for over 39 years now, How long can this continue??? My Mom is of no help as she had a hysterectomy so she cannot say about how long it will be.

4 months ago, said...

Im 42 n for about a yr my periods only last 2-3 days n are light,am i going through perimenopause?

4 months ago, said...

Sorry about the mistakes. The time without my period is 3 months + or 108 days.

4 months ago, said...

Am 52 years old and have been spotting for 3 weeks and 2 days now. Before that I didn't have a period for over 3 months (108 days, exactly). Am wondering what is going on. Any ideas?

4 months ago, said...

Hi I am 51 years old and I am 9 days late for my cycle this month I've been experiencing lots of headaches and lower back pain and bloatedness I would like to know if these are normal menopausal symptoms

5 months ago, said...

Hi. I am almost 43 and I have been premenopausal since 38. Are used to have my period twice a month since starting the pre-menopausal state and last month I had my period for 10 days in a row and then a week later had it again. Is there some kind of sign when you were going into regular menopause ? I just don't know what's going on with my body and I need some advice. This will help me when I go to the doctor

5 months ago, said...

Hi i'm 42 and I will be 43 in a couple months. I have been going through pre-menopause since I was 38 and have had my period for 31 years now. I have a question. My question is is there any type of sign at all that I will be going into regular menopause soon? My periods have been different for the past five years and recently I had a period for 10 days in a row and when I stopped I was so happy and then one week later I started again but it was only for two days and then I spotted for a couple days. should I be concerned about the period that I had for 10 days in a row or is it no concern at all? I went from having it twice a month to once a month for many days in a row

5 months ago, said...

Haven't had period since nov 2015. Got 2 days ago seems heavier and clotting. Should I be concerned???

5 months ago, said...

Hi. I'll be 41 this year, while I was working an extremely physical job last year I had lost my period, I was laid on a couple of months back & lo n behold my period returned. ..problem is now my period is super light, lasts longer than 7 days and happens closer together now. Honestly, I'm really scared. Everything you read online points to doom n gloom. Please help, our of a complete fear of doctors-well the bad things they could potentially say- I simply will not go..not right now anyway. Please someone helpmmmi want to be around to raise all of my boys and see my future grandchildren. Thank you for your time.. many blessings.

6 months ago, said...

I'm 48 years old I've had my period for three weeks I'm nervous

8 months ago, said...

I just turned 50 and still very active life is still normal as when I was 25 ....questions I missed my period for the very first time and I am wondering if I am pregnant ...I am always clock work when it comes to my period

9 months ago, said...

I have a question which may be stupid being as I am 53 years old. My period started as normal(like clockwork) on Tuesday. Very Very light barely used one pad all day. then yesterday day 6! it was very heavy in the evening lots of "clots" for about 3-4 hours. then went back to avg/heavy flow. Then today all was good til about 9a.m. then heavy again and could feel "clots" and when I went to pee I could see them. Is this weird? Should I be concerned? No cramping just feels a little crampish sometimes. It is 5 p.m and I have used 3 pads so far today first one being put on at 7 a.m.

11 months ago, said...

I am a mother of naturally conceived twins. It's very difficult to find information on genetic traits such as twinning & I wonder if indeed I release two eggs each month and if so could this lead to early menopause. I am now 41 and my last period was 2 days long (yes!). I recall symptoms such as night sweats & lack of sleep around 39 years. Is this possible and if so what is the best solution to keep oestrogen levels up?