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Period Changes in Perimenopause: What’s Common and When to Get Checked

By Mehmet Şişoğlu (developer of Pausa), based on the sources below · Updated 27 October 2026

As you approach menopause, periods often change. They can come closer together or further apart, get lighter or heavier, or be skipped. For many people, changes like these are simply part of perimenopause.

Not every change should be waved away, though. ACOG, the US college of obstetricians and gynecologists, lists bleeding that is not normal and should be discussed with a clinician: bleeding or spotting between periods, bleeding or spotting after sex, heavy bleeding during your period, bleeding that is heavier or lasts more days than usual, and bleeding after menopause.

Menopause is reached after 12 months in a row without a period. From then on, any bleeding, even a single episode or a small amount, should be checked by a doctor. Often the cause is not serious, but it is important to find out.

Quick answers

Is it normal for my periods to be irregular in my 40s?

Often, yes: irregular cycles are a hallmark of perimenopause. It is still worth mentioning changes to your clinician, especially if bleeding is heavy, happens between periods or after sex.

What can cause abnormal bleeding?

ACOG lists polyps, thinning of the womb lining (endometrial atrophy), thickening of the lining (endometrial hyperplasia) and endometrial cancer among the causes. Only an examination and tests can tell them apart.

What might the doctor do?

Usually a conversation and an examination first. Depending on your age and history, this may be followed by a pelvic ultrasound or a small sample of the womb lining (endometrial biopsy). ACOG’s patient guide describes these and other tests.

When to talk to a clinician

• Bleeding or spotting between periods or after sex.
• Heavy periods, or periods that are heavier or last more days than usual.
• Any bleeding after 12 months without a period, even once or only a little.
• Feeling dizzy, short of breath or very tired with heavy periods.

How logging helps

Exact dates are more useful than estimates. Pausa can show period days from Apple Health next to your symptoms, so you can tell your clinician when bleeding happened and what else was going on.

For personal awareness only. Not a substitute for medical advice.