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Menopause

Changes in periods

Changes in periods resulting from declining levels of oestrogen and progesterone, the two hormones produced by the ovaries which control the menstrual cycle, are usually the first sign that the menopause is near. We asked women to tell us how their periods changed during the menopause, the effect this had on their everyday lives, and how they coped with heavy bleeding.

Irregular periods
Most women expected irregular periods and other menopausal symptoms at some stage in midlife, even if they were unwelcome (see ‘What is the menopause?’). For others, however, particularly those who felt too young for the menopause or who knew little about it, missing a period could be a worry. Some women thought they might be pregnant. (See ‘Early (premature) menopause’ and ‘Relationships, sex and contraception’).

 

Lorna could ‘set the clock’ by her periods. When her periods became irregular she knew the...

Lorna could ‘set the clock’ by her periods. When her periods became irregular she knew the...

Age at interview: 56
Sex: Female
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Menopause. I think the first time I was aware was about when I was about 51, 52. 51 probably. When my periods started to not be as regular as they were. Now you could set a clock by my periods. Okay. Twenty eight days more or less to the hour, almost to the minute I mean it was amazing, and just as regular as clockwork. And they started to not be the regular twenty eight. And there were delays, the period extended. So I knew that this was the start of the menopause because I’d been so incredibly regular for so many years.

 

Vicky wondered what was wrong when she first missed a period. She thought there was ‘a problem’...

Vicky wondered what was wrong when she first missed a period. She thought there was ‘a problem’...

Age at interview: 51
Sex: Female
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People get scared when their periods stop, get worried, is there something wrong with me? Is there something wrong with my body that has caused my periods to stop? At first that is what I thought, I missed a period and then the next month too, is there a problem with my body? Because it had not happened before, I didn’t know what it was, now I have been through it, I know that is a sign of the menopause, so I tell other people there is no need to worry.

In some women periods stopped abruptly, but most we spoke to had irregular periods for several years before they finally stopped.
 

Carolyn’s periods had always been irregular so she didn’t really notice the menopause had started...

Carolyn’s periods had always been irregular so she didn’t really notice the menopause had started...

Age at interview: 60
Sex: Female
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My periods had always been fairly irregular certainly as I got older, and so I didn’t really think, I never really knew if I was going to have one or not it just happened, when they came they came. So the fact I hadn’t been having any didn’t really register either until eventually I began to think well it must be getting on for about a year which I know is the time that they say. And I was having some blood tests done for something else so they threw in the a hormone check as well and I was decreed that I was through it and I have to say I don’t think I’d had any adverse effects at all.

Women were surprised about all sorts of other differences in their periods and cycles (see ‘What is the menopause?’). One woman described her periods as coming ‘whenever they wanted to’, sometimes two close together, then gradually further and further apart, longer and heavier, then shorter and lighter for three years until they finally ceased. Another woman found her irregular cycle ‘confusing’. After having periods two weeks apart, she then had ‘heavier than normal’ periods every couple of months before they returned to a normal monthly pattern.

Periods might last two days or six or even longer; they might be very heavy or quite light. Several women experienced stomach pain. Some women said their menstrual blood looked different in colour and consistency. One described it as ‘almost globular’.
 

Maggie’s periods have become increasingly irregular in the past 16 months.

Maggie’s periods have become increasingly irregular in the past 16 months.

Age at interview: 49
Sex: Female
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My periods were fairly regular up till September, not last year, the year before, 2007, so at that point I just stopped having periods for about a period of six months, and again I wasn’t too concerned about it, I thought perhaps, I started to think then, I started to do a bit of reading about the menopause about the perimenopause, as I realised that’s probably what was happening. And sorry I’ve lost the train of thought now.

So yes I didn’t have periods for six months and then I started a relationship and I got one period in the same month that I started the relationship, and then again a gap of about eight months, and again some light bleeding for about two or three days, and that was a couple of months ago. So I think in the period of time of about sixteen months I’ve had two lots of quite light bleeding.

 

Sallie’s periods were irregular for two or three years before they stopped

Sallie’s periods were irregular for two or three years before they stopped

Age at interview: 56
Sex: Female
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I can’t remember when it started but I think the first thing I noticed was irregularity with periods. They seemed to come whenever they wanted to basically. Sometimes two close together and then gradually they were getting further and further apart.

I think that at first they were longer and heavier and then shorter and lighter as I went through it. With longer periods in between, longer gaps in between.

And have you stopped having them now?

Yes.

How long ago was that?

Probably two years. Two or three years.

So how long were they irregular for?

I think two or three. I think I started round about when I was 47. I think that’s when it started and it was probably like three years between then and 50 that it took me to realise that I was going through the menopause. And so there was more irregularity then but then the gaps got longer but it was regular, probably be like every six weeks as opposed to four weeks and then just now and again after that.

Effect on everyday life
The erratic nature and unpredictability of periods can be annoying, and at times embarrassing and debilitating. Women talked about the uncertainty they faced not knowing when to expect a period, or whether it would be heavy or light. They spoke about the inconvenience of periods which were ‘stop start, stop start’; and about the difficulty of making plans when periods ‘started coming twelve, thirty six and then seven days apart’. They needed to be organised and prepared with tampons and sanitary pads at all times, and feared being caught out in public places.

 

Judy’s periods have gradually become more irregular. An unexpected period, coming ‘out of the...

Judy’s periods have gradually become more irregular. An unexpected period, coming ‘out of the...

Age at interview: 46
Sex: Female
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It was just a gradual change really. So instead of having one every month it might be one every two months, so that would be six a year and they’d alternate between being very light and being slightly heavier. And then it came to the point where I no longer tried to predict when I was going to have one and I’d go for maybe three months and then they’d come out of the blue and I’d be completely unprepared. So the last one I had was in October when I was on holiday, the one week of the year when I went abroad and I got one there. And I just thought it’s a joke really. So that’d be October and I can’t remember when I’d had one before then.

When I had my last one in October it was a complete shock so I had no tampons or anything with me. In fact I had to ask my daughter if she had anything and she didn’t have anything either. So I just managed. It was slightly inconvenient, I had a slight bit of pleasure that I still had one so that gave me a degree of satisfaction but it’s not a problem for me I’m used to it now. I mean it’s been going on and off literally for six years so I just take each day, each week, each month as it sort of rolls by now.

 

Charlotte’s heavy periods and potential for flooding are ‘scary’ and embarrassing. Once she was ...

Charlotte’s heavy periods and potential for flooding are ‘scary’ and embarrassing. Once she was ...

Age at interview: 54
Sex: Female
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I remember having sort of heavy periods but they might have been more clotty periods early on and them being difficult to manage and not very nice but certainly this potential for flooding is scary. It’s scary. And I’ve been caught out. I’ve been in a situation where I drove to the Trafford Centre shopping with my daughter and I had tampons and pads on and I stepped out of the car and there was this woosh and fortunately my daughter’s a doctor so she’s quite comfortable, she wouldn’t have been embarrassed or anything by that. But I was terribly embarrassed. I couldn’t move, I couldn’t walk forward or backward and of course I had to send her into Marks & Spencer to get me some clothing, all of that. So it could be as bad as that standing up from sitting down somewhere at work and then realising your skirts or your trousers and got to deal with that kind of thing. Being kind of anxious about that possibility. Yeah, so yeah it can impinge on what you do. I tried not to let it impinge on things. I said I liked walking I try not to let it impinge on things like that but I’d be talking about stacks of supplies going round here there and everywhere with me that kind of thing. So, yeah, I think you perhaps know that other people struggle like that but you almost don’t say anything, sort of feel I’ve got to manage it, I’ve got to cope with it. I can’t say I’m going home now, I’m having a terrible day of it. You’ve got to just keep going.

Treating heavy bleeding
Heavy bleeding, or menorrhagia, can dent the quality of life. Women talked about various treatments they had tried to control heavy bleeding. One woman took hormone replacement therapy (HRT) (see ‘Hormone replacement therapy (HRT)’) to regularise her heavy and erratic periods which were ‘getting in the way’ of her new relationship. Another was prescribed norethisterone, a synthetic progestin used to control heavy bleeding, but stopped taking it when she put on weight.

Several women had the Mirena coil fitted to regulate bleeding. This is a plastic device inserted into the womb, which releases a synthetic progestin called levonorgestrel. It can also be used for contraception (see ‘Relationships, sex and contraception’). Some women’s periods became lighter or stopped altogether while using the Mirena coil.

 

Jill had a Mirena coil fitted to help regulate her heavy and painful periods. The bleeding...

Jill had a Mirena coil fitted to help regulate her heavy and painful periods. The bleeding...

Age at interview: 47
Sex: Female
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And it just started initially with I suppose physical things, totally irregular periods. Sometimes I’d miss a few months and then it would come back, it was just all over the shop. I went to the doctors because of this problem and she decided to fit me with a Mirena coil. That was four years ago. How that was sold to me as “You’ll never have any period problems ever again. It’s 99.9% sure you don’t have periods again.” And it usually starts to become effective within three months and a year later I was still having periods. So I went back and obviously kept just delaying it I think because the doctor was thinking, well if this didn’t work I’d have to have a hysterectomy. And I know that’s a big operation and I wanted to give it a bit longer. What happened after about a year of having the Mirena coil fitted was I did stop for quite a few months, probably about 6 months and I thought great. Felt better in myself, thought this is it. But it came back again. And that’s how it’s been really for the last four years. I can go several months without a period but then it comes back and when it does come back oh it’s awful. I have the pain and I can describe it to you because I have given birth, it’s like giving birth.

Well sometimes perhaps I’d only go two weeks and then it’d come again, then I could go eight weeks and then it would come. Sometimes it would be extremely heavy and big clots and other times it was very light browny treacly-fied. She [doctor] did explain initially that some of this bleeding was perhaps old blood that was already inside the womb. But obviously when the blood was coming out like beetroot coloured, that’s to me fresh [blood]. And I did ask the question “Well if it’s 99% effective why hasn’t it been with me?” And she just said “Well Jill you’re that 1%. We can’t guarantee anything.”

Although heavy bleeding can be a part of the normal menopause, some women worried and consulted a doctor. In some cases they were diagnosed with anaemia (iron deficiency caused by heavy bleeding). Once they began taking iron tablets their energy levels returned. In some women, heavy bleeding was a sign of underlying problems such as polyps and fibroids and needed referral to a specialist. It’s important to investigate any bleeding 12 months or more after the last period.
 

Karen’s heavy bleeding and clotting while on HRT was ‘totally inconvenient’ and interfered with...

Karen’s heavy bleeding and clotting while on HRT was ‘totally inconvenient’ and interfered with...

Age at interview: 61
Sex: Female
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Was it heavy bleeding?

Not all the time. It was clotted at points, which I think that’s when it started really getting to my brain that this was totally inconvenient. If you went anywhere you had to go prepared so it was actually interfering with my general life.

It affects almost everything you do, as I say, even going shopping, you’ve got to go prepared. I needed to know where the nearest loo was. Even going out for meals with friends, everything like that, it does affect you and it affects how you feel. And your moods, your tempers and not wanting to go out and holidays become even more difficult, you’ve got small children who want to go swimming.

And then I think it must have been, I’m trying to think when it was, must have been after about six years it became that my periods were going on and they were forced periods because of the HRT, but they were lasting longer than the days that I had off and I was feeling generally unwell and the doctor was still quite happy that I should stay on HRT. All that he really checked was my blood pressure and my weight and they seemed to be okay. Eventually he referred me to a gynaecologist at [name of hospital] it was quite quick and they did a scan and said that I’d got quite large polyps and fibroids. And they whipped me in the hospital quite quickly.

 

Sonia bled heavily. A laparoscopy showed that adhesions caused by pelvic inflammatory disease...

Sonia bled heavily. A laparoscopy showed that adhesions caused by pelvic inflammatory disease...

Age at interview: 45
Sex: Female
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So you said that you were bleeding a lot and very regularly. What impact did that have on your life?

A hell of a lot really because I was quite an active person so I used to cycle a lot. I liked swimming. So I was quite active and I felt that I couldn’t do all those things because I didn’t wear tampons. I’d stopped wearing them about ten years ago. So I was just using pads so with swimming and stuff I couldn’t really do that as much. I didn’t feel like I wanted to go out because I was bloated. I just felt frumpy and horrible really.

What about at work? How did it affect you at work?

Same thing at work, just quite down, and normally I’m quite an upbeat person, I’ve got quite a lively personality. And I was quite down a lot of the time obviously because of the bleeding and it just used to drain me. I wanted to sleep a lot as well, yeah, that was one thing, sleeping.

They did send me up to the hospital. I was at the women’s clinic because I’ve been up there a couple of times. And they did a laparoscopy or, the camera inside. Oh, that’s right. Yes, I do remember now they said that I had adhesions in the tubes from the time before I had my daughter. I had pelvic inflammatory disease so that caused me to have adhesions which had obviously stayed there. So that’s what they could see so that actually was a contributing factor as well.

And they suggested HRT and I didn’t want that so they then said to me, “Well, you can have the Mirena coil.” They explained in some people it does actually stop the periods. So I decided to give it a go. And I’ve been on that for the last two years and it’s helped me with obviously not having any periods so I don’t have any bleeding. I do get the occasional flushes but nothing that’s warranted, that I worry about it. The bleeding has totally stopped. So at the moment, touch wood, it’s quite good and it’s worked well for me.

Tests to confirm the menopause
Changes in periods, a woman’s age, and symptoms such as hot flushes usually indicate that the menopause has started. However, when periods become irregular some women ask their GP for a blood test to confirm that the menopause has begun. Tests are available to measure levels of the follicle stimulating hormone (FSH), which rise as oestrogen levels fall. However, although useful in diagnosing early menopause (before the age of 40) (see ‘Early (premature) menopause’), the tests can be unreliable for women in their forties as hormone levels fluctuate. For this reason doctors may hesitate to order tests routinely.

 

Beverley found it hard to convince doctors she was entering the menopause because she was in her...

Beverley found it hard to convince doctors she was entering the menopause because she was in her...

Age at interview: 50
Sex: Female
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I was in my late thirties and I had been someone who was always regular when it came to my monthly cycle and all of a sudden I missed a couple of months and I went to my doctor’s because I started panicking thinking I was pregnant. Did a pregnancy test and I wasn’t and then I noticed I was getting the sweats. And then I started going to my doctor’s thinking that I might be going through the menopause and they kept fobbing me off saying, “No, you’re not. You’re too young.” Apparently, the normal age is fifty plus and the fact that I was in my late thirties they didn’t think that I was going through it. And I think it took me about two years off and on of going backwards and forwards to my doctor’s before they agreed to do the test. Then they rang me and I thought something was really bad and I went in to see them and it confirmed what I had been saying.

Although fertility declines during the menopause, pregnancy can still occur. Women are advised to continue to use contraception for one year after their periods stop if over 50; or for two years after periods stop if under 50 (see ‘Loss of fertility’ and ‘Relationships, sex and contraception’). For many women, the end of the menopause brings with it a sense of freedom from the unpredictability and inconvenience of periods and the fear of getting pregnant.

 

Last reviewed July 2018.

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