An irregular menstrual cycle can be one of the first signs that your body is entering the transition towards menopause. For many women, periods that were once predictable suddenly become shorter, longer, heavier, lighter or less frequent. You may even miss a period for one or two months, only for your cycle to return unexpectedly.
Although these changes can be unsettling, they are often a normal part of perimenopause, the transitional stage before menopause. If you are experiencing an irregular menstrual cycle alongside changes in sleep, mood, energy, temperature regulation or other symptoms, it can be helpful to look at the overall picture rather than considering menstruation in isolation.
Irregular cycles are just one of the many changes that characterise perimenopause. For a comprehensive understanding of how this stage can affect different symptoms, from menstrual changes to hot flushes, changes in the skin, fatigue and hormonal imbalance, see our complete guide to perimenopause and medicinal mushrooms, which explores the scientific evidence relating to each aspect of this transition.
However, irregular bleeding should not automatically be attributed to perimenopause. Understanding what forms part of a normal hormonal transition and which situations require medical assessment is essential for looking after your health.
WHY DOES THE CYCLE BECOME IRREGULAR DURING PERIMENOPAUSE?
Perimenopause is a gradual transition, not a single hormonal event. It can begin several years before the final menstrual period, and the experience varies considerably from one woman to another.
One of the first changes often affects the menstrual pattern. According to the UK National Health Service (NHS), periods may become more or less frequent, and bleeding may become heavier or lighter. Menopause itself is defined as 12 consecutive months without a period, provided hormonal contraception is not being used.
During the reproductive years, the menstrual cycle is coordinated through communication between the brain, pituitary gland and ovaries. As ovarian function changes during perimenopause, ovulation becomes less regular. Oestrogen production can also fluctuate considerably rather than declining in a gradual, linear way.
When ovulation does not occur, the progesterone production that would normally follow is absent or reduced. This can alter the usual balance between oestrogen and progesterone and affect the development and shedding of the endometrial lining.
You may experience:
- Periods occurring closer together than before
- Longer intervals between periods
- Heavier or lighter bleeding
- Periods lasting more or fewer days
- Occasionally missing a period
- Changes in premenstrual symptoms
It is also important to remember that not every irregular period is due to perimenopause. Pregnancy, hormonal contraception, significant changes in weight, excessive exercise, stress, thyroid disorders and conditions such as polycystic ovary syndrome (PCOS) can also affect menstrual regularity.
WHAT IS CONSIDERED NORMAL AND WHICH SIGNS REQUIRE MEDICAL ATTENTION?
During perimenopause, a wider range of menstrual patterns may occur. However, not every change in bleeding should simply be accepted as “part of menopause”.
Speak to your GP or another healthcare professional if you experience:
- Bleeding between periods
- Bleeding after sex
- Very heavy periods
- Bleeding lasting more than seven days
- A sudden or significant change from your usual pattern
- Bleeding that affects your everyday life
- Persistent irregularity when pregnancy, a thyroid problem or another condition could be involved
The NHS recommends seeking medical assessment if periods become irregular, last longer than seven days or are accompanied by other symptoms that may indicate an underlying condition.
Heavy bleeding also deserves attention. If you need to change a sanitary pad or tampon every one to two hours, use two types of menstrual product at the same time, or the bleeding is having a significant impact on your quality of life, speak to your doctor.
The American College of Obstetricians and Gynecologists (ACOG) also recommends medical assessment of bleeding between periods, bleeding after sex, unusually heavy bleeding, or bleeding that is heavier or lasts longer than usual, rather than automatically attributing it to perimenopause.
If 12 months have passed without a period and any vaginal bleeding then occurs, this is considered postmenopausal bleeding and should always be assessed.
Keeping a record of your cycle can be very useful. Note the first day of each period, how long it lasts, the amount of bleeding, any spotting and any associated symptoms.
HOW NATURAL HORMONAL SUPPORT MAY HELP DURING THIS STAGE
There is no diet, supplement or lifestyle intervention that can make ovarian hormones behave exactly as they did in your twenties or thirties. The aim of an integrative approach is therefore not to artificially “balance” hormones, but to support the systems involved in this transition and help the body adapt to physiological changes.
NUTRITION TO SUPPORT METABOLIC AND HORMONAL RESILIENCE
A varied diet based mainly on whole and organic foods provides the nutrients required for energy metabolism, hormone synthesis and healthy liver and gut function. Prioritise vegetables, fruit, pulses, whole grains, nuts and seeds, high-quality protein sources and sources of omega-3 fatty acids.
SUPPORT STRESS REGULATION
The transition towards menopause does not take place in isolation from the rest of life. Chronic psychological stress does not “cause” perimenopause, but it can influence sleep, appetite, energy and mood, potentially making hormonal fluctuations more difficult to manage.
Regular physical activity, spending time outdoors, adequate recovery, relaxation practices and good sleep hygiene can all form an important part of a comprehensive approach.
CONSIDER TARGETED NUTRITIONAL SUPPORT
For women looking for additional support during perimenopause, HIFAS-Menopause by Hifas da Terra is a hormone-free formula combining extracts of adaptogenic mushrooms, including Reishi (Ganoderma lucidum), Lion's Mane (Hericium erinaceus) and Cordyceps (Cordyceps sinensis), together with ashwagandha root extract, green tea extract, probiotics, vitamin B6, vitamin D and zinc.
The rationale behind a multi-ingredient formula is to support several interconnected areas that may become relevant during perimenopause, including the ability to adapt to stress, sleep, cognitive wellbeing and overall vitality.
It is important to note that HIFAS-Menopause should not be considered a treatment for irregular periods or a substitute for hormone replacement therapy (HRT) or other medical treatments when these are appropriate. The National Institute for Health and Care Excellence (NICE) recommends an individualised approach to menopause that takes into account symptoms, preferences, health history and the potential benefits and risks of different treatment options.
Hifas da Terra has also published the results of a clinical study on its HIFAS-Menopause formula, in which improvements in overall menopausal symptoms and hot flushes were observed over six months. As this is a multi-ingredient product, these results should be interpreted as evidence relating to the formula as a whole rather than proof that any individual mushroom regulates menstrual cycles.
REMEMBER THAT FERTILITY HAS NOT NECESSARILY ENDED
Having an irregular cycle does not mean that pregnancy is impossible. Ovulation can still occur during perimenopause, even when periods are unpredictable. Fertility declines with age, but pregnancy remains possible until menopause is reached.
The NHS advises continuing to use contraception during perimenopause if pregnancy is not desired.