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Understanding Menstrual Changes & Heavy Flow
A changing menstrual cycle is often one of the first signs of perimenopause. Periods may:
- Become more frequent or less frequent
- Change in flow (heavier or lighter)
- Stop for months, then restart
This transition can last many years before periods end completely. Up to 90% of women will experience changes in their cycle timing or flow during perimenopause.
What It Feels Like
Irregular periods during perimenopause are driven by shifting hormone levels. Common changes include:
- Irregular periods: Cycles may be shorter, longer, or unpredictable
- Missed periods: Skipped cycles due to lack of ovulation
- Heavier or lighter bleeding: Some women experience flooding or clotting; others have shorter, lighter periods
- Spotting between periods: Hormonal shifts may cause mid-cycle bleeding
- Worsened PMS symptoms: Mood swings, bloating, headaches may intensify
- Double periods: Two cycles in one month, followed by skipped months
Hormonal Behind the Changes
The menstrual cycle is controlled by a feedback loop between the brain (hypothalamus and pituitary) and ovaries.
Key Hormones
- Estrogen: Declines as ovarian follicles diminish. Causes irregular cycles, changes in flow, and perimenopausal symptoms.
- Progesterone: Falls during perimenopause, leading to cycle irregularity, heavier bleeding, and worsened PMS.
- FSH (Follicle-Stimulating Hormone): Rises in early perimenopause to stimulate ovaries but becomes less effective over time.
- LH (Luteinizing Hormone): Surges mid-cycle to trigger ovulation; becomes irregular as ovulation declines.
Cycle Breakdown
- Follicular phase (Days 1–14): FSH stimulates egg maturation; estrogen thickens uterine lining.
- Ovulation (around Day 14): LH surge releases the egg.
- Luteal phase (Days 15–28): Progesterone prepares uterus; if no pregnancy, progesterone drops → menstruation begins.
As the number of follicles decreases, estrogen and progesterone production drop. Cycles become irregular, then stop entirely at menopause (12 months without a period).
Why It Happens
- Low estrogen: The uterine lining may shed unpredictably, causing irregular or heavy bleeding.
- Low progesterone: Inconsistent cycle endings → irregular periods, spotting, worsening PMS.
- Erratic ovulation: Some cycles release no egg, creating longer gaps or missed periods.
Perimenopause typically lasts 2–8 years. Early perimenopause: cycles vary by 7+ days. Late perimenopause: cycles may skip for 2+ months.
When to See a Doctor
Cycle changes are usually normal, but consult your healthcare provider if you experience:
- Periods less than 21 days apart
- Bleeding lasting more than 10 days
- Heavy bleeding (changing pad/tampon every 1–2 hours)
- Spotting or bleeding between periods
- Bleeding after sex
- Severe cramping outside of normal cycles
- Any vaginal bleeding after menopause
⚠️ Important: Even with irregular or missed periods, ovulation can still occur. Contraception is recommended until 12 full months without a period.
Tips and Strategies
- Magnesium: May reduce cramps and muscle tension
- Dong Quai (“female ginseng”): Used in traditional Chinese medicine for 1,000+ years:
- May improve circulation, relieve cramps, and modulate estrogen
- Contains ferulic acid, ligustilide, and coumarins (antispasmodic, anti-inflammatory, estrogenic effects)
- Potential benefits: relief of cramps, headaches, mood swings; improved sleep; circulatory support
- Use a cycle tracking app to monitor changes
- Try period-proof underwear for unexpected bleeding
- Carry a “just-in-case kit”: sanitary products, pain relievers, spare underwear
- Reduce stress: mindfulness, gentle exercise, sleep routines can ease symptoms
Explore Other Menopause Symptoms
This website is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about any medical concerns.
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