Bleeding During Perimenopause Can Be A Roller Coaster. Here’s What You Should Know.

If you're a Gen Xer or millennial, you may have noticed an unsettling trend lately: the mention of the word perimenopause pops up more and more. You may even be getting Facebook ads about it now (rude). But you can't argue that the frequency you find yourself Googling about perimenopause has definitely spiked. And one of the questions likely plaguing you right now is WTF is up with bleeding during perimenopause.

Here's the thing about perimenopause, which you may already have had an inkling about if you have an honest and open mother — it brings about a, well, *period* of truly unpredictable periods. Sure, you expect some bleeding during perimenopause since you know you'll likely keep menstruating to some degree until full-blown menopause enters the chat. Still, you might assume that since you're entering the end of your cycling era, blood production would be tapering off, right? Right?!

Hate to be the one to break it to you, but perimenopausal bleeding can be... a lot. Literally and figuratively. Here's what you need to know.

What is perimenopause?

Perimenopause typically starts in your mid-40s and is described as the time "before menopause." (You're considered menopausal after you've gone 12 months without a period.) During perimenopause, your body is basically preparing to "shut down" reproduction: your body releases eggs less regularly, makes less estrogen, becomes less fertile, and, yep, has more irregular menstrual cycles. You could be in perimenopause for two years, or you could be in perimenopause for up to eight years; it varies from person to person.

Bleeding during perimenopause is a common symptom but with marked changes: The menstrual cycle lengthens, with flow becoming irregular. You may go four, six, even 10 months without a period only to wake up and find you started your period again — and that countdown to menopause drops back down to zero.

No two bodies are the same, so no two people will have identical perimenopause experiences. But, in addition to irregular periods, you can probably expect PMS-like symptoms (think cramping, mood changes) when your estrogen is higher and menopause-like symptoms (think night sweats, hot flashes, trouble sleeping) when estrogen is lower.

When should you see your doctor about perimenopause symptoms?

"For [someone] who has always had normal menses, once it has been around three months of persistent irregular periods in any way, it is best to see their OB-GYN for a workup," says Dr. Monica Grover, an OB-GYN and chief medical officer at VSPOT. "If a person always had irregular menses due to conditions such as polycystic ovary syndrome (PCOS), diabetes, or even endometriosis, this becomes slightly more tricky. But, often, they are having visits every six months if these conditions are resistant to management, and perimenopause may be picked up during this time."

When is perimenopausal bleeding a cause for concern?

Period-havers have long dealt with doctors who have written off their period concerns, evident in the fact that issues like endometriosis and PCOS are only just now starting to be taken seriously. If your doctor shrugs off heavy bleeding, though, it might be time for a second opinion.

"The most common sign of perimenopause is irregular periods; generally, the periods will start spacing out," says Dr. Jennifer Overbey, an OB-GYN with Dignity Health Methodist Hospital of Sacramento. "They also may become lighter and shorter. You should see your gynecologist if your periods start becoming progressively heavier, longer (longer than seven days), or more frequent (shorter than 21 days between the start of one period and the start of the next). If you have gone one full year without a period and start having bleeding, then you should contact your gynecologist."

The big takeaway? If you're worried, talk to your doctor. If you don't like the answer? Dr. Jenna Liphart Rhodes, an educator at Nurse Together, suggests sticking up for yourself.

"While not 'normal,' bleeding for weeks is possible during perimenopause," says Rhodes. "Bleeding during perimenopause may last for a day or longer than a week. If the bleeding lasts longer than a week or is continuously very heavy, you should see a medical professional to rule out complications. If you feel like your irregular bleeding is not being taken seriously, you may need to advocate for yourself and point out the length, heaviness, and frequency of the bleeding. Perimenopause bleeding can be confused for more serious problems, such as hyperthyroidism, vaginal/cervical/ovarian cancer, and potentially even pregnancy spotting."

As with all stages of your life, it's especially important during perimenopause to make sure you're seeing a doctor you feel comfortable voicing your concerns to and who is familiar with you and your history. For so long, menopause issues just weren't discussed. For this reason, having an OB-GYN you truly trust to guide you through this stage is of the utmost importance.