Menstrual changes and menopause: what you need to know

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 the menopausal transition, 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). 

Hormonal changes can also trigger a variety of menopausal symptoms, such as hot flashes, sleep problems and mood swings.

The menopausal transition most often begins around the age of 45. A change in menstrual pattern due to fluctuating hormonal levels is usually one of the first signs that menopause is approaching. 

Every woman's menopausal journey and menstrual cycle is different, but in general menstrual cycles become irregular during perimenopause. 

At the start of perimenopause, progesterone levels drop faster than oestrogen levels. During this period, many women notice that their menstrual cycle is shorter than usual and that the bleeding is lighter. Later on, the cycles tend to be longer but more intense, causing heavy or prolonged bleeding.  

Once you've stopped menstruating for 12 consecutive months, you have completed menopause and are in the stage called postmenopause. Most women reach menopause around the age of 51. It is impossible to predict when your last period is going to be. However, research has shown that the age at which your mother hit menopause is a predictor of when you’ll stop menstruating.  

Are you taking a hormonal contraceptive? Hormonal contraceptives contain synthetic hormones which mimic ‘natural’ menstruation, so it’s possible that you haven’t noticed any changes to your period. You might even have stopped menstruating without you being aware of it. Hormonal contraceptives can also mask other signs of approaching menopause.

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. 

It’s also possible that your periods are lighter, or far more regular, irregular or even gone altogether. These temporary changes in menstrual pattern are due to hormonal imbalances. The type and duration of menstrual changes can vary from person to person. 

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.

A change in your usual menstrual pattern is a typical symptom of menopause. It is a symptom that all women experience. Are you experiencing changes in your period such as heavier periods or more period pain than usual? Then these tips can help.  

• Find time to relax and reduce stress. Stress stimulates the production of cortisol in the adrenal glands and reduces progesterone. Progesterone is important to prevent excessive build-up of the womb lining and it regulates your menstrual cycle.  

• Stabilise your blood sugar. Your blood sugar level has an effect on oestrogen and progesterone. The more spikes in your blood sugar level, the more your hormones fluctuate. Eat fibre-rich foods (vegetables), avoid sugars and make sure your diet includes protein, fats and complex carbohydrates.  

• Make healthy and varied food choices and drink plenty of water. Are your periods very heavy? Make sure your diet includes iron-rich foods such as spinach, kale, meat, tofu, beans and legumes.  

• If you are experiencing frequent bleeding and large blood clots during your period, see your GP to rule out an underlying cause. There are various medical treatments, including hormone therapy, that can reduce heavy menstrual bleeding and clots.