Normal bleed patterns

It can be difficult to distinguish normal from abnormal bleeding during the perimenopause, given this is a time in life when menstrual cycles are dynamically changing.

Cycles tend to become anovulatory in the perimenopause with reduced luteal phase progesterone, and this is associated with high irregularity. Typically, the early perimenopause is marked by cycle intervals that become shorter, before they lengthen and cease altogether.

Normal bleed patterns in the perimenopause can include:

• Irregular periods.
• Longer or shorter lengths of bleeds.
• Longer or shorter intervals between bleeds. Both short (<21 days) and long (>36 days) cycles are associated with anovulation.
• Spotting or heavy bleeding.

• For more information on when to refer or arrange further tests for bleeding symptoms, see when to investigate section.