What's actually happening.
Cycle changes are usually the first concrete sign that perimenopause has begun. Periods can become heavier, lighter, more or less frequent, or unpredictable in length. The hormonal fluctuation behind these changes can start in the early 40s, often years before vasomotor symptoms appear.
Not every cycle change is hormonal, and not every irregular bleed is benign. Bleeding between periods, after sex, or after 12 months without one needs investigating, and that is worth a longer conversation than ten minutes will allow.
Common signs
- · Cycles becoming shorter or longer than usual
- · Heavier or much lighter bleeding
- · Skipped periods, then a return to bleeding
- · Bleeding between periods or after sex
- · Periods stopping for more than 12 months
How I approach this.
For most women in their 40s with classic perimenopausal cycle changes and no concerning features, the diagnosis is clinical and we can discuss management without further investigation. NICE guidance is explicit on this. Blood tests are usually unnecessary and frequently misleading.
For anyone with bleeding between periods, post-coital bleeding, or postmenopausal bleeding, I will arrange the appropriate investigations: ultrasound scan, occasionally a hysteroscopy referral, and rarely a pipelle biopsy. These rule out the small but real chance of endometrial pathology.
Where appropriate, HRT, the Mirena coil, or tranexamic acid for heavy bleeds are all options worth discussing. We will take the route that fits your life and your risk profile.
Ready to make sense of your cycle?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.