Before reaching menopause, a woman's menstrual cycles typically decrease and the duration of the periods are longer or shorter than usual. A woman may also experience spotting or a menstrual flow that has become heavier or lighter. In perimenopause, the phase leading up to menopause, many women find that they now have an irregular menstrual cycle. They may begin to skip their monthly periods and only have one every few months. This is all very common and normal in a woman's cycle.

What is the difference between normal and abnormal menstrual bleeding?

Although it is common to experience irregular menstrual periods during perimenopause, women should not assume that all changes are due to menopausal symptoms. A health care provider should be contacted if any of the following occur:

• Extremely heavy periods, with or without "gushing"
• Clots
• Seven days or more per period or more than two days longer than a woman's usual period
• Intervals between periods become shorter than 21 days from the end of one period to the beginning of the next one
• Spotting between periods
• Bleeding after sexual intercourse

What can cause abnormal bleeding?

There are a number of potential reasons for abnormal bleeding in perimenopausal women. Some of these include:

• Anovulatory cycles (cycles in which you don't ovulate) with high estrogen and low progesterone
• Hormonal contraceptives
• Pregnancy
• Fibroid tumors
• Noncancerous growths
• Cancer (more common postmenopausally)
• Vaginal or cervical polyps
• Endometriosis
• Blood-clotting problems

Related Articles Fertility Changes Hot Flashes Mood Swings Urinary Problems Insomnia and Perimenopausal Women Lower Sex Drive Heart Palpitations in Menopause Menopause Treatments Menopause Care Kit

External Sources The North American Menopause Society Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Through Perimenopause and Beyond, (2001) The Hormone Foundation

This article was reviewed and updated June 2007.