Your cycle is often the first thing to change in perimenopause, and it can be disorienting after decades of relative predictability.
Why periods go haywire. In perimenopause you don't always ovulate, and oestrogen and progesterone rise and fall less predictably. Without regular ovulation, the womb lining can build up more than usual — which is why periods can become heavier, longer, or closer together, then sometimes skip altogether. Cycles that were a reliable 28 days might run to 24, then 35, then vanish for two months.
What's generally normal in perimenopause:
Red flags worth seeing a doctor about — don't wait:
These don't necessarily mean anything serious, but they need assessment to rule out things like fibroids, polyps, thyroid issues, or — rarely — changes in the womb lining.
Living with the change. Iron-rich foods (and an iron check if periods are heavy) help guard against the fatigue heavy bleeding can cause. If flooding is disrupting your life, effective treatments exist — you don't have to simply endure it.
While you sort out the cause, a few things make heavy days more manageable. Period pants and a menstrual cup hold far more than a standard pad or tampon and can spare you the hourly change. Iron-rich meals, and an iron check if bleeding is heavy, help protect your energy.
There is also a specific treatment many women have never heard of: tranexamic acid. It is a non-hormonal tablet taken only on your heavy days, and it works by helping your blood clot more effectively, reducing menstrual blood loss by roughly 40 to 60 per cent. It is recommended in UK guidelines, and in Britain a version is now available from pharmacies without a prescription after a short chat with the pharmacist. Two honest caveats: it eases the bleeding but does not treat the underlying cause, so it is not a substitute for getting heavy periods looked at; and it is not suitable if you have a history or raised risk of blood clots, which includes some women on HRT, so check with your pharmacist or GP first.
If bleeding is severe — soaking a pad an hour, passing large clots, or leaving you faint or breathless — that is not a day to manage at home. Contact your GP or an urgent service.
Bottom line: erratic periods are usually a normal signpost of the transition, but trust your instincts and get the red-flag patterns checked.
Are heavy periods normal in perimenopause?
Heavier or more erratic periods are common, but very heavy bleeding, clots, or bleeding between periods should be checked by a doctor.
Is bleeding after menopause ever normal?
Any bleeding after 12 months with no period should always be assessed promptly, even if it turns out to be harmless.
Keep reading: Iron, fatigue and heavy periods · Fibroids and heavy periods · The first signs of perimenopause · Your cycle, phase by phase · Take the free Hormone Quiz