18 Oct Cycle changes in perimenopause

Changes to your menstrual cycle can be one of the classic signs that you’ve reached perimenopause.  The changes can differ from person to person, but generally fall into the following categories. In some cases, these changes can occur concurrently… making for extra fun times (sigh!):

Shorter cycle length (more frequent periods)

The length of a “normal” cycle is very individual but can sit anywhere between 21-35 days.  In the very early stages of perimenopause, you may notice that you have cycles that are 1-4 days shorter than usual. This is completely normal and due to fluctuations in hormones and their effect on the timing and regulation of ovulation (1). As you enter perimenopause further, your cycle length tends to flip and become longer (40 days or more), usually indicating anovulatory cycles (a cycle where ovulation doesn’t occur.) (1,2).

Erratic cycle length

This usually occurs a little further into perimenopause and is when your cycle varies each month by 7 or more days, some months shorter and sometimes longer, making it frustratingly unpredictable to determine when your period is going to arrive (2). Again, this is due to declining reproductive hormone levels (1,2).

Heavy and prolonged periods

Crazy heavy periods are very common as we enter perimenopause and usually a sign of high levels of “unopposed” estrogen. Estrogen is responsible for building up the uterus lining, while progesterone thins the lining and helps prevent heavy bleeds.(1,3) As progesterone levels decline, estrogen thickens the uterine lining unopposed, thus causing our period to be heavier and sometimes longer, as our bodies shed the extra built- up lining. You may also experience an increase in clotting, especially large clots. (1,3)

Heavy periods may occur alongside shorter cycles, meaning you may feel like you are constantly bleeding or have very little break between bleeds. Understandably, this can be both frustrating and exhausting. A good indication that you have heavy menstrual bleeding is if you have to double up on sanitary products, you to soak through your pads or tampons in less than 2 hours, or need to change them overnight (3). If you are experiencing regular heavy bleeding, you need to be mindful of too much blood loss, which can lead to iron deficiency, anaemia and fatigue.

It’s also important to note that heavy bleeding may be the result of other underlying issues including:

• endometriosis and/or adenomyosis
• PCOS
• uterine fibroids or polyps
• endometrial hyperplasia
• thyroid disease or dysfunction

It’s therefore important to talk to your GP about your heavy bleeding for further testing and investigation. (3,4).

Shorter, lighter periods

As you enter and transition through perimenopause, you may find that your periods become lighter and stick around for a few days less than usual. This is also completely normal and due to the drops in estrogen and progesterone. Shorter and lighter periods can occur from very early perimenopause until you reach menopause. It’s important to remember that you MAY still have ovulatory cycles during this time, so be aware that you can still fall pregnant – use contraception as needed!

Other cyclic symptoms

Other cyclic changes that you may start to experience include:

• Changes to mood (new or more intense PMS – see my blog on Mood in perimenopause for more details),
• Changes to breast tissue including sore breasts (often in the few days leading up to your period)
• Increased period pain and/or joint pain.

These symptoms are common and again mostly due to (relative) high estrogen, the loss of progesterone, and possibly increased mast cell activation which can trigger inflammatory cytokines and histamine causing pain and inflammation (2, 3,4).

As with many perimenopausal symptoms, it’s important to note that cycle changes can be caused by other factors and conditions as well. These can range from more lifestyle-related causes such as stress, excessive exercising, dieting extremes, medications and obesity; to more serious issues such as the presence of tumours and conditions such as those listed earlier.

So what can you do about cycle changes?

First…breathe

Changes to your cycle length, period duration, and flow are very common and (within reason) expected, as your body’s natural response to the changing hormones occurring at this stage. This is NOT to say you need to just sit there and put up with the symptoms that occur alongside it (we aren’t living in the dark ages!). It’s more to assure you that these changes are most likely part of the natural process of this stage of life.

Start tracking!

If you’re not already doing so, use a period app (some examples include Clue, Flo, Period Tracker) to monitor your cycles and note any changes in and symptoms of a cyclic nature. Due to the unpredictability of perimenopause, you will be best to track a few months’ worth of cycles. The more info you have the easier it will be for yourself and health practitioners to see patterns and help treat any issues accordingly.

Get tested

While there isn’t a definitive test that says you’re in perimenopause (your symptoms are the best indication), it’s important to look at several pathology parameters during this stage of life, especially considering symptoms such as prolonged heavy bleeding, fatigue, pain, excess weight gain/loss. Tests you should discuss with your GP or health provider include a full blood count (FBC/FBE), ELFTs (liver markers), thyroid panel, iron studies, Vitamin B12, and fasting insulin. Others will depend on your individual symptoms. Keep an eye out for an upcoming blog where I will do more of a deep dive into testing.

Look at your diet

Are you eating enough? Excess dieting, especially calorie and carb-restricted diets can mess with our cycles, our moods and our weight.

Conversely, are you eating too much – in particular, too many refined carbohydrates? Perimenopause is a time where we are much more susceptible to insulin resistance which can also cause knock on effects to our cycle.

A wholefoods diet that includes adequate protein, complex carbohydrates, healthy fats and nutrients is essential for the production of hormones, neurotransmitters and helping regulate our blood sugar.

Check your stress

Prolonged periods of stress can wreak havoc on our cycles, causing everything from heavy and erratic bleeding to our periods stopping altogether; not to mention the increase in PMS symptoms such as pain and mood changes. Look at your schedule – can you say no to some things, delegate, or take the foot of the pedal somewhere? Also don’t forget that excessive exercise can cause stress – if you are addicted to cardio and HIIT, you may be best off swapping a few sessions for strength training, something slower paced such as walking, yoga, or Pilates or even some meditation. Ensuring adequate sleep is also essential.

Changes to your cycle during perimenopause are expected and commonplace. The changes can differ from person to person. While hormone fluctuations are often the cause, it’s important to get unexpected and concerning symptoms further investigated by your GP or health provider. As always, feel free to reach out and book a free discovery call or 1:1 consultation if you feel like you need a hand in helping navigate through this stage. You don’t need to do this alone!

References

G.E. Hale, et al., The perimenopausal woman: Endocrinology and management, J. Steroid Biochem. Mol. Biol. (2013), http://dx.doi.org/10.1016/j.jsbmb.2013.08.015

Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516.

Briden L, 2021, Hormonal Repair Manual, Every Women’s Guide to healthy hormones after 40, Macmillan, Sydney Australia

Trickey, R. 2003,  Women, Hormones, & the Menstrual Cycle, Allen& Unwin, Sydney Australia