Looking forward to waving farewell to your period? Menopause ultimately means you’ll no longer need pads, tampons and an emergency chocolate stash. But during the transition, it can also cause a heavier flow and a more irregular cycle. This expert guide explains what to expect when it comes to your periods and perimenopause. If in doubt, always carry supplies…
Find what you need quickly
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How do periods change during menopause?
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How long should periods last during menopause?
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Is it normal to still have a period during your 50s?
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Do periods get heavier during menopause?
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Is there a treatment for heavy bleeding during menopause?
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What happens to periods on HRT?
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Help! My periods haven’t improved despite HRT!
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When should you see a doctor?
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Why do you need to get postmenopausal bleeding checked out?
How do periods change during menopause?
Usually your period will come approximately every month throughout your reproductive life. During menopause, your periods will slow down and eventually stop.
How this happens can vary dramatically from person to person. In general, your periods can look quite different depending on where you are in your menopause journey.
Perimenopause
Early perimenopause typically begins in your early 40s. You may notice changes in how heavy your periods are, or frequency.
Late perimenopause is most common in your late 40s or early 50s. Periods become further apart until eventually stopping altogether. On average, your period will come every 35 days or even less often in your ten final cycles. The longer you go between periods, the closer you are to menopause.
Menopause
You have reached menopause when a year has passed since your last period. Any bleeding after this point is known as postmenopausal bleeding and needs to be checked by a doctor.
Don’t forget! It is still possible to get pregnant naturally even into your 50s, although it is less likely as you age. If your period stops, it might be worth taking a pregnancy test to be sure. Likewise, if you have any heavy bleeding or pain in your abdomen, you should see a doctor urgently. They may well want to do a test to rule out pregnancy.
Read more on contraception and menopause.
How long should periods last during menopause?
This varies from person to person. An average period can last between three and eight days, with the average being five.
You may notice that your periods become shorter or longer during perimenopause. Shorter periods are not generally a problem. However, longer periods can be associated with anaemia due to prolonged blood loss. This can also be disruptive to your life, especially if it interferes with your sex life or usual activities, such as swimming.
Talk to your doctor if you find that your periods are lasting longer or causing problems.
Find out how to talk to your partner during menopause.
Is it normal to still have a period in your 50s?
For some people, yes. The average age at menopause is 51 years. This means that some people will have your final period before this, and some afterwards.
It can be normal to still have periods in your 50s.”
Talk to your doctor if you are bleeding after having been without a period for one year and are not on hormonal contraception. This is known as postmenopausal bleeding and can be a sign of a number of conditions.
Do periods get heavier during menopause?
Often, yes. It’s common for periods to get heavier and you may also experience flooding or blood clots. Speak to your doctor if your periods are persistently heavier. They will be able to examine you and may want to do some further tests.
Heavy, unpredictable periods can have a huge impact on work, hobbies and your personal life, but there are treatments out there.
Read more about how to treat heavy periods in menopause.
What happens to periods on HRT?
This depends on the type of HRT you are prescribed. Your bleeding pattern should remain relatively unchanged if you have been prescribed oestrogen-only HRT to use alongside your Mirena coil.
Combined HRT, containing both oestrogen and progesterone, can be either continuous or sequential:
- Continuous HRT supplies the same amount of progesterone every day. It is prescribed if you have already been through menopause – i.e. it has already been over a year since your last period. It can also be used when you have been using sequential HRT for more than one year or are over 54. You should not have any periods while on continuous HRT.
- Cyclical or sequential HRT is generally used if you have not yet been through menopause. This supplies progesterone for half your cycle and is likely to give you a regular period. These will generally be more predictable and with tolerable levels of bleeding.
Your bleeding pattern should remain relatively unchanged if you have been prescribed oestrogen-only HRT to use alongside an IUD (Mirena, Levosert or Benilexa). However, the IUD itself can cause irregular or frequent periods for the first few months of use. If your IUD is new, be prepared for it to take a while to settle.
Irregular bleeding is a common side effect in the first six months of HRT use, affecting up to 41% women using continuous HRT and 38% of women using sequential HRT. It is important to check in with your doctor if this continues after the first three to six months to ensure that nothing else is causing it.
Learn more about the different types of HRT.
Help! My periods haven’t improved despite HRT!
There are a few potential reasons for this.
- Is something other than menopause causing the problem? Consider checking in with your doctor. They may want to examine you or refer you for further tests.
- Is your HRT working properly? Things that can interfere with HRT include:
- Other medications, such as antiepileptics and some herbal medicines
- Other medical conditions, especially those that interfere with hormone absorption. These could be digestive problems (if your HRT is oral) and skin conditions (if using patches, gels or sprays)
- Missing or late doses
- Problems with your method of HRT, such as patches coming off or not applying gels correctly
Read more about signs your HRT may not be working for you.
When should I see a doctor?
It is always sensible to check in with your doctor if you experience a change in your periods. This includes:
- Heavier periods
- Passing blood clots
- Soaking through pads or tampons, or having to double up on protection
- Irregular periods
- Periods which come more or less often than usual
- Any new or different period pain
- Anything else that is new or unusual for you
Seek an urgent review if you notice:
- Any worryingly heavy bleeding
- Bleeding when you could be pregnant
- Any bleeding in between periods or after sex
- Any unusual discharge
- Any signs of severe anaemia, including feeling dizzy, faint, short of breath or chest pain
- Any bleeding (yes, any at all) if you have passed menopause
- Any other serious concerns
Why do I need to get postmenopausal bleeding checked out?
There are many causes of postmenopausal bleeding, and for most people it is a benign condition.
A proportion of those who bleed after menopause will have something more serious. One example is endometrial cancer, which affects the lining of the womb. Symptoms include:
- A change to your bleeding pattern
- Bleeding after menopause
- Problems passing urine
- Painful sex
- Pain in the lower abdomen or pelvis
Current research suggests that around 10% of cases of postmenopausal bleeding will lead to a diagnosis of endometrial cancer. The vast majority of people who bleed after menopause will not have cancer but it is still important to get checked out by your doctor.
Endometrial cancer can be treated very effectively if caught early.
Find out more about menopause on our blog or in our symptoms library.
- Association of endometrial cancer risk with postmenopausal bleeding in women
- Johns Hopkins resources on endometrial cancer
- Management of the Menopause
- Menstrual patterns leading to the final menstrual period
- NHS information on anaemia
- NICE guidelines on treating menorrhagia
- Treatment of menorrhagia during menstruation: randomised controlled trial of ethamsylate, mefenamic acid, and tranexamic acid
- BMS guidelines on managing unscheduled bleeding on HRT
Try our menopause clinic
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