Irregular periods during menopause

Very few women simply suddenly stop menstruating. Before ovulation stops altogether, the menstrual cycle generally becomes more irregular in length.Changes in the flow may be experienced – blood flow may be heavier or lighter. This can start anything from two to eight years before menopause.

Finally, the intervals between menstruations become longer, with missed periods or episodes of spotting only. The irregularity may last two or three years before menstruation finally ceases. When no bleeding has occurred for one year, the menopausal transition is said to have occurred.

Bleeding after this time can be a sign of a serious underlying problem and should be seen to as soon as possible.

What causes erratic periods?
The time span leading up to menopause is a gradual process of the ovaries going into retirement. Erratic periods are caused by fluctuating levels of hormones deriving from the ovaries and pituitary gland (hormone-controlling gland in the brain) which go hand in hand with decreased frequency of ovulation.

Problems to look out for
Although it is completely normal to have irregular periods and a change in flow, one should see a doctor if any of the following symptoms are noticed, as they could signal other problems:

• Spotting between menstrual periods
• Periods that last more than seven days (or two days longer than usual)
• Very heavy or gushing flow
• Bleeding from the vagina during intercourse

What to do

• Keep a menstrual chart and make notes of the following:
  • Beginning and end of menstruation
  • Type of flow
  • Accompanying symptoms
•  Always keep a sanitary pad or tampon handy.

Reviewed and updated by Dr Alan Alperstein, obestetrician and gynaecologists in Cape Town, in February 2011. 
Previously partly reviewed by Dr Mike Davey, President of the South African Menopause Society & Dr Tobie de Villiers, gynaecologist and committee member of both the South African Menopause and International Menopause Societies.