Perimenopause & long periods: What’s normal & how to cope

Perimenopause is a normal and natural part of our lives that comes with many changes that are unfortunately not widely understood. A lack of understanding of what happens in our bodies during this time, and why, may lead to confusion and even anxiety. Especially if our periods suddenly change and become longer.

If you notice your periods becoming irregular, heavier, and longer as you go through perimenopause, keep in mind that it's a normal part of the process, and you're not alone going through this. In this article, we'll dive into everything you need to know about perimenopause and long periods and how to navigate these changes.

Is it normal to have longer and heavier periods during perimenopause? 

Experiencing a change in our menstrual cycles as we enter perimenopause is very normal. So yes, our periods can become longer and heavier, and in many cases, this won't be a cause for concern. Flow changes are one of many perimenopause symptoms, such as mood swings, hot flashes, and perimenopause fatigue, to name a few [2].

How long is a normal period? 

A menstrual cycle starts on the first day of our period and ends a day before the next bleeding occurs. Technically, there's no such thing as a "normal period" because our bodies are different, and each cycle is individual to each person. However, generally, a menstrual cycle is typically between 24 and 38 days [1].

Just like the length of our cycles, how long our flow lasts is highly individual and will vary from person to person. But on average, a period may last between two and eight days [3].

Our cycles may be irregular when we are younger during the years of puberty, but they often regulate by the time we reach adulthood before once again potentially becoming irregular when we reach perimenopause years [4]. 

What causes longer periods during perimenopause?

During our reproductive years, the levels of sex hormones estrogen and progesterone rise and drop throughout our menstrual cycles in regular patterns. Estrogen peaks at ovulation, which happens in the middle of the cycle, and then starts to drop as progesterone rises up until our period starts (if fertilization of the egg didn't happen) [1].

Now, once we reach perimenopause years, these regular patterns can change and become irregular. That happens because our ovaries start to produce less estrogen, and they might not release an egg every month [1]. This is known as an anovulatory cycle.

These wild hormonal fluctuations may make periods longer, shorter, heavier, lighter, or become intermittent. After one year of absent periods, we officially transition from perimenopause to menopause [1].

How long is too long for a period during perimenopause?

Generally, a period that lasts for longer than eight days is considered a heavy period and may be cause for concern [5]. However, a study that looked at over 50,000 menstrual cycles of over 1,000 midlife women found that 77% of perimenopausal women experienced 10+ days of bleeding on more than three occasions over a more than 10 year observation period [6].

What does this data tell us? Well, as with everything health-related, period length during perimenopause is very individual and what may be normal for some people may be a cause of concern for others.

You may want to contact your healthcare provider if your period is heavier or longer than usual or you experience abnormal bleeding such as [1]:

• Bleeding and spotting between periods
• Bleeding or spotting after sex
• Bleeding after menopause

Other period changes during perimenopause

Aside from experiencing long periods during perimenopause, you may notice other ways your flow changes:

Periods may be heavier or lighter

As we already briefly touched on before, during perimenopause, your periods may become heavier. You will know if you have a heavy period, called menorrhagia if you bleed for longer than seven days at a time and have to change your tampon or pad every two hours [7].

On the other hand, you might experience lighter periods than before. That may be due to ovulation not happening because of hormonal fluctuations [1].

Periods may become irregular

You may also notice your cycle becoming irregular during perimenopause. Because ovulation may not happen every month due to a natural reduction in estrogen production, the timing when your period shows up can vary greatly from month to month [1].

You may experience spotting

Spotting during perimenopause is something that many women experience – 66.8% of midlife women report experiencing six or more days of spotting at least three times over the 10.5 years of data collection [7]. 

“Light spotting is common, but any significant or prolonged spotting should be checked by a doctor.​ Especially when it lasts longer than 3 months,” says Natural Cycle’s Medical Advisory Board Member Dr. Jessica Shepherd.

How to cope with extended perimenopause periods

Just because it's normal to experience irregular periods during perimenopause, it doesn't mean you have to suffer through them. There are remedies that may help manage perimenopausal symptoms.

Some ways to cope are lifestyle-related, while others are medical and will require a visit to a healthcare professional:

• Contraception pills: Combined hormonal contraceptives can help manage perimenopause symptoms, including period length, flow, and even period pains [8].
• Hormone replacement therapy: Hormone replacement therapy (HRT) is a medical treatment that's prescribed to help alleviate perimenopause symptoms by supplementing key hormones we might be missing, most often estrogen and progesterone [9]. Depending on how severe your overall perimenopause symptoms are, it might be a great way to help alleviate long and heavy periods and improve your well-being.
• Leading a healthy lifestyle: Regular exercise, good sleep, and relaxing activities like yoga promote overall health and well-being, which may also help you feel better during perimenopause [10].
• Reduce alcohol intake: Research suggests there’s a link between increased alcohol consumption and increased estrogen levels in women. Alcohol consumption may also be linked to vasomotor symptoms (hot flashes ) [11], so cutting down on alcohol may reduce these symptoms. 
• Maintain a healthy weight: Obese women tend to experience perimenopausal symptoms much more severely compared to nonobese women, and losing weight tends to improve those symptoms [12], so maintaining a healthy weight can be helpful.
• Track your symptoms: Tracking and recording your perimenopause symptoms, like irregular periods, with Natural Cycles can help you understand all the changes happening in your body during perimenopause, which may help reduce anxiety and stress. Also, having a record of your health patterns may come in handy when speaking with a medical advisor because having this data can help them find the best treatment for you.

It's also a good idea to always be prepared for the unexpected. So, the best way to cope with irregular periods is to ensure you always have tampons and pads on hand, as well as over-the-counter medication for period pain if you experience it.

What if your perimenopausal bleeding won’t stop?

While it's normal to experience bleeding for longer periods of time, shorter periods, or spotting during perimenopause, if any of the symptoms become hard to deal with or cause pain and discomfort, it's a good idea to contact a healthcare provider:

• If you're bleeding for longer than seven days
• If you experience heavy bleeding where you bleed through a tampon or a pad every few hours
• If you notice blood clots larger than a bottle cap

There may also be other reasons aside from perimenopause that could be causing heavy and long periods [13]:

• Thyroid disorders
• Hyperprolactinemia (high levels of the hormone prolactin)
• Polyps
• Fibroids
• Infections
• Adenomyosis (a problem with the lining of the uterus)

It's important to seek help from a medical advisor so they can run tests and rule out any of the other possible conditions that could be causing abnormal bleeding.

Be in tune with your body with Natural Cycles

Perimenopause brings new challenges and unexpected changes to our bodies, and learning to navigate this new part of life can take time. Keeping track of your perimenopause symptoms and period changes allows you to be empowered throughout this transition, and Natural Cycles is here to support you on this journey. Why not find out how NC° can support you during your fertility journey and beyond?