Breakthrough Bleeding

Shedding small amounts of blood – too small to require the use of a tampon or a pad – is called breakthrough bleeding, or spotting. This happens when your changing hormone levels impact the buildup of the lining of your uterus, called your endometrium. Spotting is common just before or just after your period, but it also can happen mid-cycle. [2]

Heavy Bleeding

The lining of your uterus, called the endometrium, grows and thickens during your menstrual cycle in preparation for the implantation of a fertilized egg. Hormones are responsible for this, and as your hormones become variable during the menopausal transition, it can impact how much the uterine lining grows. As well, as your periods become more erratic and periods are skipped, the uterine lining will continue to thicken until it is shed during the next period. When the uterine lining is very thick, it can lead to heavy bleeding. Heavy menstrual bleeding is formally called menorrhagia.

Bleeding is considered to be heavy if you:

• soak through one tampon or pad every hour for several hours;
• need to use a tampon and a pad (double protection) to manage your menstrual flow;
• have to wake up to change your pad or tampon; or
• your period lasts longer than 7 days. [2]

Heavy bleeding can be very disruptive and affect your quality of life (QOL) as it can make it difficult or impossible to move normally through your day. Heavy bleeding can also cause fatigue and it increases your risk for iron deficiency anemia (IDA). [2][3] [4]

Changes in Blood Colour and Texture

Women know what is typical during their own periods, so it can be concerning when the colour or texture of menstrual blood changes from the ‘norm’. Variation in colour or texture is normal. The colour of menstrual blood can range from bright red to dark brown. Darker colour blood is a sign that the blood leaving the body is older, which is nothing to worry about. The texture can also change from your normal flow, becoming thin and watery or thick and clot-like. [2]

Changes in the Length of Your Menstrual Cycle 

As your estrogen levels decline, the lining of your uterus gets thinner. This can lead to lighter flow and menstrual cycles that are two or three days shorter than your normal cycle. In fact sometimes it can feel like you just finished your period and the next one is starting. This is common in the early menopausal transition. [1] [2]

As you move through the menopausal transition, however, your menstrual cycles may start to become longer and less frequent. A ‘long’ cycle is defined as any cycle that is longer than 38 days. This happens as you start to have more frequent cycles where you do not ovulate, or release an egg. These are called anovulatory cycles.

As you approach menopause, which is diagnosed as the absence of a menstrual cycle for 12 consecutive months, you may start to miss cycles completely. Be aware, though, that if you are still having periods, regardless of how infrequent they are, you are still ovulating. And that means you can still get pregnant. Unless pregnancy is your goal, ensure that you are still using birth control until you are fully in menopause, which indicates that your reproductive years are finished. [1] [2] 

The irregularity of your periods can become frustrating but it will eventually end when you reach menopause. 

Record Your Cycles

Record your cycles as this can help you visualize the patterns of your changing cycles. You can note any abnormal bleeding and discomfort, as well as any other symptoms you are experiencing. This is key information to share with your healthcare provider.

Evaluate the privacy & data protection policies for smartphone cycle-tracking apps before inputting any of your personal medical data, including cycle length.

Ibuprofen (Advil, Midol, Motrin)

Ibuprofen (Advil, Midol, Motrin) is used to help with the pain and cramping of your menstrual cramps, however it can also help reduce the flow of blood if you are experiencing heavy bleeding. Talk to your healthcare provider to find if this might work for you and if so, to find the best dosage for your individual needs. [2]

Panty Liners or Period Underwear

Leaks and stains are possible, so consider wearing thin pads or panty liners – many are disposable but there are reusable liners made of fabric if that is your preference.

Alternatively, invest in some black underwear or dedicated ‘period underwear’ so that you are not staining all of your undergarments.

Continue to Use Birth Control

Remember to use birth control! As long as you are getting periods, no matter how infrequent, you are ovulating and this means you can get pregnant. Unless pregnancy is something you want, be sure to use reliable birth control. [2]

Follicular Phase

The first day of menstrual bleeding marks the first day of the follicular phase. At this time, levels of estrogen and progesterone are low and the top layers of the thickened lining of the uterus (endometrium) break down and shed, creating the menstrual bleeding. At the same time, follicle-stimulating hormone (FSH) levels increase and cause several follicles, each containing an egg, to develop in the ovaries. Then the FSH levels start to decrease and only one follicle continues to develop and starts to produce estrogen.

Ovulatory Phase

The ovulatory phase follows the follicular phase when luteinizing hormone (LH) and FSH both rapidly increase. LH causes the egg to be released from the follicle (ovulation). Estrogen levels decrease when LH and FSH levels are heightened. Progesterone levels begin to increase.

Luteal Phase

In the luteal phase both LH and FSH levels decrease. A structure called the corpus luteum forms from the ruptured follicle (that just released the egg) and it begins to produce progesterone. Estrogen levels stay elevated for much of the luteal phase. The presence of progesterone and estrogen cause the uterine lining to thicken in preparation for the implantation of a fertilized egg.