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    Mayo Clinic Q and A: Menstrual irregularities not uncommon in decade prior to menopause

woman on couch having menstrual cramps or intestinal stomach pain

DEAR MAYO CLINIC: I am 41 and have had regular periods (every 28 days) my entire life, until recently, when I didn’t have a period for more than two months. It was then extremely heavy and lasted much longer than is typical for me. Should I be concerned? Do I need to see my doctor about this?

ANSWER: This is a very common situation for women your age. One episode of an irregular period usually isn’t cause for concern. But from this point on, keep track of your periods. If they continue to be unpredictable or unusually heavy, or if you start to have other symptoms, such as pain, hot flashes or night sweats, please make an appointment to see your health care provider for an evaluation.

Even though the average age of menopause is around 51 years, it’s not uncommon for women to experience menstrual irregularities in the decade prior to menopause, most often during their 40s. Once you notice a change in your period, it’s a good idea to start monitoring your period closely. Write down when they happen, how often they last and how heavy they are in terms of how many pads or tampons you use in a 24-hour interval.

If after four to six months your periods are still irregular, then an assessment is in order. Your primary care provider is the best place to start. He or she can do a physical exam, order any needed testing and check for possible underlying medical conditions that could be triggering your symptoms.

Two common causes of menstrual irregularity are thyroid disorders and a disorder called endometrial hyperplasia, in which the lining of the uterus thickens. Noncancerous growths of the uterus, known as uterine fibroids, may also lead to changes in your periods. Your health care provider may also check you for anemia. It’s a condition in which the body doesn’t have enough healthy red blood cells. Anemia is a common side effect of heavy menstrual blood loss.

As you monitor your cycles over the next several months, if you have very heavy bleeding that is saturating a maxi pad or tampon in one hour or less, for more than two hours, or if you have bleeding that lasts for more than 10 days, no matter how heavy it is, contact your health care provider right away. Do the same if you notice other new symptoms, such as night sweats or hot flashes.

Also, if you have factors that raise your risk for endometrial hyperplasia, including obesity, high blood pressure and diabetes, and the irregularity continues, the amount of time you monitor your condition before you call your provider is shorter. If you are at increased risk of endometrial hyperplasia and irregularity persists for two to three months, contact your provider.

Although an underlying condition can lead to menstrual irregularities, in many premenopausal women your age, period changes are a result of reproductive aging and not a sign of a medical problem. In those cases when heavy bleeding is an ongoing issue, a variety of treatments are available to manage it. Options include nonsteroidal anti-inflammatory drugs, or NSAIDs (such as ibuprofen), oral contraceptives and a hormonal intrauterine device, among others.

For now, though, chart your periods over the next several months. Note any changes you see and, if irregularities persist, talk to your health care provider. He or she can assess your condition and recommend the next steps that are appropriate for your situation. Petra Casey, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.