Perimenopause · Periods
Perimenopause periods: what changes and what to check
Your cycle was predictable for years, and now it isn't. Here's what tends to happen to periods in perimenopause, which changes to bring to your doctor first, and what you can keep track of in the meantime.
In perimenopause, your periods can come more often or less often, and the bleeding can get heavier or lighter [1][5]. Some women get a period about every 3 weeks for a while before they start to skip periods [5]. These changes are common, but bleeding that gets heavier, lasts longer or shows up between periods should be checked by your doctor first [1][2].
Many of the women I see in Östermalm mention their periods almost in passing. “My cycle is just a bit odd lately.” Then it turns out they’re changing pads at night, planning meetings around their bleeding, and feeling more tired than they can explain. So I want to start with what’s common, and then be clear about what needs a doctor.
What happens to your cycle in perimenopause
Perimenopause is the phase before your periods stop for good. It usually affects women between 45 and 55, though it can start earlier [3]. During these years, hormone levels fall, and your cycle often reflects that [3].
The NHS describes it simply: periods may happen more often or less often, and bleeding may get heavier or lighter [1]. In practice, that can look like:
- periods closer together, for example about every 3 weeks [5]
- heavier periods [1]
- lighter periods, or a period that comes late [1]
- skipped periods [5]
Many people also notice other changes at the same time, such as lighter sleep, night sweats or mood swings. You can read more about these on my page about perimenopause symptoms.
Menopause itself is usually counted in hindsight: once you’ve gone 12 months without a period [1]. Until then, your cycle may surprise you.
Periods closer together
Periods coming more often is one of the changes that worries people most, because it can feel like you’re bleeding all the time. MedlinePlus notes that some women get a period every 3 weeks before they start skipping periods [5].
Shorter cycles can be part of the transition. Still, I’d always ask your doctor to look at it if periods come closer together and the bleeding is heavier, or if you also have spotting between periods [2][5]. Spotting or bleeding between periods is not something to wait out [2][5].
Heavy periods in perimenopause
Heavy periods can be normal at certain times of life, including as you approach menopause [2]. According to the NHS, signs that your periods are heavy include [2]:
- needing to change your pad or tampon every 1 to 2 hours
- periods that last more than 7 days
- passing blood clots larger than about 2.5 cm (about 1 inch)
- bleeding through to your clothes or bedding
Heavy bleeding can have other causes than hormone shifts. The NHS lists conditions affecting the womb, such as fibroids and adenomyosis, bleeding disorders, and some medicines, including certain blood thinners [2]. That’s why heavy periods go to your doctor first, even when perimenopause seems like the obvious explanation.
Heavy periods are also a very common cause of iron deficiency anemia [4]. Its symptoms include tiredness and lack of energy, shortness of breath, noticeable heartbeats and paler skin than usual [4]. If you bleed heavily and feel worn out, ask your doctor about a blood test. The NHS mentions blood tests for iron deficiency anemia as part of looking into heavy periods [2].
What you can keep track of
Before your appointment, a simple bleeding diary helps a lot. For two or three cycles, write down:
- the first and last day of each period
- how many pads or tampons you use on your heaviest days
- any clots, and roughly how big
- spotting between periods or after sex
- how you sleep, your energy and your mood across the month
It takes a few minutes a day, and it gives your doctor or gynecologist something concrete to work with. It’s also a good basis if we meet, because it shows how your cycle connects with sleep, stress and energy.
What your doctor may offer
Your doctor can look at what lies behind the bleeding and talk with you about options. The NHS mentions some types of contraceptives, medicine to reduce bleeding such as tranexamic acid, and anti-inflammatory painkillers on prescription [2]. If these don’t help, or if your doctor suspects something else, you’ll usually be referred for tests or to a specialist [2]. In Sweden, 1177 advises contacting a gynecology clinic about bleeding changes that worry you, and your vårdcentral about other symptoms you think come from menopause [6].
These are decisions you make with your doctor. I don’t replace that step.
How I work with perimenopause and your cycle
Once your doctor has checked the bleeding, I work in parallel with your doctor, whether or not you take HRT or other medicines. At your first visit, we go through your whole picture: your cycle and bleeding diary, sleep, energy, stress, food, digestion and what you’ve already tried.
Then you get a written plan. Depending on what we find, it can include:
- advice on food, sleep and stress
- Chinese and Western herbs, homeopathy and high-quality supplements
- acupuncture, mainly Japanese style
- lab tests through a private lab if needed, alongside the tests your doctor takes
I’m honest with you about the research: I haven’t found good studies showing that herbs or acupuncture change heavy or frequent periods in perimenopause, so I don’t promise that. What we can work on together is how you feel around your cycle, and making sure you have clear notes and questions for your doctor. We follow up and adjust the plan as your cycle changes.
If you’re weighing your options around hormones, you may also want to read perimenopause without HRT, and my main page on perimenopause.
If you’d like to take a next step
You can book a first visit: 60 minutes, 3,500 SEK, at Kommendörsgatan 9 in Östermalm or online, in English or Swedish. Not sure it’s the right fit? You can book a free 15-minute call on Tuesdays, or text or email me first. All options are on prices.
When to see a doctor
Contact your vårdcentral (local primary care clinic), a gynecology clinic or 1177 (Sweden’s public health information service) if:
- you’re bleeding more, not less, than before, or your bleeding pattern has changed in a way that worries you [1][6]
- you bleed between periods or after sex [2][5]
- you need to change pads or tampons every 1 to 2 hours, or your periods last more than 7 days [2]
- you feel very tired, short of breath or notice your heartbeat, which can be signs of anemia [4]
- you start bleeding again after 12 months or more without a period [1][6]
If you’re bleeding very heavily and feel faint or dizzy, or in any emergency, call 112.
Sources
- NHS. Symptoms: Menopause. 2026. https://www.nhs.uk/conditions/menopause/symptoms/
- NHS. Heavy periods. 2026. https://www.nhs.uk/conditions/heavy-periods/
- NHS. Menopause. 2026. https://www.nhs.uk/conditions/menopause/
- NHS. Iron deficiency anaemia. 2026. https://www.nhs.uk/conditions/iron-deficiency-anaemia/
- MedlinePlus, U.S. National Library of Medicine. Menopause. 2026. https://medlineplus.gov/ency/article/000894.htm
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- Klimakteriebesvär. 2026. https://www.1177.se/Stockholm/sjukdomar--besvar/hormoner/klimakteriebesvar/
Common questions
Why are my periods closer together in my 40s?
In perimenopause, periods can come more often or less often than before. Some women get a period about every 3 weeks for a while, before they start skipping periods. That can be part of the normal transition, but it's worth checking with your vårdcentral or gynecologist, especially if the bleeding is also heavier, lasts longer or comes between periods.
Are heavy periods normal in perimenopause?
Bleeding can get heavier or lighter in perimenopause, and heavy periods are common as you approach menopause. Still, heavy bleeding should be checked by a doctor first, because it has other possible causes too, such as fibroids. Heavy periods are also a common cause of iron deficiency anemia, which can leave you tired and short of breath.
How long do period changes in perimenopause last?
It varies a lot from person to person. According to the NHS, menopause symptoms usually last 7 to 9 years, sometimes longer, and they can change during that time. Your cycle may be irregular for a while before periods stop. Menopause itself is usually counted from 12 months without a period.
Can I see you about my periods?
No, changes in bleeding go to your doctor or gynecologist first, so they can check what lies behind them. Once that's done, I work in parallel with your doctor. We can look at sleep, energy, food and stress around your cycle, and you're welcome to bring your bleeding diary and lab results to both of us.
Want to know how I can help?
Book your first visit with me in Östermalm, or start with a free 15-minute call.