Irregular Periods (Perimenopause)
Changes in the menstrual cycle are often the first noticeable sign of perimenopause, the transition leading up to menopause. Periods may become irregular, with cycles lengthening or shortening. Flow can become heavier or lighter, and spotting between periods may occur. Skipped periods are also common. These changes result from fluctuating hormone levels, particularly estrogen and progesterone, and less predictable ovulation. While expected, significant changes like very heavy bleeding, bleeding after sex, or bleeding after 12 months without a period warrant medical evaluation.
Management Strategies
- Endometrial ablation or hysterectomy are options for persistent problematic bleeding refractory to other treatments.
- Keeping a menstrual calendar can help identify patterns and inform discussions with provider.
- Generally managed by awareness, symptom management for heavy flow (e.g., adequate iron intake).
- Low-dose hormonal contraceptives (pills, patch, ring) can regulate cycles and reduce heavy bleeding
- Progestin therapy (oral or IUD like Mirena) can manage heavy/irregular bleeding
- Tranexamic acid for heavy bleeding episodes
- NSAIDs can sometimes reduce flow and cramping
Diagnostic Considerations
Based on menstrual history in appropriate age group. Rule out other causes of abnormal bleeding (e.g., fibroids, polyps, thyroid issues, pregnancy, malignancy) especially if bleeding patterns are concerning.