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One of the most noticeable symptoms of the perimenopause and menopause is that your normal bleeding pattern can change. Most of us are used to having monthly bleeds, although some women have more irregular periods.
As you start your menopause transition, you may start to experience any of the following changes:
It’s worth remembering that many women take hormones for contraception that can also change their periods. For example, many women don’t bleed, or experience changes to their pattern of bleeding, with the Mirena™ coil, progesterone-only pill, implant or contraceptive injection. The combined oral contraceptive pill can keep your menstrual periods regular even through the perimenopause.
So if you’re taking hormones, you can’t rely on changing bleeding patterns to work out whether or not you’re in the perimenopause or if you’ve been through the menopause.
Having a regular monthly bleed relies on several hormones (chemical messengers) working together.
Your brain and ovaries communicate to keep your hormones in a monthly cycle. Hormones from the ovary (oestrogen and progesterone) cause changes to the lining of the womb (called the endometrium), so that every month it thickens (just in case it needs to look after a pregnancy). Then, if you’re not pregnant, it sheds – this is the bleeding you see with a period.
In the perimenopause, your hormones can become out of sync and communication between your brain and ovaries breaks down. That regular thickening and shedding of your womb lining doesn’t happen.
Bleeding can become erratic, or you may not get any at all. In the menopause, when oestrogen levels are low, the lining of the womb stops thickening and bleeding stops.
There are other reasons for abnormal bleeding, such as fibroids, polyps in the lining of the womb (endometrial polyps), and – more rarely – precancerous and cancerous changes. Bleeding can also come from the cervix – that’s why it’s essential to keep up to date with your cervical smears – as well as from the vagina and vulva.
Some women experience vaginal bleeding after menopause – that is bleeding after your periods have stopped for more than 12 months. This is called postmenopausal bleeding. Bleeding after the menopause always needs to be checked by a doctor, even if it has only happened once and even if it’s spotting or looks brown or pink.
The cause of postmenopausal bleeding is usually not serious, but it can be a sign of cancer. This type of cancer is easily treated if found early.
The most common cause of postmenopausal bleeding is that the tissues of the vulva, vagina, cervix or womb lining have become thin and delicate, making them more prone to bleeding. There are other causes too, such as polyps on the cervix or womb lining. These are small growths that are usually not cancerous.
In a survey by the British Menopause Society, over 50% of the women interviewed reported changes to their periods .
Period changes related to the menopause start in the perimenopause. The perimenopause typically starts up to eight to ten years before the menopause (though it can be shorter) and usually in your mid-to-late 40s.
Many women will be taking hormones to help regulate their periods, either as contraceptives or to treat heavy periods or endometriosis. So if you’re taking hormones, you can’t rely on changing bleeding patterns to work out whether or not you’re in the perimenopause or if you’ve been through the menopause.
Ultimately, all women who are having periods will go through the menopause, where their periods will stop. The average age for the menopause in the UK is 51, and by the age of 55, most women will have naturally stopped having periods.
You should see a doctor if:
You may also need a full blood count and a check of your iron levels.
Irregular and heavy bleeding can go on for years in the perimenopause. You may want to consider treatment to stop or lighten your periods. There are hormonal and non-hormonal options to help with this:
Both of these options can be prescribed by GPs, or in our menopause clinic.
If you are referred to a gynaecologist, they may talk to you about endometrial ablation (lining of the womb ablation). This is a surgical treatment to treat heavy periods (menorrhagia). During the procedure, most of your womb lining (endometrium) will be destroyed or removed. This may stop your periods completely or they may become lighter. Having a hysterectomy for bleeding issues alone is an absolute last resort.
Finally, if your bleeding has suddenly stopped, don’t forget to do a pregnancy test if you’re sexually active and there is the possibility of pregnancy.
If you’re concerned about period changes, see your GP, gynaecologist, or book an appointment with our menopause clinic. As we are an online clinic, we can’t fit Mirena™ coils. Many GPs and nurses fit Mirena™ and you can usually get this done at your GP practice or a local sexual health clinic.
Dr Clare Spencer
Registered menopause specialist, GP and co-founder
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Source: Currie H, Moger SJ. Menopause – Understanding the impact on women and their partners. Post Reprod Health. 2019 Dec;25(4):183-190.