Why Do Periods Change in Your 40s?
During perimenopause, ovulation becomes less predictable, and hormone levels rise and fall unevenly. As a result, your periods may change in several ways:
- Cycles that are shorter (every 2–3 weeks) or longer (every 6–8 weeks)
- Skipped periods
- Heavier or lighter bleeding than usual
- Periods that last longer
- Spotting between periods
When estrogen is high relative to progesterone, the uterine lining can build up more, leading to heavier bleeding.
What's Normal—and What's Not?
Some irregularity is expected in perimenopause. But certain changes should be checked by a provider:
- Very heavy bleeding: Soaking through a pad or tampon every hour for several hours, or passing large clots
- Periods lasting longer than 7 days
- Cycles closer than 21 days apart
- Bleeding between periods or after sex
- Any bleeding after menopause (after 12 months without a period)
- Symptoms of anemia: Fatigue, dizziness, shortness of breath, or feeling very weak
What Else Could Be Causing It?
Not all bleeding changes are due to perimenopause. Other possible causes include:
- Fibroids or polyps in the uterus
- Thyroid conditions
- Thickening of the uterine lining (endometrial hyperplasia)
- Bleeding disorders or certain medications
- Less commonly, uterine cancer—which is why bleeding after menopause always needs evaluation
How Is It Evaluated?
A provider may recommend blood work (such as a complete blood count, iron studies, and thyroid tests), a pelvic ultrasound, or other tests depending on your symptoms.
Treatment Options
Depending on the cause, options may include hormonal treatments like progesterone or a hormonal IUD, non-hormonal medications that reduce bleeding, iron supplements if you're low, or procedures for fibroids or polyps.
Learn more about provider-guided support here: Heva Hormone Optimization
The Bottom Line
Irregular periods are common in perimenopause, but very heavy bleeding, bleeding between periods, or any bleeding after menopause should be checked. Treatment can help you feel better and protect your health.