How can menstrual periods change during perimenopause?

During perimenopause, the transition phase leading up to menopause, the failure to ovulate causes significant disturbances in the menstrual cycle. As ovarian activity declines, women may experience several changes in their menstrual patterns:

• Irregularity: Cycles may become unpredictable, with women occasionally missing one or more periods.
• Interval Changes: There may be prolonged intervals between periods or, conversely, irregular bleeding episodes.
• Flow and Duration: The length of the periods can vary, and the menstrual flow may become either more scant or more profuse than usual.
• Cessation: While most women experience these gradual changes, in a small minority of cases, menstrual periods may cease abruptly.

Because these symptoms can mimic signs of pregnancy, a medical examination is recommended to establish a proper diagnosis during this time.1