Changing menstrual patterns

• During perimenopause, the balance between oestrogen and progesterone changes. Initially, progesterone often decreases more rapidly, which can result in shorter cycles or lighter periods.
• Later in perimenopause, cycles often become more irregular, and periods may become heavier or longer.
• If you haven’t had a period for twelve months, you’ve reached menopause. The average age for this is 51 years.
• If you use hormonal contraception, such as the pill, your period may be artificially regulated, making changes less noticeable. Other menopause symptoms may also be masked.

Make sure to educate yourself about the effects of the contraceptive pill.

Your menstrual cycle is driven by sex hormones. The female sex hormone oestrogen ensures the buildup of the uterine lining in the womb, which is essential for pregnancy. If fertilisation does not occur, progesterone levels drop, causing the lining to break down: this is menstruation.

During menopause, the production of oestrogen and progesterone in the ovaries gradually decreases and fluctuates significantly. You become progressively less fertile, eventually leading to the cessation of menstruation. However, before your periods stop entirely, many women experience changes in their menstrual patterns due to fluctuating hormone levels. For instance, you might suddenly have a shorter cycle or menstruate for a longer or shorter duration. It’s also possible to go for a period of time without menstruating. These hormonal fluctuations can cause your menstrual pattern to change in various ways.

Many women not only notice changes in their menstrual cycle but also experience other menopause symptoms, such as sleep problems, feelings of restlessness, and low energy. Some women even experience these symptoms early in perimenopause, before noticing any changes in their cycle.

Not every change in your menstrual pattern is directly related to menopause. Factors such as fibroids, polyps, thyroid issues, prolonged stress, or the use of hormonal contraception can also affect your cycle. If bleeding persists, becomes increasingly heavy, or occurs outside of your period, it’s advisable to consult a doctor.

During perimenopause, your periods may become heavier than usual. This happens because, at the beginning of menopause, your body tries to stimulate fertility by sending extra follicle-stimulating hormone (FSH) to the ovaries in an attempt to find a new balance. The increased production of FSH stimulates the ovaries, which can lead to relatively higher oestrogen levels. The thicker the uterine lining, the heavier the period if the egg is not fertilised. A period is considered heavy if you need to change your tampon, cup, or pad every two hours (or more frequently).

Your period may also include blood clots, which can be caused by hormonal changes during menopause. Blood loss with clots occurs when menstrual blood mixes with mucus and tissue. In most cases, this is normal and is seen on the heaviest days of your period (around day two or three in a normal cycle; in a heavy or prolonged cycle, clots may persist longer).

Clots are often accompanied by dark red blood, as the uterine lining has had more time to build up. Blood loss with clots is therefore more common in women who experience heavy bleeding during menopause.

If the clots are very large (larger than the size of a bottle cap) and occur with every period, or if they suddenly appear between periods, consult your doctor. Blood clots (even during menopause) can be a sign of a miscarriage, fibroids, endometriosis, a tumour, or the rare Von Willebrand disease.

While it’s normal for your menstrual cycle to change during perimenopause, daily bleeding is not. You may experience more frequent or prolonged periods, but if bleeding lasts more than two weeks during your period or occurs daily, consult your doctor. This could indicate a fibroid, polyp, or infection. About ten per cent of women report experiencing postmenopausal bleeding. If you experience bleeding after menopause, also consult your doctor. It could indicate an infection or polyp.

There are ways to support your body if you’re experiencing a changing menstrual pattern. What helps varies from woman to woman and depends on the cause and severity of the symptoms. Nutrition and lifestyle form the foundation. In some cases, supplements, medication, or hormone replacement therapy (HRT) may also play a role.

When your hormone levels change during menopause, it can affect your energy levels, sleep, digestion, and metabolism. Healthy eating, regular exercise, and rest can help prevent or alleviate symptoms. Small adjustments can make a big difference in how you feel.

When using medication or supplements, a balanced lifestyle supports your body’s ability to absorb nutrients and process medication, making supplements and medication more effective. Experts recommend the following for a changing menstrual pattern:

• Schedule enough rest and reduce stress. Stress stimulates the production of cortisol in the adrenal glands and reduces the availability of progesterone, which is essential for building the uterine lining and regulating menstruation.
• Stabilise your blood sugar levels. Your blood sugar levels influence oestrogen and progesterone. The more fluctuations in your blood sugar, the more hormonal imbalances you may experience. Eat plenty of fibre (vegetables), avoid sugars, and opt for sufficient protein, fats, and complex carbohydrates.
• Eat a healthy and varied diet and drink enough water. If you experience heavy bleeding, ensure you consume enough iron-rich foods, such as spinach, kale, meat, tofu, beans, and legumes.
• Do you lose a lot of blood or menstruate very frequently? Consult your doctor to investigate potential underlying causes, such as polyps or fibroids. Various treatments, including hormone therapy, can help reduce heavy menstrual bleeding or blood clots.

During menopause, oestrogen and progesterone levels fluctuate. These hormonal changes can cause irregular or heavier menstrual patterns. In some cases, targeted hormonal treatment can help regulate the cycle or reduce bleeding.

For a changing menstrual pattern, treatment often involves a progestogen, such as Primolut. This medication can help stabilise the uterine lining and reduce heavy or prolonged bleeding. Whether this is suitable depends on your symptoms and personal situation.

Hormonal treatment is always prescribed by a doctor and carefully tailored to your situation to ensure the treatment is safe and effective.

Many people are unaware that there are proven effective non-hormonal medications available to relieve menopause symptoms. While hormone therapy can address multiple symptoms simultaneously, non-hormonal medication often targets a specific symptom. For example, certain antidepressants (SNRIs) for hot flushes, anti-inflammatory drugs for joint pain, or antacids for heartburn.

Non-hormonal medication is always prescribed by a doctor and can be a good option for those who cannot or do not want to use hormone therapy. These medications work directly on the symptom without affecting your hormonal balance, allowing you to address your specific complaints.

During menopause, changes occur in how your body produces energy, builds muscle, and repairs skin. You can naturally support these processes with high-quality supplements. Magnesium, vitamin D, and omega-3 are recommended for every woman going through menopause.

The effectiveness of supplements depends on factors such as your lifestyle and health and can vary from person to person. The quality of the product also determines how well it works. Choose high-quality supplements without unnecessary fillers.