“MY PERIOD USED TO BE LIKE CLOCKWORK. NOW IT’S MORE LIKE A GAME OF CHANCE.“ Unknown

One of the firsts signs I was in or entering perimenopause was when my cycle started to change. It became shorter in duration and more frequent. It was different, but still predictable. Until it wasn’t. We know menopause is different for everyone, so it’s not uncommon for changes in your menstrual cycle to start in your mid-late thirties , forties or fifties. You’ll begin to notice that your periods are becoming less frequent, more unpredictable, or just plain erratic. You’re likely in perimenopause which can bring about a range of changes in your body, including irregular periods.

Irregular periods during menopause are a normal part of the transition into this next stage of life. Let’s take a look at what causes irregular periods during menopause, how to manage the symptoms, and some tips for surviving the wild ride. (You can read more about when perimenopause starts in a previous blog post.)

If you’re experiencing bleeding after menopause, you may be wondering what’s going on. You may have thought menopause meant the end of periods, but in some cases, bleeding can still occur. Don’t worry, you’re not alone. It’s estimated up to 9% of women experience postmenopausal bleeding. However, if you are experiencing postmenopausal bleeding for the first time it is good to have it checked out by your healthcare provider to make sure it is not due to a concerning cause.

WHAT CAUSES IRREGULAR PERIODS DURING PERIMENOPAUSE?

The menstrual cycle is regulated by a complex interplay of hormones, including estrogen and progesterone. During perimenopause and menopause, these hormone levels start to fluctuate, causing changes in the menstrual cycle.

Now, as for why periods become irregular during perimenopause, it’s all due to estrogen and progesterone (the two hormones that regulate the menstrual cycle) fluctuating wildly. This can cause a woman’s cycle to become shorter or longer, with periods that are heavier or lighter than usual. Some women may even experience skipped periods or bleeding that lasts longer than usual.

Don’t skip on checking things out with your healthcare provider if you sense something is going on, but here are some of the most common reasons for irregular periods during perimenopause that may shed some light:

• Hormonal fluctuations: Estrogen and progesterone levels fluctuate as your ovaries start to produce less of these hormones, making periods unpredictable.
• Eggs releasing less regularly: According to the American College of Obstetricians and Gynecologists, the hormonal changes that occur during perimenopause can also cause the ovaries to release eggs less regularly, leading to skipped periods.
• Aging ovaries: As our ovaries age with the rest of our body, they become less responsive to the hormonal signals that regulate the menstrual cycle, which can contribute to cycle irregularity.
• Health conditions: While irregular periods are a common symptom of perimenopause, they can also be a sign of other underlying health issues, such as polycystic ovary syndrome (PCOS) (heavy bleeding) or thyroid problems. It’s always a good idea to check in with your primary healthcare provider to rule out any other potential causes.
• Lifestyle factors: Stress, weight gain or loss, unhealthy diet and lack of exercise or sleep can impact the regularity of periods.

MANAGING IRREGULAR PERIODS DURING PERIMENOPAUSE

Irregular periods during perimenopause can be unpredictable and inconvenient. It’s like waiting for your first period all over again. If you are finding it challenging not knowing when your period is coming, try keeping track of when they happen, how heavy and other symptoms to help with predictability.

Here are some ways to solve for the irregularity to consider:

1. Relaxation techniques such as yoga, meditation or deep breathing exercises are excellent ways to manage stress. Cortisol is produced when you’re under stress and can disrupt the balance of estrogen and progesterone in your body.
2. Maintain a healthy weight through regular exercise and a balanced diet can reduce excess body fat that can cause imbalance of hormones, including estrogen and progesterone and cortisol. Women who are overweight or obese may have a higher risk of experiencing irregular periods during perimenopause.
3. Eat a balanced diet rich in fruits, vegetables, whole grains, and lean protein. Diet’s high in processed foods and sugar (read about toxins and menopause weight gain) can disrupt hormonal balance and contribute to wonky periods.
4. Exercise regularly can help regulate your menstrual cycle by reducing stress, improving insulin sensitivity, and maintaining a healthy weight. Aim to get at least 30 minutes of moderate exercise most days of the week.
5. Sleeping enough is important for hormonal balance and can help regulate your hormones. Sleeping is an issue during perimenopause (that’ll be another blog post!), but if you can, aim for 7-9 hours of sleep each night.
6. Hormone therapy involves taking estrogen and/or progesterone to regulate the menstrual cycle. This treatment is effective in reducing the frequency and intensity of hot flashes and night sweats, improving vaginal dryness, and preventing bone loss. However, hormone therapy is associated with some risks, such as an increased risk of breast cancer, blood clots, and stroke, and it may not be suitable for everyone.
7. Oral contraceptives, or birth control pills, can be used to regulate menstrual cycles and reduce hot flashes. Combination pills that contain both estrogen and progesterone are most effective for this purpose. However, women with a history of blood clots, certain types of cancer, or liver disease should not use oral contraceptives.
8. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken to reduce menstrual cramps and heavy bleeding during periods. These medications are available over-the-counter and are effective for short-term use. Be aware that long-term use of NSAIDs can lead to stomach ulcers and bleeding.
9. Progestin is a hormone that can be taken alone or in combination with estrogen to regulate menstrual cycles. Progestin in IUDs can reduce the frequency of hot flashes and help prevent uterine cancer in women who still have a uterus. However, progestin therapy may cause side effects such as bloating, mood changes, and acne.