Perimenopause is the natural transition period before menopause, usually occurring between the ages of 40 and 55 years. During this time, hormone levels fluctuate, causing changes in the menstrual cycle. While irregular periods are common, abnormal or heavy bleeding should never be ignored.

What Changes Can You Expect?

During perimenopause, you may notice:

- Periods becoming irregular

- Cycles that are shorter or longer than usual

- Heavier or lighter menstrual flow

- Bleeding lasting longer than 7 days

- Skipped periods followed by heavy bleeding

These changes often occur because ovulation becomes irregular.

When Should You See a Gynaecologist?

Please consult your doctor if you experience:

- Very heavy bleeding requiring frequent pad changes

- Large blood clots

- Bleeding between periods

- Bleeding after sexual intercourse

- Bleeding after 12 months without a period (postmenopausal bleeding)

- Persistent or prolonged bleeding

- Dizziness, weakness, or symptoms of anaemia

What Could Be the Cause?

Although hormonal changes are the most common reason, abnormal bleeding may also be caused by:

- Fibroids

- Endometrial or cervical polyps

- Adenomyosis

- Thyroid disorders

- Side effects of certain medications

- Endometrial hyperplasia (thickening of the uterine lining)

- Rarely, cancer of the uterus

How Is It Evaluated?

Your gynaecologist may recommend:

- A detailed medical history and examination

- Blood tests to check for anaemia and other conditions

- Transvaginal ultrasound to assess the uterus and ovaries

- Endometrial biopsy or hysteroscopy, if required, to examine the uterine lining

Treatment

Treatment depends on the underlying cause and may include:

- Medicines to reduce bleeding

- Hormonal therapy

- Iron supplements for anaemia

- Hormonal intrauterine device (Mirena)

- Hysteroscopic removal of polyps

- Surgery in selected cases

The Take-Home Message

Do not assume that every heavy or irregular period is "just menopause." Most causes are treatable, and timely evaluation helps detect serious conditions at an early stage. If your bleeding is affecting your health or quality of life, seek medical advice without delay.

Healthy menopause begins with timely care and regular gynaecological check-ups.