What can I do about erratic periods in the perimenopause?

Most women’s periods will go from regular to irregular to stopping in the journey towards menopause. It is normal for periods to change in nature. The periods may come more frequently initially (every 3 weeks or so), and later space out to come only every few months. The periods are usually much heavier: some women say their menstrual blood looks different in colour or may appear ‘globular’. Irregular periods during the perimenopause are frustrating: the inconvenience of totally erratic stop-start periods makes planning difficult.

This happens because in the perimenopause, ovulation isn’t occurring every cycle. Progesterone, which is usually produced after ovulation and is needed to counter-balance the actions of oestrogen is therefore deficient. This result in erratic periods that can be associated with all the other symptoms of perimenopause: breast tenderness, mood swings, anxiety, migraines, insomnia and intermittent hot flushes that may be terrible for a few weeks then disappear altogether, only to return weeks later.

Irregular periods during the perimenopause are normal, but speak to your doctor if the bleeding is very heavy or occurs more than every three weeks. In these cases it is certainly worth having your iron levels tested and worth getting a pelvic ultrasound scan done as there are a few other causes that may be contributing:

Polyps – usually benign growths of womb tissue or on the cervix – these would require removal

Endometrial hyperplasia  (thickened lining of the womb): hormones decline at different rates and often progesterone declines first. Progesterone helps keep the womb lining thin, so lack of progesterone results in the womb lining becoming thickened.  Rarely, endometrial hyperplasia progresses to endometrial cancer.

Fibroids – non cancerous growths of muscle and fibrous tissue in the womb. Again bioidentical progesterone can help control the symptoms of heavy bleeding caused by fibroids. Treatments to shrink or remove fibroids include focused ultrasound (a non-invasive outpatient procedure to shrink fibroids) or a procedure such as a fibroidectomy.

What can I try for my erratic periods?

To alleviate the symptoms of perimenopause, an individualized approach is essential.