We hear your frustration, friend. You should be in menopause by now, right? Perhaps you have gone a few months without a period, and now it is back with a vengeance. Or maybe you are having two periods in one month. This is getting ridiculous at this point, right? If any of these thoughts pertain to you, know that you are not alone. Perimenopause periods can be hell, to say the least.
Irregular periods are the name of the game when it comes to perimenopause. However, the changes in your period can often be frustrating and sometimes even concerning. Let’s dive into some of your most common questions about why your period is not stopping.
I am over 50. Shouldn’t I be done having periods?
The average age of menopause is 51. But keep in mind this is just an average. Women can enter menopause in the 40s, 50s, and 60s. Some women go into menopause as early as their 30s. However, this is a health condition known as premature ovarian insufficiency and can be difficult for women who would like to get pregnant. Early-onset menopause can also increase your risk for low estrogen conditions such as osteoporosis.
Women tend to enter menopause around the same time as their mothers, sisters, and aunts, so ask your female relatives when they hit menopause to get an idea of what is in store for you. There are some blood tests that your doctor may perform to see how close you are to menopause, including follicle-stimulating hormone (FSH) and Anti-Mullerian hormone (AMH).
Why am I having irregular periods? I just turned 40.
Irregular periods are often a sign that you are starting menopause. The time before menopause is called perimenopause. Irregular periods are one of the first signs that you are in perimenopause. Some women can enter perimenopause at 40 or even earlier.
Your period can become irregular in the following ways:
Duration of period shortens or increases
Bleeding becomes heavier
Spotting in between periods
Periods become more frequent
Color of the blood changes
PMS-like symptoms worsen including cramping and headaches
Once you start noticing irregularities in your cycle, make an appointment with your doctor. This is a great time to have a thorough health visit to review your symptoms as well as get a complete physical exam. Irregular periods can be a symptom of other health conditions, including:
Acute or chronic stress
Uterine polyps of fibroids
Pelvic Inflammatory Disease
Polycystic Ovarian Syndrome
Premature Ovarian Insufficiency (which is diagnosed in women under age 40)
Uterine or cervical cancers
Medications including hormonal contraceptives, anti-coagulants (or blood thinners), and steroids
Your doctor will help rule out other conditions that may impact your period and offer advice on how you can manage your symptoms during perimenopause.
I constantly have to wear panty liners for spotting. Is this normal?
Spotting in between periods is common in perimenopause. Often, spotting is the result of hormonal imbalance, which is what is happening inside your body during perimenopause. Estrogen and progesterone can fluctuate erratically as your ovaries begin to decline. This means that you can experience several unpleasant symptoms such as hot flashes. There are other causes of hormonal imbalance that may cause spotting, including thyroid issues, and starting or stopping hormonal contraception. Similarly, spotting may also be caused by:
Infection (which may be caused by sexually transmitted infections, douching, and intercourse)
Pelvic Inflammatory Disease
Cervical, vaginal, uterine, and ovarian cancers
If you are frequently spotting, it could be a sign that something else is going on.
A good rule of thumb is to have your doctor examine you to rule out other medical conditions if you are spotting.
I have my period twice a month. What is going on?
That sounds...great? Yikes, we feel for you, and we have been there. Perimenopause can decrease the number of days between your periods, so yes, it is not uncommon to have your period twice in one month. As you near menopause, your ovaries begin to function less effectively. In fact, once you reach menopause, your ovaries are no longer working. They do not produce estrogen and progesterone, nor do they release eggs. Rapid hormone changes affect your menstrual cycle as you get closer to menopause.
Always check with your doctor to make sure you are not having more frequent periods because of another health condition and make sure to eat nutritious meals that contain iron to prevent iron deficiency or anemia due to heavy periods.
My periods are SO heavy. When should you go to the hospital for heavy bleeding?
If you are alarmed, you should always seek medical advice to ensure you are not suffering from a severe complication. Generally, women who soak through a pad or tampon each hour for a few consecutive hours should let their doctor know. If you have had heavy bleeding and also experience lightheadedness, palpitations, vertigo, or impaired cognition, seek emergency help as you may be suffering from a severe complication such as hemorrhage.
Many women experience a heavier flow in perimenopause, which can be annoying and unnerving. Heavy periods (or menorrhagia) can also be the result of other health conditions such as PCOS, uterine fibroids and polyps, and inherited bleeding disorders. Check out what is behind your heavy periods by consulting your doctor to rule out other causes, and make sure you are not deficient in crucial vitamins and minerals.
I have been menopausal for well over one year. Is bleeding after menopause always cancer?
Vaginal bleeding after menopause is rightfully concerning. You should not bleed after you have reached menopause, so it is usually a sign that something is amiss. However, postmenopausal bleeding is not commonly caused by cancer. Studies have found that 9% of women with postmenopausal bleeding get diagnosed with cancer. Of the percentage of women diagnosed with cancer, 90% reported bleeding.
So yes, vaginal bleeding after menopause can be a sign of cancer, specifically endometrial cancer. However, the most common causes of postmenopausal bleeding include:
Thinning and inflammation of the vagina lining
Endometrial hyperplasia (or inflammation of the inner lining of the uterus) caused by HRT
If you have postmenopausal bleeding, even if it is light spotting or it only happened once, see your doctor. If you have no symptoms or aren’t entirely convinced it was blood, it is best to play it safe and still meet with your provider.
If you have postmenopausal bleeding, even if it is light spotting or it only happened once, see your doctor.
If you are wondering, “why is my period not stopping?” reach out to your health care provider. If you are in perimenopause, this is likely a normal part of your menopause journey. Indeed, perimenopause can last up to 10 years! Although you may have heavier periods in perimenopause, heavy menstrual bleeding can be caused by other health conditions. Your menstrual health is of vital importance and can be a window into your overall health. Connect with your doctor if you are concerned about any menstrual irregularities.
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.
Meet The Author
Perry Babe Julia ( RN, BSN, BA) is a registered nurse based in Colorado. Julia's nursing background in women’s health has ranged from neonatal and postpartum care to labor and delivery, to outpatient gynecological medicine for both adolescent and adult populations.
Much of her education and clinical experience are related to educating women on women’s health topics ranging from lifestyle improvements, disease management, and general health education.
Find Julia's Perry community profile right here.