Irregular periods in perimenopause

How do periods typically change?

Some people see shorter cycles early in perimenopause; others notice long gaps then a heavy period. Flow may be lighter or much heavier. The unifying theme is less reliable ovulation, not a single pattern everyone follows.

---

Which bleeding changes need urgent attention?

Seek urgent care for bleeding so heavy you feel faint, soak through protection hourly, or pass large clots repeatedly — and for any bleeding rule your clinician has already called urgent. Non-urgent but important: bleeding after intercourse, new pain, or bleeding after a year without periods.

---

When should you see a doctor about irregular periods?

Some variation is expected in perimenopause, so the useful question is not "is this normal?" but "does this pattern warrant review?" Book a routine appointment if any of the following apply:

• Cycles consistently shorter than 21 days or longer than 35 where they used to be regular.
• Bleeding that lasts more than 7 days.
• Bleeding between periods, or after sex.
• Flow that limits work, sleep, exercise, or leaving the house.
• Symptoms of iron deficiency — breathlessness on stairs, unusual fatigue, or pica.
• You need contraception advice, since pregnancy remains possible until periods have stopped for 12 months.

Seek urgent care for bleeding so heavy you feel faint, soaking through protection hourly, or repeated large clots.

One rule sits apart from the rest: any bleeding after 12 consecutive months without periods should be assessed promptly. This is postmenopausal bleeding, and it is investigated regardless of how light it is or how well you feel.

---

What your clinician will likely ask

Knowing the questions in advance makes a ten-minute appointment considerably more productive:

• When did the pattern change, and what did it look like before?
• Dates of the last few periods, even approximate.
• How heavy — measured in protection changes per hour on the worst day, clots, and flooding, rather than "heavy".
• Bleeding between periods or after sex, which is asked specifically because it changes the workup.
• Contraception in use, and whether pregnancy is possible.
• Other symptoms: hot flushes, sleep, mood, weight, bowel habit.
• Medications, including anticoagulants and hormonal contraception.
• Family history of clotting disorders or gynaecological cancer.

Two of these — bleeding pattern and flow measured concretely — are the ones people most often struggle to reconstruct from memory in the room.

---

How can you prepare for a focused visit?

Bring dates of last few periods (even approximate), pad/tampon use, iron symptoms if any, and contraception needs. A clinical brief from tracking can complement a paper calendar if your flow is hard to recall verbally.

For the wider appointment structure — what to ask, what to bring, and how to make sure the visit ends with a plan — use how to prepare for a menopause appointment.