Casey, age 53, woke up chilled. At 4 am this morning. 

Had she actually slept through a hot flash? Miracle of miracles, she could only hope. 

Still groggy, she managed to register some gratitude and relief that it wasn’t 1 am, which it had been for the last several weeks. She sighed, turned to her other side, and touched her cheek down to a fresher spot on her pillow. Another sigh. 

She counted 6.5 hours of glorious, uninterrupted, deep sleep. “At last,” she thought, “Maybe I’m getting the hang of… wait. What was that?” A warm liquid flood released with her new sleep position. She tentatively touched the mattress behind her back, and the backside of her underwear and sure enough. Evidence… bold, red, and wet was there. “Noooo… no, no, no… I thought I was done with periods.” 

It had been 6 months since her last cycle… and there was no mistake that she was having one now.

Not sure where you are in the menopause transition? Take our Menopause Assessment.

Annoying but normal

If you haven’t experienced skipped (or extra) periods in perimenopause, allow us to assure you, it can be a normal (and annoying) part of the process.

As hormone levels change, menstrual cycles may go from reliable and familiar to whose-period-is-this? Changes may include: 

• Length of your cycle. Have periods been 4-5 days and then gone? They may be longer or sometimes shorter, depending on your body and what it’s going through. 
• Timing of the beginning of a cycle. If you’ve had a reliable routine to the point where you know that your cycles begin in the mornings (or whichever time of day/night), that may change and you may be surprised by the appearance at a different time of day or night. You may also experience monthly periods that have more or fewer days between cycles (e.g. 28 days, the next one is 32 days later, then the next is 29 days after that).
• Unfamiliar or lack of your body’s signals that an egg is gonna drop. If you’ve had regular physical symptoms that you’re body is entering a cycle, such as lower back soreness or cramping, those may change or they may intensify. 
• Flow. These irregular periods could be heavier flow and some could even be lighter. It may switch up from month to month. You may have less (or no) “getting started” hours or days and go straight to heavy flow or menstruation flooding with irregular periods. 

What’s going on? 

In order to illustrate, let’s do a comparison of what goes on during a regular period and a perimenopausal irregular period. 

Most periods until perimenopause

An egg matures in the ovaries during a period with the help of an increased level of FSH (follicle-stimulating hormone). It’s the follicles that produce estrogen, and the estrogen, in turn, causes the lining of the uterus (the endometrium) to thicken, to prepare to receive a fertilized egg. 

Ovulation, the release of the mature egg, creates progesterone. Most eggs aren’t fertilized. What happens next is, the progesterone goes away and the endometrium is sloughed off. This is what we know as a period.

Perimenopause periods

During perimenopause periods, there aren’t as many follicles to stimulate, so the body really increases the FSH, resulting in more estrogen being created. More estrogen means the uterine lining becomes even thicker – causing heavier bleeding and perimenopause periods lasting longer. This whole process can take longer, too, resulting in longer gaps between periods.  

What about ovulation in perimenopause? Is that a thing?

Yes, indeed it can happen more often than not. In some cycles, the endometrium continues to thicken until it has to be shed – resulting in a very heavy flow.

A word about abnormal bleeding

During a cycle that has a heavier flow than you’re familiar with, it can feel surprising, baffling, even a little scary to see more blood and clots than you are used to. 

Bear in mind, you may experience feelings of disappointment, exasperation, weariness, all in addition to increased or intensified cycle symptoms. Be easy on yourself and ramp your self-care if you can. Your body and mind are going through a significant transformation.

This being said, a regular period can release between 2 tablespoons over the course of 4-6 days, or more, for more days or fewer. We’ve also seen reports of regular or normal period bleeding as being 2-3 tablespoons over 3-5 days.

Abnormal bleeding, specifically may look like very heavy bleeding or bleeding that:
 

• Lasts longer than normal
• Occurs more often than every 3 weeks
• Occurs after sex or between periods

In order to really dial into your own health and body, consider a check-in with one of our Telemedicine doctors. This is for assurance, guidance, support, and it will keep your files noted with new data and insights.

Be prepared, stay prepared

No, not hyper-vigilance. Just simple awareness. Here are a few ways to be and stay prepared for an unexpected period:

Keep count.

 When was your last period? How many months have you gone without a cycle?

Bring supplies.

 Menstrual cup, tampons, or pads, have something on-hand until you’re sure you’ve gone 12 months without a period. Desk, car, bag, duffel, wherever. And it doesn’t have to be a lot of supplies, just the right one for you to get you through a few hours.

Practice awareness of body changes and any other symptoms.

If you’re experiencing multiple perimenopause symptoms, it’ll make more sense and may feel more normal to have irregular periods at this time. Journal about them, keep a record on Post-it notes at your bedside, record them in a notes-application on your mobile device. They may prove useful and paint a bigger picture when you…

Check-in with your doctor or other health  support systems.

Let your doctor or professional know what’s going on with you and your body. Support, education, and care will really help you navigate through perimenopause to menopause by making informed choices about your options.

Was this one my last one?

We have no idea when or which one our last period is. There’s no indicator that we’re on the final countdown, tallying 12 full months of no menstrual cycle to achieve and unlock the menopause level. 

Best you can do is to be aware, consult your doctor (or speak with one of ours), practice some extra self-care, and know that this could be the last or at least one of the last, periods you’ll go through. You’ll be closer, if not finished. Regardless, transformation is, indeed, happening. 

What have you experienced around irregular periods in perimenopause? And… what are your questions about period reoccurrence during perimenopause? Check-in and chat in our Gennev Community Forums.