Expert Advice Q&A: Irregular Periods During Perimenopause
Q: I am a healthy 43-year old and haven't had a period for three months, am I perimenopausal?
A: One of the first symptoms you may notice during perimenopause is irregular periods. The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.
What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.
Prior to menopause your periods are usually very regular. The amount of hormones that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.
How long this irregularity lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.
Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.
You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.
If you suspect you may be perimenopausal, keep track of your periods. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.
If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.
One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.
Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.
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Wendy Klein, M.D., is co-author of the book The Menopause Makeover and a national leader in women’s health. She is Associate Professor Emeritus of Medicine, Obstetrics & Gynecology at Virginia Commonwealth University School of Medicine. She cofounded the VCU Institute for Women’s Health and created their Women’s Health Residency Program, lauded as one of the best such programs in the United States.
Staness Jonekos is an advocate for women's health, wellness and empowerment. An award-winning television writer, producer and director, she was one of the original executive producers who launched the television network Oxygen Media, cofounded by Oprah Winfrey. She is also co-author of The Menopause Makeover.