If you hit 40 (or 45 or even 35) and suddenly your periods start going a little wonky, it can be massively inconvenient, but it’s probably just your body beginning the very normal transition into perimenopause.

One of the earliest signs of perimenopause is periods not occurring at expected times: missed periods, more frequent periods, perimenopause irregular periods lasting longer or closer together, heavier, lighter, more cramps, fewer cramps, and for the occasional woman, periods that simply stop and never come back: Aunt Flo has left the building.

But Aunt Flo is rarely so polite, and that can make things confusing. Irregular bleeding is a hallmark of perimenopause, but sometimes irregular bleeding during this time of our lives can signal something more serious. How do you know when you need to consult with your doctor?

We talked with our Director of Health, OB/GYN Dr. Rebecca Dunsmoor-Su, to help us better understand what to expect when we’re expecting an end to the bleeding.

What constitutes “ perimenopause irregular periods” during a time when cycles are already pretty irregular?

Dr. Rebecca: That is a very good question, and the answer is not very specific. As women transition into perimenopause, occasionally (and more frequently as time goes on) the ovary fails to release an egg. When that happens, there is no progesterone to stabilize the lining of the uterus.

The uterine lining keeps building irregularly and eventually will start to bleed a little here and a little there. Sometimes a month or two later you will release an egg and the cycle works correctly, but you’ll have a really heavy menses – after all, you’ve been building up to it for months! Heavy periods before menopause are common for this reason.

All of these are versions of irregular bleeding. If it is disrupting your life, it is worth bringing to your doctor. Sometimes this can also be a sign of something more serious, so mentioning it to your OB/GYN is important.

If you are dealing with irregular periods, a Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

What are some of the possible causes of irregular bleeding during perimenopause? Could it be my new birth control or other medications?

Dr. Rebecca: Birth control usually stabilizes the lining, but if you aren’t good about taking your birth control every day, you can have irregular spotting or bleeding, sometimes in lieu of a period altogether.

One medication type that can commonly cause bleeding issues is blood thinners. Many women start these in perimenopause or menopause due to heart conditions or blood clotting.

Structural problems of the uterus such as polyps or fibroids can cause irregular bleeding.

Rarely, early pre-cancer or cancer of the lining of the uterus can too, which is why it is important to mention it to your doctor.

When should I see a doctor?

Dr. Rebecca: If your bleeding pattern has changed significantly or the bleeding is heavy, please call your doctor. An occasional missed period is OK to watch and wait. If you haven’t had a period in a year and start to bleed again, please call for an evaluation.

A Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.

Sometimes I see blood clots in my menstrual blood. That’s new. Is it bad?

Dr. Rebecca: No, it is likely because of the irregular growth of the lining, or the increased space between periods. If you enough heavy bleeding to soak a maxi pad an hour and this lasts for more than 3 hours, then you should call.

If I see my doctor, what will (or should) she do?

Dr. Rebecca: First, she will take a history and discuss the bleeding pattern with you. She will do an exam looking for sources of bleeding and to see if there is any indication of structural problems with the uterus. She may recommend an ultrasound or even a biopsy.

If it is just normal, peri-menopausal irregular bleeding, is there anything I can do about it?

Dr. Rebecca: Birth control pills don't delay menopause symptoms but we most commonly use oral contraception at this time of life to manage the bleeding and peri-menopausal symptoms. It regulates hormones and the bleeding.

A lot of woman also use the Mirena IUD (a progesterone IUD) as it minimizes the lining and can manage bleeding really well. Sometimes we will use other medications to stop the bleeding. In some cases, if there is a uterine issue, you may require surgery.

The good news is the bleeding will end with menopause.

The good news is…

We’re thinking of getting that done in needlepoint and hanging it on our wall: “The good news is the bleeding will end with menopause.”

Irregular bleeding happens to many if not most women during the perimenopause > menopause transition, and the vast majority of the time, it’s natural and normal and not a cause for concern. However, if you have any of the warning signs above or even just a nagging feeling that something’s not right, trust your gut and see your doctor.

Have you dealt or are you dealing with irregular bleeding? We encourage you to meet with your doctor. If you don't have one, [book an appointment ](https://gennev.com/plans)with one of our menopause-certified gynecologists.