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Perimenopause
By Mary E. Peterson, M.D.

Mary E. Peterson, M.D.

Menopause officially begins when a woman has not had a period for 12 consecutive months and there is not pathologic reason for this – i.e., she is not pregnant or had a hysterectomy. The average age of menopause in the US is about 51. The 2-5 years prior to a woman’s last menstrual period is called perimenopause. It can be a time of changing hormones, confusing symptoms and irregular bleeding. Now, some woman breeze through this transition period with no symptoms what so ever. For everyone else, here is a guide for some of the changes – normal and not.

Periods during Perimenopause

What is normal?
Almost anything can be normal. Periods may be closer together or further apart. They may be lighter or heavier. They may be shorter or longer. It is normal to skip 1,2 or even 8 periods and then start having them closer together again.

In early perimenopause there tends to be more estrogen in relation to progesterone in your body. We call this “estrogen dominance”. During this time it is not unusual for your periods to be heavier, longer and a bit closer together. You may also note more breast tenderness, bloating, and cramping. On the positive side, you don’t tend to have hot flashes as much during this time. In later perimenopause your estrogen levels begin to drop. At this point you may notice your periods being further apart, lighter and shorter. You tend to have less breast tenderness and cramping, but more mood swings and hot flashes.

The “joy” of perimenopause is that your hormones are totally unpredictable and can go from one extreme to the next. This is why testing hormone levels is not usually helpful, because the levels can vary from day to day and hour to hour. The other effect of this is that you may have periods that come closer together for a few months and then skip periods and get hot flashes. After that you may go back to no hot flashes and periods closer together again! This unpredictability can be a bit disruptive to say the least. But, as long as the periods and symptoms are tolerable, you can let nature take its course.

What is not normal?
So, with the periods being so irregular and unpredictable, how do you know when to worry and call your gynecologist? As a general rule there are 4 bleeding patterns that are not normal and for which you should contact your gynecologist/practitioner.

  1. Flooding periods – to have periods which are much heavier than your usual is not normal. It is ok if they are a little heavier, but if you feel like you are “hemorrhaging” or if you are soaking a pad every hour for more than an hour or two, you should contact your doctor/practitioner.
  2. Very frequent periods – the length of time between periods is measured from the 1st day of one period to the 1st day of the next (not the end of one to the beginning of the next). As long as there is at least 21 days from the start of one to the start of the next, it is considered normal. If there is less than 21 days it is not normal. That being said, if you have a period and then 18 days later get another period and then 40 days later get another period – that is frustrating, but ok. You should call if periods are less than 21 days apart consistently for 2 or more cycles.
  3. Random spotting – this is never normal. It is ok to get a little spotting just before or just after your period. It is also, not uncommon to get a little spotting at the time of ovulation (should last less than 48hours). Spotting that occurs at other times during your cycle and persists throughout is not normal. If it occurs, you should contact your doctor.
  4. Bleeding after sex. Now, occasionally, if you have an especially active episode of intercourse, you may note a little spotting of blood, and that is ok. But, if bleeding occurs after sex consistently, you should be seen by your doctor/practitioner.

Dr. Mary E. Peterson, Director, Women's Midlife Health Center at Magee, can be reached at (412) 641-8889.

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