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.

23 days ago, said...

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

2 months ago, said...

I just turned 50 and still very active sexually....my 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 I just turned 50 and still very active sexually....my 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 Hide

3 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... Show more 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. Hide

6 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? 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? Hide

9 months ago, said...

I am 51 and last 6 months been skipping periods and then would have light ones. This month I started and although not super heavy very steady going on 8 days now and not lightening up. Is this normal I am 51 and last 6 months been skipping periods and then would have light ones. This month I started and although not super heavy very steady going on 8 days now and not lightening up. Is this normal Hide

9 months ago, said...

My god this sucks! If I had known I wasn't having children I would have saved thousands on tampons by having operation . Yes you are welcome Playtex or Kotex. Btw what happened to OB? Huh? My god this sucks! If I had known I wasn't having children I would have saved thousands on tampons by having operation . Yes you are welcome Playtex or Kotex. Btw what happened to OB? Huh? Hide

9 months ago, said...

Last October 2014 was my last period and now July 27 2015 it's back heavy flown of blood how long will this stay and will I get my period every month now my age 49 sore stomach Hot flashes real bad sweating were do I stand now thanks Last October 2014 was my last period and now July 27 2015 it's back heavy flown of blood how long will this stay and will I get my period every month now my age 49 sore stomach Hot flashes real bad sweating were do I stand now thanks Hide

11 months ago, said...

Hi im 48 and have always had regular periods with no change at all im not showing any signs of going through the change ie change in periods amounts off blood changing any hot swets im late for the first time by a week could i be starting with the change Hi im 48 and have always had regular periods with no change at all im not showing any signs of going through the change ie change in periods amounts off blood changing any hot swets im late for the first time by a week could i be starting with the change Hide

12 months ago, said...

I am 53 and have regular normal flow periods, but after finishing period sometimes start spotting days after. Is that normal? I am 53 and have regular normal flow periods, but after finishing period sometimes start spotting days after. Is that normal? Hide

over 1 year ago, said...

Hi Im 47 and have not had my period instead been passing old blood browm discharge when i go to the tiolet for about two weeks ive been sterized and know im not pregnant ive gone for a smear test i was wondering if this could be menopause Hi Im 47 and have not had my period instead been passing old blood browm discharge when i go to the tiolet for about two weeks ive been sterized and know im not pregnant ive gone for a smear test i was wondering if this could be menopause Hide

over 1 year ago, said...

Should I be concerned if my period lasts 10 days or more with heavy clotting? I am 51 years old. Should I be concerned if my period lasts 10 days or more with heavy clotting? I am 51 years old. Hide

about 2 years ago, said...

I am 50 and have been on a period for3 weeks guess means the start of menopause? No hot flushes but mood swings maybe? I think will go dr to go on hrt will this stop the periods? I also had large fibriod and had embolized so not gone just smaller . Never ending problems just sounds like going to start I am 50 and have been on a period for3 weeks guess means the start of menopause? No hot flushes but mood swings maybe? I think will go dr to go on hrt will this stop the periods? I also had large fibriod and had embolized so not gone just smaller . Never ending problems just sounds like going to start Hide

about 2 years ago, said...

I haven't had a period since March 27, 2013. Does this mean I am finished? I haven't had a period since March 27, 2013. Does this mean I am finished? Hide

over 2 years ago, said...

I am 48 next week. I am having periods every few weeks some times. They are heavier than normal as i am normally very light. They are also lasting longer. Is this a sign of the menause I am 48 next week. I am having periods every few weeks some times. They are heavier than normal as i am normally very light. They are also lasting longer. Is this a sign of the menause Hide

over 2 years ago, said...

I am 49, turning 50 this November 2013. Started using a product from Thialand called "Pueraria mirifica" (Ainterol Brand) which I purchase on Amazon and is referred to as a natural hormone replacement therapy. It has really helped me get through some of the symptoms because it balances out the estrogen levels. There is research information on the net for those looking for something natural. Looking forward to the end of having periods!!! I am 49, turning 50 this November 2013. Started using a product from Thialand called "Pueraria mirifica" (Ainterol Brand) which I purchase on Amazon and is referred to as a natural hormone replacement therapy. It has really helped me get through some of the symptoms because it balances out the estrogen levels. There is research information on the net for those looking for something natural. Looking forward to the end of having periods!!! Hide

over 2 years ago, said...

Hi I have been pleading now for 7 weeks heavy with clotting I am 52 went to doctor she said its normal is this the case. Hi I have been pleading now for 7 weeks heavy with clotting I am 52 went to doctor she said its normal is this the case. Hide

over 2 years ago, said...

I started a period 6 days before I ended my last cycle of birthcontrol pills. I stared my new cycle of pills 6days ago. I have had a period for about 3 wks. I have an appt to see my OBGYN and I have been having back pain. The back pain is normal symptom of my period for me, since I have a tilted pelvis and I rarely ever have any cramping. I can say that I have had the lower back aches for a couple of months. I exercise regularly and I am almost 41. I have been nervous as to what to my... Show more I started a period 6 days before I ended my last cycle of birthcontrol pills. I stared my new cycle of pills 6days ago. I have had a period for about 3 wks. I have an appt to see my OBGYN and I have been having back pain. The back pain is normal symptom of my period for me, since I have a tilted pelvis and I rarely ever have any cramping. I can say that I have had the lower back aches for a couple of months. I exercise regularly and I am almost 41. I have been nervous as to what to my Dr will say about whats going on. I had an annual exam in July. I was about 2 weeks after this appt that I started with my period and Im still having it. Any insight or advice would be very appreciated. Please and Thank you. Hide

over 2 years ago, said...

hi i got those long lasting periods now or not at all for few months ,is that normal hi i got those long lasting periods now or not at all for few months ,is that normal Hide

almost 3 years ago, said...

ive had no period for 3months, and im 43yrs old .im not pregnant,and i want to hyserectomy.and im off all my food, eating small amounts, ie picking at it. ive had no period for 3months, and im 43yrs old .im not pregnant,and i want to hyserectomy.and im off all my food, eating small amounts, ie picking at it. Hide

about 3 years ago, said...

Been to drs. Having bad night sweats. Abnormal periods very heavy.grouchy a lot. But they say not yet. What do I need to ask them to do because I'm almost sure I'm in medapause? Been to drs. Having bad night sweats. Abnormal periods very heavy.grouchy a lot. But they say not yet. What do I need to ask them to do because I'm almost sure I'm in medapause? Hide

about 3 years ago, said...

I'm Premenopausal age 51, I had a . March 30th of this year, lasted for about 4an days, and started bleeding again, I've been bleeding very heavy with clots since then almost a month now is this normal for pre menopausal woman?. I know that every woman is different, and everybody flows differently, should I be concerned? I'm Premenopausal age 51, I had a . March 30th of this year, lasted for about 4an days, and started bleeding again, I've been bleeding very heavy with clots since then almost a month now is this normal for pre menopausal woman?. I know that every woman is different, and everybody flows differently, should I be concerned? Hide

about 3 years ago, said...

I'm 40 and I've never had a faithful period every month. My question is that is it normal to bleed more than 7 days? BTW I've been noticing that I'm having symstoms of perimenopause, Is this part of perimenopause of bleeding more than 7 days? I'm 40 and I've never had a faithful period every month. My question is that is it normal to bleed more than 7 days? BTW I've been noticing that I'm having symstoms of perimenopause, Is this part of perimenopause of bleeding more than 7 days? Hide