PERIMENOPAUSE
Irregular Periods and Perimenopause
Assessment of menstrual change during perimenopause, with time to review the pattern properly and determine whether further investigation is needed.
For many women, one of the first signs of perimenopause is a change in the menstrual cycle. Periods may become earlier, later, heavier, lighter or less predictable. Some women skip periods. Others notice spotting or more marked variation in flow.
Even relatively subtle change can be concerning if the cycle has previously been regular. This is a common reason women begin to wonder whether menopause may be approaching. For the broader menopause overview, see menopause and HRT.
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Are irregular periods normal in perimenopause?
They can be. Perimenopause is associated with hormonal fluctuation and changing ovulation patterns, which can affect menstrual timing and flow. However, common does not mean that every bleeding change should automatically be attributed to perimenopause.
A proper assessment is particularly important if bleeding is unusually heavy, prolonged, very frequent, occurs after sex, or appears repeatedly between periods.
Consultation
What the consultation may cover
Your age and the pattern of menstrual change, whether bleeding is heavier or lighter than usual, whether there is intermenstrual bleeding, whether pain, clotting or other symptoms are present, whether you also have symptoms suggestive of perimenopause, contraception and medication history, and whether further investigation is required. Depending on the clinical picture, your GP may recommend review through the wider menopause pathway, blood tests, examination, or referral.
Same-day appointments available. Book online or call 020 7736 7557.
Investigation
When blood tests may help
Where bleeding is heavy or the picture is mixed, useful investigations may include blood tests, hormone blood tests and thyroid blood tests. If broader women’s health review would be useful, a Well Woman Check may also be relevant.
Common questions
How do I distinguish perimenopausal changes from other causes of irregular periods?
Perimenopausal cycle change tends to be gradual — cycles shortening or lengthening over months, occasional missed periods, increasing variability — and usually starts in the 40s. Other causes (thyroid dysfunction, PCOS, stress, weight change, contraceptive effects) can present similarly. The GP reviews the pattern alongside other symptoms and, where needed, investigation.
At what point should irregular periods prompt investigation?
Investigation is worth considering when the pattern is significantly disrupted, when there is bleeding between periods, when periods have stopped for several months (particularly before the typical perimenopausal age range), or when the change is associated with other symptoms worth reviewing.
Are blood tests useful in clarifying perimenopause?
Sometimes. FSH, oestradiol and thyroid function can be useful in specific situations, but perimenopause is largely a clinical diagnosis based on symptoms and cycle pattern rather than one blood test result. The GP advises when testing genuinely adds to the picture.
FURTHER READING