Periods changing after 40: could it be perimenopause?

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Could changing periods indicate perimenopause?

If previously predictable periods become irregular in your forties, perimenopause may be one possible explanation. Periods may come earlier or later, last for fewer or more days, or become lighter or heavier.

Age alone should not be used to assume that every menstrual change is caused by perimenopause. Pregnancy, thyroid problems, fibroids, uterine polyps, medicines, PCOS and other conditions can cause similar changes.

What is perimenopause?

Perimenopause is the transition leading up to menopause. It begins when changes related to declining ovarian function first appear and ends one year after the final menstrual period. Natural menopause most commonly occurs between 45 and 55 years. It is confirmed after 12 consecutive months without a period when there is no other medical explanation.

What changes may occur?

• Periods arriving earlier or later, or one or more periods being skipped.
• A shorter or longer cycle, with lighter or heavier bleeding.
• Hot flushes or night sweats.
• Difficulty sleeping, mood changes, anxiety or irritability.
• Vaginal dryness or discomfort during sex.
• Urinary urgency or leakage.
• Reduced concentration or a feeling of “brain fog”.

Symptoms vary considerably. Some women have very few, while others find that sleep, work and quality of life are affected.

Which bleeding changes should be assessed?

• Bleeding repeatedly occurs less than 21 days apart.
• A period lasts longer than seven days or is considerably heavier than usual.
• You repeatedly pass large clots.
• Bleeding occurs between periods or after sex.
• Periods stop before age 45, particularly before age 40.
• You feel unusually tired, dizzy, breathless or weak.
• Changes affect work or daily activities.

These symptoms do not necessarily indicate a serious condition. Assessment can identify anaemia and exclude other causes. Depending on your history, a doctor may advise a pregnancy test, blood count, thyroid testing, pelvic examination, cervical screening, ultrasound or other evaluation. Not every woman needs every test.

Can pregnancy still occur?

Yes. Ovulation becomes less predictable, but pregnancy remains possible until menopause has occurred. A missed period should not automatically be attributed to perimenopause when pregnancy is possible.

Should hormones be taken for the symptoms?

Hormonal and non-hormonal treatments can help selected women, but treatment should be individualised according to symptoms, medical history, age and preferences. Do not start hormone therapy or unverified “menopause supplements” without medical advice. Recording cycle dates, bleeding, hot flushes, sleep and other symptoms for two or three months can make a consultation more useful.