Looking forward to waving farewell to your period? Menopause ultimately means you’ll no longer need pads, tampons, and an emergency chocolate stash. But the transition can cause a heavier flow and usually results in an irregular cycle for months or years. This expert guide explains what to expect when it comes to your periods and perimenopause. If in doubt, always carry supplies…
Find what you need quickly
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How do periods change during menopause?
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How long should periods last during menopause?
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Is it normal to still have a period during your 50s?
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Do periods get heavier during menopause?
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What happens to your periods on HT?
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Help! My periods haven’t improved despite HT!
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When should you see your healthcare provider?
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Why do you need to get postmenopausal bleeding checked out?
How do periods change during menopause?
Most people menstruate every 25-30 days for most of their life. During the first part of the menopause transition, called perimenopause, your periods will slow down and eventually stop. How this happens can vary dramatically from person to person. Once you have not had a period for 12 months you are in menopause.
Perimenopause
Perimenopause does not have an exact beginning – it starts when you begin to notice consistent changes in the length of your cycle or the amount you bleed and/or when you begin to have menopausal symptoms like hot flashes and mood swings. This typically happens in your early 40s.
Perimenopause typically lasts between two and seven years. Periods become further apart until eventually, they stop altogether. The longer you go between periods, the closer you are to menopause.
Menopause
You have reached menopause when a year has passed since your last period. Any bleeding after this point is known as postmenopausal bleeding and needs to be checked by your healthcare provider.
Don’t forget that it is still possible to get pregnant naturally even into your 50s, although it is less likely as you age. If your period stops, it might be worth taking a pregnancy test to be sure. Likewise, if you have any heavy bleeding or pain in your abdomen, you should see your healthcare provider urgently. They may want to do a test to rule out pregnancy.
Hysterectomy
You will not have menstrual periods again if you have had your uterus removed while you are still having periods. But, if one or both ovaries were not removed, your body is going through the same menopausal hormone transition and you are just as likely to have menopausal symptoms.
If you have all your ovarian tissue removed at hysterectomy while you are still having periods, then you experience menopause immediately. Read our guide to learn more. You should talk to your healthcare provider about starting HT as soon as possible.
Medically-induced menopause
Some people have surgical or medically-induced menopause. This can cause sudden symptoms. Read our guide to learn more. You should talk to your healthcare provider about starting HT immediately.
How long should periods last during perimenopause?
This varies from person to person. An average period can last between three and eight days, with the average being five.
You may notice that your periods become lighter or heavier during perimenopause. Lighter periods are not generally a problem, but heavier periods can cause anemia due to excess blood loss. This can also be disruptive to your life, especially if it interferes with your sex life, hobbies, such as swimming, or the work that you do.
Talk to your healthcare provider if you find that your periods are heavier, lasting longer, or causing other problems.
Is it normal to still have a period in your 50s?
For some people, yes. The average age at menopause is 51 years. This means that some people will have their final period before this, and some afterwards.
It can be normal to still have periods in your 50s.
Talk to your healthcare provider if you are bleeding after having been without a period for one year and are not on hormonal contraception. This is known as postmenopausal bleeding and can be a sign of a number of conditions, some serious.
Do periods get heavier during perimenopause?
Often, yes. It’s common for periods to get heavier and you may also experience flooding or blood clots. Speak to your healthcare provider if your periods are persistently heavier. They will be able to examine you and may want to do some further tests.
Heavy, unpredictable periods can have a huge impact on work, hobbies, and your personal life, but there are treatments out there.
Read more about how to treat heavy periods in menopause.
What happens to your periods on HT in perimenopause?
This depends on the type of HT you are prescribed. Combined HT, containing both estrogen and progesterone, can be either continuous or cyclical:
- Continuous HT supplies the same amount of progesterone every day. It is usually prescribed if you have already been through menopause – i.e. it has already been over a year since your last period. You should not have any periods while on continuous HT
- Cyclical or sequential HT is generally used if you have not yet been through menopause. When you use cyclical HT you usually take progesterone or another progesterone-like medicine for two weeks every month. The goal is to produce predictable bleeding, every month
Your bleeding pattern should remain relatively unchanged if you have been prescribed estrogen-only HT to use alongside a hormonal IUD. Keep in mind that for the first few months, the IUD can cause irregular or frequent periods. If your IUD is new, be prepared for it to take a while to settle.
Irregular bleeding is also a common side effect in the first months of HT use, particularly with continuous HT and with three-monthly cyclical HT. That said, you should contact your provider any time after you start HT if you experience vaginal bleeding that concerns you.
Learn more about the different types of HT.
Help! My periods haven’t improved despite HT!
There are a few potential reasons for this.
- You are in perimenopause and you have not been prescribed cyclical HT. Speak to your healthcare provider about this
- It has been less than three months since you started your new medications. Typically it takes at least three months and up to six months for new medicine to work fully
- Is something other than menopause causing the problem? Consider checking in with your healthcare provider. They may want to examine you or refer you for further tests.
- Is your HT working properly? Things that can interfere with HT include:
- Other medications, such as antiepileptics and some herbal medicines
- Other medical conditions, especially those that interfere with hormone absorption. These could be digestive problems (if your HT is oral) and skin conditions (if using patches, gels, or sprays)
- Missed or late doses
- Problems with your method of HT, such as patches coming off or not applying gels correctly
Read more about signs your HT may not be working for you.
When should you see your healthcare provider?
It is always sensible to check in with your healthcare provider if you experience a change in your periods. If you are already experiencing irregularities due to perimenopause, you will need to decide if something that happens is different enough to justify further evaluation.
This includes:
- Heavier periods
- Passing blood clots
- Soaking through pads or tampons, or having to double up on protection
- Any new or different period pain
- Anything else that you think is concerning, new, or unusual for you
Seek an urgent review if you:
- Think you could be pregnant
- Bleed after vaginal intercourse
- Notice any signs of severe anemia, including feeling dizzy, faint, short of breath, or chest pain
- Notice any bleeding (yes, any at all) if you have not had a period for 12 months or more
Why do you need to get postmenopausal bleeding checked out?
Vaginal bleeding after you have reached menopause is quite common. Studies estimate that 4-11% of people have postmenopausal bleeding and usually, it does not mean something serious is going on.
A small proportion – less than 7% – of people with postmenopausal bleeding will have cancerous or precancerous uterine changes. Cancer in the uterus – endometrial cancer – can be treated very effectively if caught early, so don’t hesitate to see your healthcare provider.
Find out more about menopause on our blog or in our symptoms library.
- JAMA Internal Medicine journal, Association of endometrial cancer risk with postmenopausal bleeding in women
- John Hopkins Medicine, Resources on endometrial cancer
- Menopause journal, Menstrual patterns leading to the final menstrual period
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