A woman I’ll call Katie came to see me about concerns related to her changing period.
Healthy overall, and 46, Katie had done her homework. She’d recorded her period for the past 12 months in a notebook, including the dates of her period, how long it lasted, and how heavy it was each time.
Katie’s notes told us that her period ranged from two days of light spotting to eight days of heavy flow, followed by a day of dark spotting. Her period was never more than 60 days apart, and she had gone one month without a period. She also had occasional spotting in the middle of her cycle, only requiring a pantyliner.
I asked Katie if she experienced other symptoms related to her period cycle. She told me she felt especially hot at night around the time her period began each month, but she never really made the connection. She simply thought she was using too many blankets.
She also noticed she felt edgy and irritable at different times of the month, but she hid it most of the time. Overall, her biggest complaint was her constantly changing period and never knowing what to expect each month.
My first goal as a specialist in perimenopause and menopause is to make sure nothing abnormal is afoot. In other words, the abnormal bleeding is just a result of ovarian aging.
We began talking about what was happening to her body. I used a diagram of the uterus, ovaries and brain to describe the hormone conversation that must occur to have a normal cycle each month.
When a period happens, the brain tells the ovary to make another egg with the signal follicle-stimulating hormone. A follicle, or premature egg, starts to develop. The cells around the egg first secrete estrogen and then, after ovulation, progesterone.
Here’s another way to look at it. The lining of your uterus is like a lawn, and estrogen is the equivalent of fertilizer for the lawn. Progesterone helps the lawn mature, not just grow longer. It’s the equivalent of weed killer. If just the right amount of hormones are secreted, the lawn is perfect and ready for a baby to be planted.
If there’s not a pregnancy, then a message isn’t sent back to the cells to keep making estrogen and progesterone. Therefore, the cells die off and the lining of the uterus falls off, resulting in a period.
I continued to explain to Katie that when periods become closer together, farther apart, heavier or lighter, it means that the hormone balance is changing. As an ovary gets older, the estrogen levels become more erratic—some days higher, some days lower—and the progesterone levels are lower and fall more quickly. During some cycles, progesterone levels are almost nonexistent.
As a result, the most common changes are a period that is closer together and heavier, followed by a normal cycle, followed by a period that is farther apart and lighter again.
After we discussed Katie’s symptoms, the next step was to check her blood work for thyroid and prolactin disorders, which could signal that other hormones might be disrupting the ovary-brain conversation. The blood work showed that Katie had normal thyroid and prolactin levels, so I ordered a pelvic ultrasound to confirm she had a normal uterus. She did, in fact, without fibroids or abnormal thickening of her uterus lining to indicate uterine polyps, or precancerous or cancerous growths.
After her tests were complete, Katie came back to see me. I performed a Pap smear (she was already due for one) and a biopsy of her uterus lining to confirm she didn’t have abnormal cells. She didn’t, so then we discussed her options.
Here are the options we looked at:
- Continue to observe her period and changes, but don’t make any adjustments. Simply knowing the changes are normal—and don’t indicate something seriously wrong—can offer peace of mind. With time, many women cycle through these changes without much incident.
- Start taking birth control. Since Katie isn’t a smoker, this could be an option for her. The pill can turn off the ovary and allow for a light, regular period every month. It can also help decrease night sweats and regulate mood changes related to cycling hormones. Katie had been on birth control in the past and didn’t feel well while taking it, so she eliminated this option.
- Use an intrauterine device containing progesterone. An intrauterine device, or IUD, releases progesterone mainly inside the uterus. Many women who don’t tolerate the pill do very well with an IUD without any side effects. For most women, an IUD will make their periods very light or even nonexistent for up to five years. This is an especially good option for women who smoke, are at risk of leg or lung blood clots and are not good candidates to take estrogen.
- Have a uterine ablation. An ablation is done by several methods—all with the goal of destroying the lining of the uterus to avoid bleeding. It has an approximately 80 percent success rate in a normal uterus. This is a potential option for Katie because her uterus is normal. If she had fibroids or other uterus abnormalities, the ablation would most likely not work.
Katie decided to choose the IUD with progesterone option, and she was pleased with the results.
After three months of almost daily spotting, her period stopped. She could rest assured that her system was normal and healthy, and she could finally get on with her life.
My 13 year old daughter has autism as well as several serious health problems…feeding tube, wear diapers, pro-longed qt interval to name a few. She has not started her period (I did not start until I was 17). We know our daughter will not handle periods well. With her heart problem deprovara has been taken off the table. An abaltion was suggested. I know a few woman who had problems with this and ended up in the ER with heavy bleeding.
Any input you have would be most welcome. I remember you from Dr. Holt’ s office.
~Wendy S. Scholten
Hi, Wendy,
I am glad you asked this question about ablation, and I’m sorry your daughter has to deal with these health problems. Hopefully she starts her period late. This can be a difficult situation to address, because everything we offer has risks. It sounds like systemic hormones are off the table, and an ablation at such a young age will not be effective because it tends not to last long. There is significant time for the lining of the uterus to grow back and/or pockets of blood to collect in her uterus and not be able to get out. This can cause acute pain and a possible need for surgery. A better option could be an IUD which contains progesterone; the systemic dose is minimal and should not affect her heart. Another option is very drastic: a hysterectomy. We do not offer this lightly, and it would have to be a thorough discussion between all of her doctors weighing the risks and benefits. I would not even consider a hysterectomy until she starts having periods to see how she is affected by them. As a result of her health status, her periods might be very light and infrequent, and there will be no more reason to worry. That is what I sincerely hope for you and your daughter!
Dr. Diana Bitner
What are your thoughts on bio-identical hormone replacement in this situation? Why wasn’t it even an option given to the patient? I am also 46 and had similar symptoms. I am now taking progesterone 14 days of my 28 day cycle and also estradiol and testosterone since my blood work showed I was low in all 3. My thyroid also is low. I am working on boosting that through vitamin B5 and B6 and some other supplements. Is the progesterone in the IUD that Katie chose synthetic or natural, bio-Identical?? I feel natural replacement of hormones is the way to go. I have read so many good things about this option. I also feel most doctors fear using them due to lack of proper studies. The only bad results (stroke, heart attack, cancer) coming from studies were when synthetic hormone replacement had occurred, not bio-identical.
Hi, Lisa,
Most of the hormones I prescribe are bioidentical, but they are FDA-approved bioidentical.
Bioidentical hormones are identical to the hormones made in your body. There is a really good article about this in the women’s lifestyle magazine “MORE” that tested the medicines sold as bioidentical hormones in non-FDA-approved forms by doctors prescribing supplements—not approved drugs. You can read the article at more.com/health/perimenopause-menopause/are-natural-hormones-safer. The survey showed that the medicines were tested by an outside lab and contained between 0 percent and 1,000 percent of what was promised on the label.
My first concern is, and always will be, safety. I agree that the Women’s Health Initiative study in the “MORE” magazine article showed more adverse events with the synthetic progesterone, and that is why I almost exclusively prescribe FDA-approved bioidenticals.
The IUD contains synthetic progesterone, but it mostly stays in the uterus, and I do not worry about a systemic effect to the point where it could cause a bad side effect. The other key point from the article about the safety of hormones is that most bad events—heart attacks, strokes and blood clots—occurred in women older than age 65 who also had a high underlying risk for these events to happen anyway. Most of the women who experienced the events also had metabolic syndrome: central obesity, high blood pressure, high “bad” cholesterol and elevated blood sugar levels.
Everything I prescribe has risks and benefits; my goal is to minimize the risk and promote good habits and good health. For many, for example, the risk of the IUD with progesterone is minimal, and it can save them from having a hysterectomy, prevent uterine cancer and be an alternative if they do not tolerate systemic progesterone.
I hope this helps. Thank you.
Dr. Diana Bitner
I think I’m at the late stages on menopause. I expect TiVo be through menopause within the next year or so. When I do menstrate it’s very light now (yay). I’m only 34. Is it important to see a doctor for hormone replacement? Or, can I just go through this change without anything? I feel fine and am ok with most of the symptoms, I understand it’s all part of the change. But I hate what’s happening with my teeth and hair (especially at my age). Do calcium pills help or hurt?
Thanks!
Phone auto-correct made “to” into “TiVo”.
Appreciation to my father who informed me about this blog,
this weblog is actually remarkable.
I’m 50. Mine is finally changing, well, it has never been regular until the last few years. It was showing up every month between the 4th and the 9th when I turned around 33. That is also when the migraines started. Then, about 6 to 8 months ago, I noticed the cycles getting noticeably shorter. They would start every 3 weeks. Now it is annoyingly down to 2 weeks. They’re extremely heavy during the middle and it seems to last a couple of days longer so I’m hoping this is close to the end. I’ve been really tired off and on (this is normal), more frequent migraines, chest pains (I can no longer afford insurance to go get looked at due to the so-called “affordable care act” aka obamacare.) I have had a few days of just being really super sick with feeling faint, vomiting, and extreme fatigue and lack of breath other days, and weirdness like heat flashes although I don’t know if that is what a heat flash is. I hope it doesn’t last too much longer because it is driving me INSANE. *smiles*
I’m 46, an will be 47 in two weeks. I just had my period on the 4th of may, then I was spotting it stopped then I came back on my period on the 16th of may an I’m still on. Am I starting menopause.?
Hi Deane. We recommend you chat with your OG/GYN or family physician about these changes in your cycle, as he/she will be able to best provide guidance based on your personal health care situation.
Did you ever figure this out? I’m having the same thing happening. Let me know
Thanks
T
Do you have an opinion on the BioTE hormone pellets as an option for managing symptoms?
Hi, Not sure if these comments are still active since I see they date back to 2014. My question is directed at Tina. When you mentioned “your teeth”, what kind of problem were you experiencing with your teeth if you don’t mind me asking ?
Hi, i have never had very regular periods but they mostly came at a gap of 30 to 40 days for 5 days. However, since three cycles, i have been having periods every 15..17 days and there have been no changes in my lifestyles. I have nevee had much pain before or during periods and same is the case now. I am 27 years old and am really worried. What can be the reason?
Hi Esha, We suggest you reach out to your primary care provider or go to the local clinic to discuss your symptoms. He/she should be able to give you the best diagnosis and treatment advice. Best wishes to you.
As you get older (i turn 40 in about a month) do periods get closer together before hitting menopause? . . About 20 -22 days inbetween bleeding before was about 30 to the day.
Thanks
Jen
Hi Jen, Thanks for your question. Period frequency may change in perimenopause, but this could also signal an underlying concern. We suggest you share this information with either your primary care physician or OB/GYN. They will be able to give you the best medical information personalized to you. Best wishes to you.
I’m 44 and think I have been in peri for a while now. I had a lot of heat for a few years, but now my periods are changing, I also have painful breasts and increasing mood swings. My concern is this month, my period came lasted around 6 days and 7 days later my period is back again, heavier, is this normal? I use natural progesterone cream, I’ve been using it for years because of how the pill messed up my hormones. I get a bit panicky because a few years back I had lletz for CIN 3 and then got an infection and was rushed into hospital and lost 2 pints of blood and nearly died. I am scared and hope this is normal peri menopause, should I be concerned?
This is probably one of the most informative articles that I’ve read about having abnormal periods and the symptoms and frustration that goes along with it. As I’m reading Katie’s story about her period, I’m finding more and more facts that I can relate to – irregular cycle, spotting in between cycles, going 40+ days without any signs of a period, 8 days of heavy bleeding. And the explanation I gathered from that was because of aging ovaries.
Here’s my issue though, I’m 20 years old. I’m noticing my periods are getting further apart, almost 50 days now, and the bleeding is heavier, the pain in more intense, and several other abnormalities (pain on one side, intense mood changes). I experienced irregularity when I first started my period at 15, which I know is normal, but the past 6-12 months have been completely different.
I do have a family history of thyroid diseases – could this be the reason? I’m just looking for an answer other than “because you’re young”. Maybe it’s hormonal changes? I welcome any and all advice for how to handle the anxiety that comes with having such an sporadic and painful cycle, or what I can do to ease some of the symptoms.
Thank you!
-Abbie
Hi Abbie,
I’m glad this article was helpful to you, and I’m sorry to hear you’re having these issues at such a young age. Are you able to talk with your OB/GYN or primary care provider about these symptoms? They would be able to run tests, perform an exam to help determine why you’re experiencing these issues… and then help you with a treatment plan.
Hope you’re able to get answers soon.
Best,
Cheryl
Hi Cheryl,
Thanks so much for replying quickly!
I haven’t seen any doctor out of fear of coming in contact with COVID, but I probably will soon.
Based on your knowledge however, do you have any suggestions as to what I can do to ease some symptoms? I’ll gladly take any advice you give.
Thanks so much!
-Abbie
Hi I’m 24 and been getting my period every two weeks out of no where. But i’ve been on birth control idk if it’s because of that?
Hi Gaby, We recommend you discuss this with your health care provider. He/She will have the best advice for your individual situation.
I’m 38 and I have tracked my cycles for the last 10 years or so. I’ve noticed that since June, of this year, my cycles went from 28 days apart to between 19-21. Some are light and some are heavy. Typically, my first two cycle days are my heaviest. This last cycle, however, was light the first two days and then extremely heavy the 3rd and 4th. I always know when I’m ovulating because I feel my left ovary twinge. It was right on time this month, BUT I then started spotting brown which then lead to bright pink. Now I’m on what feels like a regular period and I’m 12 days out from the end of my last one…so SUPER early. I went to the Dr. and he did a urine test, and an exterior and vaginal ultrasound to be extra thorough and check for an ectopic pregnancy since I’ve had my tubes tied since 2010. The only thing they found were a couple of cysts, which is not atypical for me. Is it possible that I’m in the Peri phase of life? I have trouble sleeping, have gained some weight in the belly area despite eating healthy and working out and my libido is non-existent. Thanks for any advice!!
Hi Ashley – We suggest you discuss these trends with a women’s health provider. If you live close to Grand Rapids, Michigan, Spectrum Health has women’s health specialists who focus on midlife, menopause and sexual health. Learn more at https://www.spectrumhealth.org/patient-care/womens-health. If you live farther away, we suggest you find a OB/GYN who specializes in perimenopause and menopause as well as sexual health and wellness. All the best to you!