Menstrual changes and menopause

Your menstrual cycle is regulated by the complex interaction of sex hormones. The female sex hormone oestrogen causes the lining of the uterus to thicken, so that a fertilised egg can implant. If fertilisation doesn’t occur, the egg dies off and the body sheds the uterine lining to prepare for the next cycle. This is when you have your period.  

During menopause, your ovaries gradually produce less of the female sex hormones oestrogen and progesterone. Your ability to get pregnant reduces significantly over time until your periods stop altogether. For many women, the time preceding their last period is marked by menstrual changes due to fluctuating hormone levels. Changes can range from shorter, longer or missed periods, to different bleeding patterns (heavier or lighter).

Most women also have other menopausal symptoms besides menstrual changes, such as sleep problems, restlessness or fatigue. Some women even get these symptoms before they notice anything unusual about their menstrual cycle. 

During perimenopause, your body makes more follicle stimulating hormone (FSH) to trigger ovulation and stimulate fertility as your ovaries release fewer eggs. Your body needs to adjust to this change and restore balance. FSH stimulates oestrogen production, which causes the lining of the uterus to thicken more. As a result, your periods are heavier than usual. Menstrual periods are considered heavy when you bleed through a pad or tampon in two hours (or less) or need to empty your menstrual cup more regularly than the packaging suggests.

Heavy bleeding with blood clots is common among women transitioning into menopause. This is because when you approach menopause, your hormones start to change. Menstrual clots are gel-like blobs of coagulated blood, cervical mucus and tissue.  

Although it can be alarming, it’s normal to experience blood clots during menstruation on days when your period is heaviest (i.e., day two or three of a regular cycle; women with a longer or heavy cycle may pass blood clots on more days). The clots are usually dark red or brown in colour. This is because the uterus lining has had longer to break down and shed. Menstrual clots are more common in women with heavy menopausal bleeding.  

Are your blood clots larger than 2.5 cm (about the size of a 10p coin) and do you get them every month? Or do you get any clots between periods? Then speak to your doctor or GP. There is a possibility that you’re having a miscarriage. Blood clots can also be a sign of fibroids, endometriosis, a tumour or a rare bleeding disorder called Von Willebrand disease. 

While it’s normal for your menstrual pattern to change during perimenopause, persistent (almost daily) bleeding is cause for concern. Even if you normally have frequent or prolonged periods, you should get examined by a doctor to rule out an underlying cause, such as polyps, fibroids or an infection, if your period lasts more than two weeks or you lose blood daily.  

About 10 percent of women experience postmenopausal vaginal bleeding. If you have bleeding after menopause, you should call your GP and let them know. Postmenopausal bleeding is never normal and may be caused by fibroids or an infection.