How do you know when perimenopause is coming to an end?

Comparing premenopause and perimenopause

Perimenopause and menopause symptoms are very similar and are managed similarly. There are both at-home and medical ways to manage symptoms at each stage.

Premenopause management

Managing premenopause involves alleviating the symptoms of PMS. This can include taking over-the-counter pain medications and using heating pads for premenstrual cramps.

Some women use oral contraceptive pills to help reduce pain and discomfort during premenopause.

Perimenopause management

Women in perimenopause often experience irregular periods, which can cause heavy bleeding and cramping. This is sometimes treated with a low-dose oral contraceptive pill.

Oral contraceptive pills have been shown to reduce some of the effects of decreasing hormone levels related to menopause. Examples include reduced bone loss and protection against endometrial and ovarian cancers.

Help for hot flashes

For perimenopause and menopause-related hot flashes, there are several ways to minimize symptoms. These include:

  • avoiding triggers, such as spicy foods, hot drinks, and warm climates
  • breathing deeply and slowly
  • wearing loose-fitting, layered clothing that can be removed easily
  • keeping a fan nearby, especially at night
  • drinking cold liquids when a hot flash occurs

Medical treatments

Doctors may recommend low-dose estrogen pills, patches, or creams to reduce the effects of severe hot flashes.

However, estrogen therapy is associated with increased risks for some cancers, especially breast cancer. Therefore, it is important that a woman takes the smallest effective dose.

If a woman does not wish to use estrogen therapy, she may be able to take antidepressants, such as venlafaxine or selective serotonin reuptake inhibitors (SSRIs), to help with the symptoms.

Postmenopausal management

While most women will experience a reduction or complete stop of vasomotor symptoms after menopause, they may still have some symptoms. These include vaginal dryness, difficulty sleeping, and mood swings.

Applying a water-based lubricant before sex can help to reduce the effects of vaginal dryness and discomfort.

Some women may choose to take menopausal hormone therapy (MHT). This type of medication includes estrogen and progesterone. If a woman has had a hysterectomy, she will only take estrogen.

These treatments can reduce vasomotor symptoms and the occurrence of mood swings. However, they do increase the risk for blood clots, heart attack, stroke, and breast cancer.

A woman should carefully consider the risks before beginning treatment.

8 Ways Your Period Changes When You Reach 40

From the very first day you got your period, you’ve been able to count on it coming back month after month (except during pregnancy) for close to four decades. Call it what you will—a curse, a burden, a crimson ode to your femininity—but you’ll probably be dealing with it until around age 52, which is the average age for American women to reach menopause.

RELATED: What Your Period Reveals About Your Health

Despite its inevitability, you will experience some changes in your menstrual cycle throughout the decades, especially since your period is directly tied to your hormones. And when you turn 40? That’s when your body really starts to shake things up. Whether you’re approaching the big 4-0 or want to know what can happen to your flow when you do, here’s what ob-gyns say to expect.

Your periods could become less frequent

Before you reach menopause, your body goes through perimenopause, a transition time between normal periods and full menopause (defined as 12 straight months without a period), which can last one to five years, says Rebecca Dunsmoor-Su, MD, an ob-gyn in Seattle. “Perimenopause is a time that’s characterized by irregular menses, which are usually more spaced out.” As your hormones start to fluctuate, “it can lead to scanter, lighter periods,” adds Adeeti Gupta, an ob-gyn and founder of Walk In GYN Care in New York City.

You might start skipping it here and there

Don’t freak out (or start celebrating) if your period goes entirely MIA one month. “A skipped period is the first sign of deteriorating egg quality,” says Dr. Dunsmoor-Su. “Some months, the eggs just don’t reach a point where they release, and so a period gets missed.” Remember: You’re not in menopause until you go a full year without a period, so skipping a month doesn’t necessarily mean you can toss all your pads and tampons.

RELATED: 5 Period Side Effects That Aren’t Cramps

Your periods can come closer together

Because there’s no “normal” when it comes to your menstrual cycle, some women might actually experience more periods post-40. In some cases, “estrogen and progesterone surges during the menstrual cycle become shorter and higher,” says Dr. Gupta. “That means your periods could come closer together.”

Your flow might get heavier

As your ovaries start their normal pre-menopause wind down, your period schedule will get a little wonky. “Some months, the egg makes it to release on time and everything’s fine,” says Dr. Dunsmoor-Su. “Some months, it’s a bit behind, and your period will be late, and some months, it doesn’t make it at all and you skip a month or two. When you miss an ovulation, the lining of the uterus continues to grow, so that when you finally bleed it tends to be heavier.”

Your PMS can feel even worse

All those hormonal ups and downs that start at 40 can do a number on your mood and emotions before your period begins. “As the hormones fluctuate more dramatically, those women who have mood symptoms with their periods tend to see more fluctuations in those moods,” says Dr. Dunsmoor-Su. “Some women get very depressed as the hormonal fluctuations become more significant.”

If you find yourself becoming significantly depressed, don’t be afraid to reach out to your doctor. “Anti-depressants are very helpful in this kind of depression, and if left untreated, it can become very severe during the menopausal transition,” she says.

RELATED: 5 Reasons You Should Have Sex on Your Period

Your cramps could become more painful

Well this sucks: Even though your periods might come less frequently or might be lighter than before, you’ll still experience those gut-churning cramps—and they might actually be worse. “Cramps can get worse in the beginning of perimenopause due to the closer and stronger surges of estrogen and progesterone,” says Dr. Gupta. The good news, however, is that as you close in on menopause, your flow shows up less often and is lighter—hence, less cramps, she says.

You might start breaking out before your period

Once you hit 40, “it’s like going through puberty again,” says Dr. Gupta, who warns women that they might start breaking out again, just like in high school. “I call it the second wind of the dying female hormonal machine,” she adds. Women also start to get hot flashes and night sweats during perimenopause, but these symptoms tend to come and go as hormones fluctuate, says Dr. Dunsmoor-Su.

RELATED: Why Your Period Screws Up Your Poop Habits—and How to Deal

You’re less fertile, but you can still get pregnant

Your chances of getting pregnant decrease as you move through your 40s. But you can absolutely get pregnant in this decade, says Dr. Dunsmoor-Su. “There is an ovulation (egg release) 14 days before each period as long as you have your period,” she explains. “However, eggs at this time of life tend to be of poor quality with a lot of genetic ‘mistakes,’ and miscarriage rates are very high.” If you don’t want to get pregnant in your forties, you should still be using birth control.

Changes in your cycle over time are normal, but they could signal abnormalities, and sometimes it’s hard to tell the difference. Don’t immediately assume the worst if you experience one month of period weirdness. But “if you have significant sudden changes in your cycle, you should see an ob-gyn for evaluation for possible structural causes (like fibroids or polyps) or pre-cancer syndromes,” suggests Dr. Dunsmoor-Su. Otherwise, just enjoy the fun.

Why do I have two periods in a month?

Possible causes of having two periods in 1 month include:

1. One-time anomaly

Share on PinterestHaving two periods in a month is not always a sign of a problem.

A person may occasionally have a shorter menstrual cycle that includes two periods in a month.

Following this, their periods may return to their regular cycle.

This occasional change is why doctors look for consistent patterns of frequent bleeding before making a diagnosis or suggesting treatments unless there is an infection or more serious issue present.

2. Young age

Irregular menstrual cycles are common in young people who have just started to have periods.

People tend to have shorter or sometimes longer menstrual cycles during puberty, which may lead to them having two periods in 1 month.

Hormone levels fluctuate significantly during puberty. Research suggests that a young person’s menstrual cycle can take around 6 years to become regular from the time they start having periods.

3. Endometriosis

Endometriosis is a condition where tissue that is similar to uterine tissue grows in other areas of the body.

Endometriosis can cause abdominal pain, abnormal cramping, and irregular bleeding. Sometimes, bleeding can be heavy enough to seem like another period.

A doctor can, in some circumstances, diagnose endometriosis using a pelvic exam and ultrasounds.

However, a minor surgery called laparoscopy is the only definitive way to diagnose the condition.

4. Perimenopause

Perimenopause refers to the years leading up to menopause when a person’s hormones start to change.

Perimenopause may last up to 10 years. During that time, people often experience irregular menstrual cycles, including having shorter or longer cycles, skipping periods, or experiencing heavier or lighter bleeding.

When someone has had no periods for 12 consecutive months, they are in menopause.

5. Thyroid problems

Share on PinterestThyroid problems may cause changes to periods.

The thyroid is a regulator of hormonal processes in the body.

This small, butterfly-shaped gland sits just in front of the throat and controls functions, such as body temperature and metabolism.

Irregular menstrual cycles are a common symptom associated with thyroid problems. This is true in both underactive thyroid or hypothyroidism and overactive thyroid or hyperthyroidism.

According to the U.S. Department of Health & Human Services, an estimated one in eight women will experience thyroid problems in their lifetime.

Symptoms of hypothyroidism include:

  • always feeling cold
  • constipation
  • feeling tired all the time
  • heavy menstrual bleeding
  • pale skin
  • puffy face
  • slow heart rate
  • unexplained weight gain

Symptoms of hyperthyroidism include:

  • always feeling hot
  • bulging of the eyes
  • diarrhea or frequent bowel movements
  • difficulty sleeping
  • irritability
  • rapid heart rate
  • unexplained weight loss

Both conditions are treatable, so people should see a doctor if they think they may have a thyroid condition.

6. Uterine fibroids

Uterine fibroids are growths that occur in the uterus. Fibroids are usually not cancerous but can cause bleeding, especially heavy menstrual bleeding.

Additional symptoms of fibroids can include:

  • feelings of fullness or pressure in the pelvis
  • frequent urination
  • low back pain
  • pain during sex

While doctors do not know what causes uterine fibroids to develop, they do know that they tend to run in families, and changes in hormone levels can affect them.

Doctors can often diagnose the condition by conducting a pelvic examination or performing imaging studies, such as an ultrasound.

What is happening to my periods? Is this normal?

What causes changes to your periods?

Falling oestrogen levels will affect the monthly cycle so your periods can become light, heavy, long, short, late, early or missing, and in any combination! You can get one set of symptoms then a few months later something completely different can happen.

Confusing? Absolutely! And it is also impossible to tell which ones you will get or how long all this will last!

But, hopefully I can shed a little light on what might be going on.

The average age for this chaos to start is 45-55 but some women can start earlier, especially if other close female relatives started around the same age. Ethnic origin, smoking, obesity and certain chronic health issues may mean an earlier menopause too.

Missing periods

You may find that you miss one period then get one or two back, then miss several and so on, and eventually your periods stop for good – this can take up to several years. A few lucky women can find that their periods just stop without warning and that’s it!

What should you do?

There is really nothing specific: this is just your hormones naturally winding down.

Heavy periods

Periods can still be regular but start to get heavier and heavier, or you may find that you miss a few then the next one you get is really heavy.

What should you do?

Heavy periods, if they continue can cause anaemia, which in turn can cause fatigue, low mood, poor sleep, muscle/joint aches, flaky nails and brittle hair; so taking a gentle iron tonic would be a good idea.

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Periods getting further apart

Instead of being regular your periods start to come later and later. Usually this leads to missing some, and then they stop.

What should you do?

This is just the way your hormones are naturally winding down so you don’t need to do anything.

Periods getting closer together

You may find your get a period then 2 weeks later get another one. These are often heavy and can last up to seven days or more at a time.

What should you do?

Periods like this can cause anaemia too, so a gentle iron tonic would be a good idea. Some women find the herb Agnus castus helpful, as this is traditionally used to help restore a proper monthly cycle when periods have started coming too close together. If they start to get really heavy or end up running into each other then please see your doctor.


You may suddenly find that your periods are so heavy that you are bleeding very heavily. You may need to change sanitary towels or tampons very frequently or find that you are bleeding so much that you stain your clothes.

What should you do?

Go to the doctor immediately: this must be treated! Although this is common it is not good for you. As well as causing anaemia it can cause dizziness and weakness. We have many women contacting us who do the right thing and go to their doctor who says it is fine and not to worry. Please don’t accept this. If you were bleeding this way from any other part of your body you would be rushed to hospital!. If the doctor still refuses to help, go to Accident and Emergency.

Short periods

Instead of your periods running the usual length of time, you may find they only last a few days. These tend to be light but some women find that they can start to get really heavy.

What should you do?

If your periods are light there is no need to do anything. If they are heavy then a gentle iron tonic would be a good idea. If they are really heavy, follow the advice above re doctors/A&E.

Long periods

You may find your periods start to run for longer than normal. These can be light or heavy or a combination, usually starting light then getting heavier and heavier.

What should you do?

Again if they are getting heavy go for an iron tonic, or to the doctor if it’s a case of flooding.


This can happen in between periods or instead of a period, lasting a day or going on for weeks.

What should you do?

If the spotting is accompanied by pain, especially if it is between periods or it goes on and on, then it is best to check with your doctor.

Painful periods

Some women find they suddenly start to get painful periods when they have not had them before, and some women who have painful periods find that they get worse. Often, if you have missed a few periods then you can get one that is painful too.

What should you do?

A daily magnesium supplement can often calm this down, and if the painful periods are also closer together you may find the herb Agnus castus helpful. However, if the pain is severe or affecting your daily life do get it checked out by your doctor.

Phantom periods

Even though your periods are missing you still get the usual symptoms and it almost feels like one is coming on. Although your hormones are falling there is still a monthly cycle, not high enough to trigger a bleed but still high enough to give PMS-like symptoms.

What should you do?

This is very common at the start so you don’t really need to do anything, but a magnesium supplement and a vitamin B Complex may help to ease the symptoms. However, if the pain is severe or affecting your daily life do get it checked out by your doctor.

Periods come back after being missing for a year

Many women find that they can go without a period for over a year or more then suddenly either get a single one back again or a few months’ worth. This is often caused by things such as a ‘last fling’ by your hormones, stress, illness, strenuous exercise, dieting, change of diet (especially if you improve it); even starting a new relationship can ‘re-boot’ your hormones!

What should you do?

This is very common but remember that you are considered through the menopause after not having had a period for 2 years but if you get a period back you have to start counting from the beginning again, sorry! It is best to get this checked out by your doctor as well.

Periods come back after 2 years or more without any

Same as above but it is really important to check with your doctor.

Periods have changed colour or smell different or you are getting clots

Many women find that the blood looks different, maybe darker and thicker or lighter and thinner and it can smell different. Blood clots can occur at this time too.

What should you do?

This is very common and usually just part of the hormonal changes going on. However, you can also be more prone to vaginal infections so if these symptoms are accompanied by pain or discomfort then do get them checked out. The same with clots if they are big or you are getting lots of them.

Get in touch!

If you are getting any symptoms that I have not listed or you are wondering about what is happening to your periods please do get in touch with me via email or Live Chat or please feel free to leave a comment below.

Just a word of caution

If any of these symptoms are worrying you in any way at all please go and see your doctor. It is amazing how many women contact us with on-going symptoms and they just don’t want to ‘bother’ their doctor. Remember: it is your National Health Service and that is what your doctor is there for!

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