Perimenopause and shorter cycles

The menstrual cycle is guided by signals between the brain, ovaries and womb. In early perimenopause, ovulation may happen earlier or less consistently, and the time before bleeding can shorten. Periods may therefore arrive closer together, then become longer apart later in the transition. Flow can also vary from light to heavy, and spotting may occur.

A shorter cycle is not automatically caused by perimenopause. Fibroids, polyps, thyroid problems, pregnancy-related causes and some medicines can alter bleeding. The pattern, your age, pregnancy possibility and other symptoms help determine whether examination or testing is needed.

Use a calendar or app to mark the first day of each period, spotting, flow, clots, pain and medicines. Note fatigue, dizziness, hot flushes and missed activities as well. Bring this record to an appointment if cycles remain close together or the change is bothersome. Ask about treatment if bleeding affects sleep, work, exercise or intimacy, and review contraception because ovulation may still occur.

Arrange medical care for bleeding between periods, after sex, or after a missed period, or for a pattern that is new and persistent. Seek prompt help if bleeding is very heavy, lasts unusually long, or comes with dizziness, weakness or breathlessness. Severe pelvic pain or a positive pregnancy test with pain or bleeding needs urgent assessment.

Ask what might explain the shorter cycles, whether you need a pregnancy test, blood tests or an examination, and which options can reduce troublesome bleeding. Mention pain, clots, fatigue and any medicines or contraception.