Your periods in perimenopause: what changes and when it ends

In perimenopause your periods usually change first. Cycles often get shorter at first, then vary by a week or more, then stretch out and start to skip, until your final period.¹,⁴ Menopause is confirmed once you have gone 12 months without one, and that is also when perimenopause ends.²

The surprise is the early direction. Many people expect periods to fade gradually. For many women they arrive early before they arrive late. Moody data point the same way: average cycle length shortens with age, and month-to-month variability widens again in the mid-forties. See your cycle gets shorter as you age, not longer.

What happens to your periods in perimenopause?

The Menopause Society puts the cause plainly: the ovaries produce hormones erratically and release an egg less often.¹ As ovulation becomes less regular, your cycle follows. In STRAW+10, the staging system used in research, the early transition is defined by a persistent difference of seven days or more between consecutive cycle lengths. The late transition is defined by gaps of 60 days or more.⁴ Cycles without ovulation become more common in the late transition.⁴

Along the way you may notice that your period comes earlier or later than usual, that flow is heavier, lighter or different from one cycle to the next, and that bleeding lasts a different number of days.¹ PMS can also feel different. Mood swings, bloating, breast tenderness and headaches may last longer or feel stronger. About 40% of women have PMS-like mood symptoms in perimenopause, according to an ACOG figure quoted by Harvard Health.⁵

Are spotting, a missed period or two periods close together normal?

Often, yes. Mayo Clinic says irregular bleeding is common in perimenopause and usually harmless.² Light spotting between periods, a missed period, and even two periods close together can all happen as ovulation becomes unpredictable. There are limits, though. Periods that are consistently less than 21 days apart are a reason to check in with a healthcare provider, as is any bleeding between periods that is frequent, heavy or disruptive.²,³ A short cycle now and then is one thing; a pattern is another.

When should you see a doctor about period changes?

Mayo Clinic notes that certain bleeding patterns may point to a reproductive health problem that needs evaluation, even though irregular bleeding is common in perimenopause.² A check-up can sort one from the other. If the thought of an appointment makes you nervous, read why going to see your gynecologist is nothing to fear.

Some changes need a closer look, because other conditions can cause irregular bleeding. Contact a healthcare provider if:

• You soak through a pad or tampon every one to two hours.³

• Bleeding lasts more than seven days, or much longer than your usual period.²

• Your periods come less than 21 days apart.²,³

• You bleed between periods or after sex.³

• Heavy bleeding comes with extreme pain, dizziness or exhaustion.

• You bleed after going 12 months without a period.²

That last one matters. Bleeding after menopause is not a normal perimenopause pattern and needs checking.

How do you know perimenopause is ending?

The clearest sign is your periods spacing out. Gaps of 60 days or more mark the late transition, and the late transition lasts about one to three years.²,⁴ When 12 months pass without a period, you have reached menopause.² You will only know in hindsight.

Blood tests are less clear-cut. FSH, a hormone that rises as the ovaries slow, can read in the menopausal range one time and in the range of the reproductive years another during the late transition, so a single number can be misleading.⁴ If a test is on the table, it is a conversation for your healthcare provider.

What about symptoms? Many women hope hot flashes, mood swings and poor sleep fade as the end of perimenopause approaches, and for many they do, but the timing is not fixed. Hot flashes are most likely in the late transition and the first two years or so after your final period, when FSH and estradiol are still settling.⁴ The Menopause Society says most symptoms improve after menopause, even without treatment. Hot flashes generally improve over time, while vaginal and urinary symptoms often worsen without treatment.⁶ So a calmer stretch is possible, but it is not a guarantee.

What can you do about changing periods?

Track them. Cycle length runs from the first day of one period to the first day of the next, so that is the day to record. Note the first day of each period, how heavy it is, any spotting, and any skipped cycle. Seeing a week-or-more swing in your own numbers is far more convincing than a vague sense that something is off, and it gives your doctor real information, such as how many days your periods last, how often you are changing products on heavy days, and how many cycles you have skipped. The Menopause Society also suggests keeping a record of your bleeding on a calendar or app.¹ In the Moody app you can log your cycle, flow, mood, sleep and physical symptoms in one place, which makes patterns easier to spot.

Everyday habits such as regular movement, a consistent sleep routine, stress-reducing practices and plenty of whole foods may help you feel better through the changes, although they are not shown to stop your cycle from changing. If period changes or PMS disrupt your daily life, ask your healthcare provider about both hormonal and non-hormonal options. Cleveland Clinic notes that birth control pills are one option doctors may discuss, as they can stabilize hormone levels and typically relieve symptoms.³ And remember that you can still get pregnant while you are having periods. If you do not want to, ask about contraception until menopause is confirmed.¹

Read next: What is perimenopause? Your hormones and the four stages, What are the symptoms of perimenopause