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Irregular periods

Why periods change in the years before menopause, and when to see a doctor about them.

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Why periods change

As oestrogen levels slowly drop, the level of follicle-stimulating hormone (FSH) rises. Menstrual cycles may then get shorter at first, and later get longer.

Heavier, more painful periods

Some women have heavier and more painful periods, with more clots, during this time. This is due to a hormonal imbalance. Hormone levels swing up and down, and an egg is not released every month, so in some cycles there is more oestrogen in the body with less progesterone available to balance it.

Breast changes

Changes in the breasts can happen at the same time:

Tenderness
Tingling
Nipple sensitivity
Heaviness

See a doctor promptly if you notice a new lump, discharge from the nipple (especially if it is bloody), dimpling of the skin, a nipple that turns inwards, or pain in one spot that does not go away.

When to see a doctor

Please see a doctor if your menstrual cycles change

Changes in your periods are not always due to the perimenopause. Your doctor will want to rule out other problems, such as:

fibroids (non-cancerous growths in the womb)
adenomyosis (when the womb lining grows into the muscle wall of the womb)
uterine hyperplasia (thickening of the womb lining)
cancer
ovarian cysts

Get checked soon if you have

bleeding between periods, or after sex
any bleeding once your periods have stopped for a year or more
very heavy bleeding (soaking a pad every hour, or large clots)
periods that come less than 21 days apart, or last more than 7 days

Get help urgently if heavy bleeding makes you feel faint, dizzy or breathless.

What to expect when you see a gynaecologist and treatments for heavy or prolonged periods.

Your doctor can help you work out what is going on and talk you through your options.

When to consult a doctor