Rules during perimenopause: what you need to know

Periods are often one of the first visible signs of hormonal changes. During perimenopause, these changes may occur gradually or more dramatically, which can raise questions and even cause concern.

Understanding why these changes happen and how to interpret them helps you approach this period with more perspective and calm.

Why do periods change during perimenopause?

Perimenopause is a phase of hormonal transition during which ovarian function becomes less regular. The ovaries continue to function, but ovulation can become more irregular and sometimes less efficient.

Hormonally speaking, progesterone tends to decrease earlier than estrogen, mainly due to increasingly frequent anovulatory cycles. Estrogen levels, on the other hand, can vary greatly from one cycle to the next, sometimes increasing and sometimes decreasing.

This imbalance can alter the timing and appearance of menstruation. However, menstrual changes do not necessarily indicate dysfunction; rather, they are a sign that the reproductive system is gradually adapting to a new phase.

What are frequent changes in menstruation?

Changes in menstrual patterns during perimenopause vary from woman to woman. These changes can occur individually, in combination, or evolve over the months.

Shorter or longer cycles

Cycle length is often one of the first things to change. Some women observe shorter cycles, while others experience longer and irregular ones.

These variations are due to irregular ovulation and changes in the hormonal signals that regulate the cycle.

Heavier or lighter periods

Menstrual flow can also change. Heavier periods may occur when the uterine lining is exposed to fluctuating estrogen levels without adequate progesterone. Conversely, some women experience shorter or lighter periods.

These changes may be sudden or gradual, without following any predictable pattern.

Irregular or unpredictable periods

Irregularity is a common indicator of perimenopause. Periods may occur earlier or later than expected, sometimes with no apparent pattern. This can be unsettling, especially for women whose cycles were previously regular.

This unpredictability reflects more variable ovarian activity, not a sudden cessation.

More pronounced associated symptoms

Periods may be accompanied by more intense symptoms than before: increased premenstrual syndrome, pelvic pain, increased fatigue, or more noticeable emotional changes.

These symptoms are often linked to the rapid hormonal fluctuations and individual sensitivity to these variations.

Keep in mind that, when faced with unusual or poorly tolerated changes, it is recommended to consult your primary care physician, midwife, or gynecologist for an assessment of the situation.

Abnormal periods: when should you seek medical advice?

Although many changes are common during perimenopause, you should seek medical advice if you experience any unusual symptoms to ensure that they are aligned with the expected hormonal context.

It is recommended to consult a doctor in the event of:

• very heavy or prolonged bleeding, especially if it causes significant fatigue or anemia,
• bleeding between periods or after intercourse,
• very close cycles or, conversely, prolonged absence of periods without explanation,
• intense or unusual pelvic pain,
• a sudden or recent change in a woman with previously stable cycles.

This approach makes it possible to rule out other possible causes, such as certain gynecological conditions, thyroid disorders, or hormonal imbalances unrelated to perimenopause.

At Ainoha™, we believe that understanding your menstrual cycle is a crucial first step, empowering you to regain control.

Periods can provide valuable information about hormonal changes. Understanding them helps you navigate this transition more easily and move forward at your own pace, with clear guidance.

The goal is not to worry, but to better understand what is changing, without judgment or haste.