Menopause

Changes in periods

Changes in periods resulting from declining levels of oestrogen and progesterone, the two hormones produced by the ovaries which control the menstrual cycle, are usually the first sign that the menopause is near. We asked women to tell us how their periods changed during the menopause, the effect this had on their everyday lives, and how they coped with heavy bleeding.

Irregular periods
Most women expected irregular periods and other menopausal symptoms at some stage in midlife, even if they were unwelcome (see ‘What is the menopause?’). For others, however, particularly those who felt too young for the menopause or who knew little about it, missing a period could be a worry. Some women thought they might be pregnant. (See ‘Early (premature) menopause’ and ‘Relationships, sex and contraception’).
In some women periods stopped abruptly, but most we spoke to had irregular periods for several years before they finally stopped.
Women were surprised about all sorts of other differences in their periods and cycles (see ‘What is the menopause?’). One woman described her periods as coming ‘whenever they wanted to’, sometimes two close together, then gradually further and further apart, longer and heavier, then shorter and lighter for three years until they finally ceased. Another woman found her irregular cycle ‘confusing’. After having periods two weeks apart, she then had ‘heavier than normal’ periods every couple of months before they returned to a normal monthly pattern.

Periods might last two days or six or even longer; they might be very heavy or quite light. Several women experienced stomach pain. Some women said their menstrual blood looked different in colour and consistency. One described it as ‘almost globular’.

Effect on everyday life
The erratic nature and unpredictability of periods can be annoying, and at times embarrassing and debilitating. Women talked about the uncertainty they faced not knowing when to expect a period, or whether it would be heavy or light. They spoke about the inconvenience of periods which were ‘stop start, stop start’; and about the difficulty of making plans when periods ‘started coming twelve, thirty six and then seven days apart’. They needed to be organised and prepared with tampons and sanitary pads at all times, and feared being caught out in public places.

Treating heavy bleeding
Heavy bleeding, or menorrhagia, can dent the quality of life. Women talked about various treatments they had tried to control heavy bleeding. One woman took hormone replacement therapy (HRT) (see ‘Hormone replacement therapy (HRT)’) to regularise her heavy and erratic periods which were ‘getting in the way’ of her new relationship. Another was prescribed norethisterone, a synthetic progestin used to control heavy bleeding, but stopped taking it when she put on weight.

Several women had the Mirena coil fitted to regulate bleeding. This is a plastic device inserted into the womb, which releases a synthetic progestin called levonorgestrel. It can also be used for contraception (see ‘Relationships, sex and contraception’). Some women’s periods became lighter or stopped altogether while using the Mirena coil.

Although heavy bleeding can be a part of the normal menopause, some women worried and consulted a doctor. In some cases they were diagnosed with anaemia (iron deficiency caused by heavy bleeding). Once they began taking iron tablets their energy levels returned. In some women, heavy bleeding was a sign of underlying problems such as polyps and fibroids and needed referral to a specialist. It’s important to investigate any bleeding 12 months or more after the last period.

Tests to confirm the menopause
Changes in periods, a woman’s age, and symptoms such as hot flushes usually indicate that the menopause has started. However, when periods become irregular some women ask their GP for a blood test to confirm that the menopause has begun. Tests are available to measure levels of the follicle stimulating hormone (FSH), which rise as oestrogen levels fall. However, although useful in diagnosing early menopause (before the age of 40) (see ‘Early (premature) menopause’), the tests can be unreliable for women in their forties as hormone levels fluctuate. For this reason doctors may hesitate to order tests routinely.

Although fertility declines during the menopause, pregnancy can still occur. Women are advised to continue to use contraception for one year after their periods stop if over 50; or for two years after periods stop if under 50 (see ‘Loss of fertility’ and ‘Relationships, sex and contraception’). For many women, the end of the menopause brings with it a sense of freedom from the unpredictability and inconvenience of periods and the fear of getting pregnant.

Last reviewed February 2015.

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