Bleeding during perimenopause: What you need to know

What is perimenopause?

Perimenopause is the time leading up to menopause – when you have your last period. The word ‘peri’ means ‘around’. It usually happens between the ages of 45 and 55, and can last for several years.

During perimenopause, your ovaries gradually stop making as much of the hormone oestrogen and don’t release eggs as regularly. This can disrupt your periods and cause a range of other physical and mental symptoms too.

Once you haven’t had a period for 12 months in a row, you’ve reached menopause. At this point, you‘re unlikely to become pregnant naturally anymore.

How can you tell if you’re in perimenopause?

The symptoms of perimenopause can start years before your periods stop altogether. There are lots of different signs which can affect everyone differently. But you might have:

• irregular periods
• hot flushes
• night sweats
• trouble sleeping
• heart palpitations
• brain fog
• vaginal dryness
• less interest in sex
• discomfort during sex
• pain in your joints
• repeated urinary tract infections
• urinary incontinence
• weight gain
• anxiety
• mood swings

How does perimenopause affect your periods?

During perimenopause, your hormone levels – especially oestrogen, progesterone and testosterone – start to change. These hormones help to control your menstrual cycle. As your ovaries gradually make less oestrogen and stop releasing an egg for fertilisation every month, your periods can become unpredictable.

During perimenopause, you might find that your period:

• comes earlier or more often than expected
• arrives later than usual
• skips a month — or several
• is shorter than normal
• lasts longer than it used to
• is heavier than you're used to
• is lighter than usual
• comes with spotting in between cycles

Irregular periods. In the lead-up to menopause, your periods might arrive closer together, further apart, or not show up at all. When they do come, your periods may be longer or shorter than usual.

Heavy or light periods. Your flow may be lighter than you’ve experienced previously. Or it could be heavier and you might find yourself needing to change your menstrual products more often.

Bleeding or spotting between periods. You might also notice light bleeding or spotting between periods. You may see it on your underwear or when you wipe, but it’s not usually enough to need menstrual products.

What colour is perimenopause bleeding?

During perimenopause, your period blood might look darker than usual. It could appear dark red or brown, which is often a sign of older blood leaving your body.

When should I be concerned about perimenopause bleeding?

Most of the time, changes to your usual bleeding pattern are a normal part of perimenopause. But there are times when it’s a good idea to see a doctor. Abnormal bleeding can occasionally be a sign of another health condition, like fibroids or polyps, so it’s always best to get it checked out.

See a doctor if you:

• have very heavy bleeding, and need to change sanitary products every 1 to 2 hours
• bleed for more than seven days straight
• bleed more often than every three weeks
• bleed after sex
• feel dizzy or have pelvic pain
• regularly experience spotting or bleeding between periods
• bleed after menopause
• notice changes to the colour, smell or texture of your discharge

Whether you’re ready to say goodbye to your period or not, irregular bleeding is to be expected in the transition to menopause. Try to keep track of when your period comes and goes, and speak to your doctor if anything feels off.