Menopause and menstrual cycle changes: Causes, treatments, and relief strategies for 2025

What you’ll learn:   

• Hormonal fluctuations during perimenopause can cause significant changes in your menstrual cycle, including irregular periods, changes in flow, and spotting.       
• Understanding the causes and risk factors of menstrual cycle changes during perimenopause can help you better prepare for and manage them.     
• Lifestyle adjustments and other treatments can help. Your doctor will help you find the best approach to dealing with menstrual cycle changes. 

Menopause doesn’t happen overnight—it’s a gradual process, and one of the earliest signs is a shift in your menstrual cycle. Periods that were once regular may start coming earlier or later, become heavier or lighter, or skip months entirely. 

As you might know, menopause literally means the end of your period, so it’s no surprise that your cycle will change leading up to it. But it rarely just stops one day, and that’s it. These changes can be unpredictable and sometimes even painful. Along with them, you might experience other uncomfortable symptoms like hot flashes, mood swings, and weight gain. 

Understanding why these things are happening can help you deal with them. The biggest cause is the fluctuating levels of hormones, particularly estrogen. We’ll go through when you can expect changes and what you might experience. Most importantly, we’ll talk about what you can do to ease your symptoms and tell you what might help (and what doesn’t!)

While these changes can feel unpredictable, you don’t have to go through them alone. Understanding what’s happening can help you manage symptoms and feel more in control.

Understanding menstrual cycle changes during menopause

There’s a lot going on inside your body as it goes through the transition to menopause. Hormones, particularly estrogen and progesterone, direct your menstrual cycle. They go up and down throughout the month, telling your body to thicken the uterine lining and to shed it before your period. When your hormones start changing as you approach menopause, these signals can get out of whack, leading to periods that look and feel different. Let’s look at the stages of menopause and what period changes you can expect:

Menopause occurs in three stages, each affecting menstrual cycles differently:

• Perimenopause (can begin in the late 30s): This phase begins several years before your period stops. During this time, ovulation becomes irregular, and menstrual cycles may lengthen, shorten, or become unpredictable. Symptoms like hot flashes, mood swings, and sleep disturbances can also appear sporadically. How long will it last? It depends on the person. Perimenopause can last anywhere from 2 to 8 years.
• Menopause (average age of 51): When you have gone 12 consecutive months without a period, you are officially in menopause. This means you have stopped ovulating. Your levels of estrogen and progesterone will be significantly lower. The average age of menopause in the U.S. is 51, but it varies from person to person.
• Postmenopause: While your menstrual cycles have stopped, you may experience an increased risk of osteoporosis and heart disease due to lower estrogen levels. A healthy diet, exercise, and regular check-ups can help support your health long-term.

What’s happening in the body during perimenopause?

Now that you understand the stages, let’s take a closer look at perimenopause, where all the changes in the menstrual cycle happen. As menopause approaches, the ovaries produce less estrogen and progesterone, the two key hormones that regulate what happens during your cycle. Estrogen levels can also fluctuate wildly during this transitional time. With lower and unstable hormone levels:

• Ovulation becomes irregular or may stop entirely.
• The uterine lining thickens inconsistently, which may lead to irregular spotting or lighter or heavier periods.
• You may skip cycles or have some that last longer than usual.
• Eventually, hormone levels drop low enough that menstruation stops completely.

How common are menopause menstrual cycle changes?

Menstrual cycle changes are a common part of perimenopause, but they don’t follow a set pattern. According to a study, irregular cycles become more common after age 45, with periods becoming longer and more unpredictable. Before 45, cycles tend to shorten gradually, but as menopause approaches, they can become erratic, skipping months or arriving unexpectedly. Those between 51 and 55 experience the highest rate of irregular periods (45%), while those aged 36 to 40 have the lowest (28%).

When do these changes start, and who experiences them?

Most people begin noticing menstrual irregularities in their 40s, which often signals the beginning of perimenopause. Genetics, lifestyle, and overall health play a role in when and how these changes occur. If you smoke, have certain medical conditions, or have undergone chemotherapy, you may enter menopause earlier. Also, having a hysterectomy where just the uterus is removed may cause early menopause; if both your uterus and ovaries are removed, you will experience menopause immediately.

What do menopause menstrual cycle changes feel like?

Menstrual cycles during menopause can be unpredictable. Some people experience:

• Longer or heavier periods, while others have shorter, lighter flows
• Spotting between cycles
• Worse cramping, bloating, or PMS-like mood swings
• Skipped cycles, making it difficult to predict when the next period will come

While these changes are a natural part of perimenopause, they can be disruptive. If symptoms like excessively heavy bleeding, prolonged periods, spotting between periods, or severe pain occur, it’s important to check in with a doctor. They will make sure nothing else is going on, and can help manage symptoms, and recommend treatments.

Causes and risk factors of menopause menstrual cycle changes

In general, anyone with a uterus and ovaries will eventually experience changes in their menstrual cycle as they approach menopause. The main driver behind these shifts? Fluctuating hormone levels as your egg reserves gradually dwindle. Your genetic makeup, certain health conditions, and even lifestyle factors can influence how and when you experience these changes. Here’s a closer look at what’s behind these shifts.

Aging

At its core, menopause is a natural part of aging. A female is born with all of the eggs she will have in her life. After 40ish years of menstrual cycles, they are almost all gone. As the egg reserves dwindle, your ovaries slow down their function, producing fewer hormones. This gradual process leads to menstrual cycles becoming irregular before stopping completely. Menopause usually happens between the ages of 45 and 55, but the exact timing varies from person to person.

Hormonal shifts

Estrogen and progesterone are the two key hormones that regulate your menstrual cycle. As you approach menopause, your ovaries produce these hormones inconsistently because they’re running low on eggs. This natural aging process means fewer egg follicles are available to respond to your brain’s hormonal signals. Egg follicles are small, fluid-filled sacs in the ovaries that contain immature eggs, and they’re important for the development and release of eggs during the menstrual cycle. With this declining reserve, your ovaries produce inconsistent hormone levels. Let’s take a closer look at each:

• Estrogen: This hormone is the one that’s primarily responsible for building your uterine lining. As menopause approaches, estrogen levels become unpredictable—sometimes dipping low (causing missed or lighter periods) and other times surging unexpectedly (leading to heavier bleeding). 
• Progesterone: After ovulation, progesterone stabilizes the uterine lining and prepares it for possible pregnancy. During perimenopause, you’ll ovulate less frequently, resulting in cycles with little to no progesterone. When progesterone is low but estrogen is present, the uterine lining can build up excessively, causing unpredictable or heavier periods. This imbalance explains why some people in perimenopause experience longer, heavier flows followed by lighter or skipped periods.

These hormonal fluctuations continue until estrogen and progesterone levels eventually drop low enough for menstruation to stop completely.

Genetic predisposition

Your family history can give you clues about how menopause will be for you. While every person’s experience is unique, your genetics may help predict how menstrual changes might begin and which symptoms you may experience. One study identified 290 genetic factors that influenced the age at which a person’s menstrual period stopped. Research in this area continues to evolve, but here’s what we know about genetic influences:

• Family timing patterns: If your female relatives experienced early menopause or had specific patterns of irregular cycles, you’re likely to follow a similar timeline. One study found that genetics explains about 85% of the difference in when non-twin sisters go through menopause. 
• BRCA1 mutations: BRCA1 gene mutations are changes in the BRCA1 gene that can increase the risk of certain cancers, especially breast and ovarian cancer. Those carrying BRCA1 gene mutations may experience period changes or reach menopause earlier than those without the mutation. This occurs because BRCA1 plays a role in DNA repair within ovarian follicles, and mutations can accelerate ovarian aging. Studies have shown that those with BRCA1 gene mutations had a median age of 50 at the time of menopause versus 53 for those without these genetic mutations.
• Ovarian aging genes: Studies suggest that genes that regulate follicle development, hormone response, and cellular aging also play a role in ovarian aging. Some genes help eggs mature properly, while others regulate hormone levels like estrogen and progesterone, both of which play a key role in reproduction and menopause. When these genes don’t function well, it can lead to earlier menopause, hormone imbalances, or a faster decline in fertility. This explains why some people experience menopause earlier or have more intense symptoms like hot flashes and bone loss, while others go through it later or with milder effects.

Underlying health conditions

It’s not just age, hormones, and genes that affect when menopause arrives—certain health conditions can bring on menstrual cycle changes earlier than expected. Here’s what might be happening behind the scenes:

• Autoimmune disorders: If you’re dealing with conditions like rheumatoid arthritis, thyroiditis, or lupus, they might be affecting your ovarian function and hormone production, potentially leading to menopause showing up ahead of schedule.
• Polycystic ovary syndrome (PCOS): While PCOS itself doesn’t cause early menopause, it can make your cycles so unpredictable that it’s hard to tell when the transition to menopause is actually happening.
• Thyroid disorders: Thyroid disorders are associated with changes in the menstrual cycle and may increase the risk of early menopause due to ovarian dysfunction. An overactive or underactive thyroid could also mimic menopause symptoms, so you might not know which is causing cycle changes, hot flashes, or mood changes.

Lifestyle factors

The choices you make every day might influence your period and how you experience it. These include the following lifestyle factors:

• Chronic stress: We all deal with stress, but when it becomes a constant companion, it can throw your hormones out of whack. Studies have shown that high levels of stress are associated with a high probability of menstrual cycle irregularity. 
• Weight fluctuations: Your weight plays a surprising role in all this. If you’ve experienced major weight loss or an increase in weight, your estrogen levels might be affected. Fat tissue produces estrogen, but excess body fat can disrupt your cycle in other ways, too—by increasing estrogen levels and by causing metabolic changes like insulin resistance, which may interfere with normal ovulation. On the flip side, being very lean is associated with hypothalamic dysfunction, where the brain reduces the production of hormones needed to trigger menstruation. Both situations can cause irregular periods, though it’s not clear whether they affect the timing of menopause.

How menopause menstrual cycle changes affect daily life

Menstrual cycle changes that lead up to menopause aren’t just an inconvenience; they can impact your daily routine, mood, and overall well-being. Not only can the pain and discomfort affect your ability to function during day-to-day tasks, but the uncertainty that can come with prolonged or irregular cycles can also take a mental toll. Let’s take a look at some of these impacts: 

• Irregular periods: If your periods are very unpredictable, you may find yourself concerned about when the next one will show up. Studies have shown that irregular periods are associated with poor sleep, depression, and other psychological health problems.
• Prolonged or heavier periods (sometimes referred to as heavy menstrual bleeding (HMB) or menorrhagia): These could interfere with your daily life. One study found that during perimenopause, people reported that the unpredictability and heavy bleeding had made their periods nearly debilitating.
• Painful periods: Erratic estrogen levels could lead to more pain and cramping during your period (also called dysmenorrhea). Depending on how severe the cramps are, it may affect your daily life. A survey found that 38% of women said menstrual symptoms, like painful cramps, kept them from doing their usual daily activities. (The study included women aged 15 to 45, so while some may have been perimenopausal, the exact number wasn’t specified.)

If you feel that your menstrual cycle changes are keeping you from living your life well or doing the things you normally do, speak to your healthcare provider; there are treatments you can consider.

When to see a doctor about menstrual cycle changes

Menstrual cycle changes are one of the biggest clues that you are in perimenopause. The thing is, they don’t always follow a predictable pattern. Irregular periods, skipped cycles, or unexpected heavy bleeding can all be signs of impending menopause, but they can also be signs of other conditions like uterine fibroids, endometriosis, PCOS, and even certain cancers. Here’s when to call your doctor:

• Periods lasting more than seven days or happening more than every 21 days
• Noticeably heavier periods
• Bleeding in between periods
• Severe pain
• Unusual discharge.
• Any bleeding after menopause (12 months after your last period) needs to be addressed.
• Go to the ER for extremely heavy bleeding that soaks through a pad or tampon in under an hour.

How to deal with menopause menstrual cycle changes

Perimenopause can bring all kinds of surprises when it comes to your period, like heavier bleeding, irregular cycles, and even more intense cramps. But there are strategies you can use to manage these changes. Tracking your cycle, keeping extra period supplies on hand, and managing discomfort with medication, heating pads, and gentle movement can go a long way in easing symptoms when cramps hit harder than usual. Here are some practical strategies you can use:

Track your cycle and symptoms

Keeping track of your periods can help you and your doctor make sense of what’s happening. Logging flow changes, symptoms like cramps and bloating, and mood shifts can help you recognize patterns and prepare for the unexpected. If your cycles become erratic or you notice unusual symptoms, having a record can also be helpful for your doctor.

If you want an easy way to do this, find a menstrual cycle tracking app. It can help you understand how your cycle affects your energy, cravings, and overall well-being, so you can make choices that work with your body, not against it.

Be prepared for heavy or irregular bleeding

When your period becomes unpredictable, it can catch you off guard. To stay prepared:

• Keep extra pads, tampons, or period underwear on hand in case your flow is heavier than usual.
• If heavy bleeding starts interfering with daily life, talk to your doctor about medications like tranexamic acid or hormonal options that can help regulate your cycle.

Ease cramps and discomfort

Some women notice that perimenopause makes cramps worse. If you’re dealing with more pain than usual, try:

• Using a heating pad to relax muscles and ease cramps.
• Taking an over-the-counter pain reliever when needed.
• Doing gentle stretches or yoga to reduce tension and improve circulation in the pelvic area.

Can hormone replacement therapy (HRT) help?

HRT is one of the most effective treatments for managing several common symptoms of the menopause transition, like hot flashes, night sweats, and mood changes. It works by replenishing estrogen and progesterone levels, which naturally decline during perimenopause and menopause.  That said, HRT isn’t used to manage menstrual irregularities during perimenopause.

Tailoring HRT around an active menstrual cycle can be complex. When your body is producing fluctuating hormone levels, standard HRT doses often aren’t strong enough to override that activity or fully regulate bleeding patterns. In many cases, contraceptive-level hormone therapy is more effective for addressing irregular bleeding or severe menstrual symptoms during perimenopause.

What’s the difference between contraceptives and HRT?

Contraceptives and HRT both contain hormones, but they’re used for different reasons. Birth control pills have higher doses of estrogen and progestin to prevent pregnancy and regulate periods for certain conditions. HRT has lower doses designed to ease menopause symptoms like hot flashes, night sweats, and genitourinary symptoms like vaginal dryness. Birth control is for preventing ovulation and pregnancy, but it’s also commonly prescribed to help regulate irregular cycles.

Is it safe to use HRT while having menstrual cycle changes?

HRT is generally safe and effective for most healthy people during perimenopause and after menopause when used appropriately, but like any treatment, it comes with some risks. Studies have shown that short-term HRT use (typically less than five years) is safe and can provide significant relief from menopause symptoms within 10 years of menopause and for people less than 60 

Long-term use of combined HRT (estrogen and progesterone) has been linked to a slight increase in the risk of blood clots, stroke, and certain types of breast cancer. However, estrogen-only HRT hasn’t shown this increase and may even reduce breast cancer risk. (Though people with a uterus will need to use combined HRT to protect the uterine lining.) Newer forms of HRT—especially transdermal options like patches or gels—appear to carry a lower risk of blood clots. 

A lot of fear around HRT comes from a study by the Women’s Health Initiative in 2002 that initially suggested high risks for conditions like breast cancer. Later analysis showed that the risks were overstated, especially for younger people. Today, experts agree that HRT is a good option, particularly for healthy people under 60 and within 10 years of menopause. As long as there’s no medical reason to avoid hormone therapy, the benefits tend to outweigh the risks.

There are a lot of misconceptions about HRT, from outdated safety concerns to myths about who can use it. To separate fact from fiction, check out this guide. If menopause symptoms are interfering with your quality of life, talk to a healthcare provider about whether HRT is right for you. There’s no single “right” way to navigate menopause—only what works best for you.

Another hormonal treatment that might help

A hormonal IUD, like Mirena, is one of the most effective treatments for heavy or irregular bleeding during perimenopause. It’s a small, T-shaped device that sits inside the uterus and slowly releases a low dose of progestin (a hormone called levonorgestrel). This helps thin the uterine lining, which can make periods much lighter or stop them altogether. Some people experience mild side effects like spotting, cramping, sore breasts, or mood changes, especially in the first few months after it’s placed.

Lifestyle changes that might help ease perimenopause menstrual cycle changes

Period changes are one of the most universal experiences leading up to menopause. While HRT and other medical treatments are going to give you the quickest and most effective relief, lifestyle changes can help, too. Increasing exercise and eating a nutrient-dense diet might help balance hormones, reduce symptoms, and support your overall well-being. Bonus: It can help other symptoms of menopause, too! Here’s what to do:

• Fuel your body: A nutrient-rich diet can help stabilize hormones and reduce inflammation. Focus on fruits, vegetables, whole grains, healthy fats, and lean proteins to keep your body functioning optimally. Studies suggest that people who follow a Mediterranean-style diet often experience fewer menopause symptoms. Another study also showed that those with menstrual irregularities tended to have a lower intake of protein and certain vitamins. To make sure you’re getting the proper nutrition to support this transition, check out Noom’s guide on how to create a balanced perimenopause diet.
• Stay active: Exercise is one of the best natural ways to regulate hormones and boost your mood. Aim for at least 150 minutes of moderate activity per week—this can be as simple as a brisk walk, yoga, or a fun dance session in your kitchen. Regular movement may also help reduce hot flashes and improve sleep quality.
• Maintain a healthy weight: Extra weight could increase your risk for heavy or irregular periods, as well as worsen other perimenopause symptoms like hot flashes and night sweats. According to studies, regular exercise and maintaining a healthy BMI are recommended for people with heavy menstrual bleeding. Research suggests that losing as little as 10% of body weight can help ease these symptoms. Complicating all of this is the fact that metabolism slows during menopause, increasing the likelihood of weight gain. 
• Talk to your doctor about supplements: Some essential nutrients become even more important during menopause. Talk to your doctor before adding supplements to your routine to make sure they’re right for you.
  • Heavier periods can mean you’re losing more blood and may be at risk for iron deficiency anemia. If this is the case, you may need to take an iron supplement. Vitamin C might also be recommended to help you absorb more iron.
  • If you’re experiencing menstrual cramps more often or intensely, vitamin E, magnesium, or zinc may help with the pain. 

Making these small, sustainable changes can help you feel your best throughout the menopause transition. While every woman’s experience is different, a proactive approach can go a long way in managing symptoms and maintaining overall well-being.

How can stress & sleep management help?

Hormonal changes can amplify stress levels and disrupt sleep, but a few small habits can help keep things in check. Studies have shown that high levels of perceived stress have been associated with irregular menstruation among premenopausal women. Chronic stress can also make menopause symptoms feel even worse, according to studies. Find stress-relief techniques that work for you—whether it’s deep breathing, meditation, or simply taking time to unwind. Even short, mindful moments throughout the day can make a difference.

• Find your calm: Chronic stress can worsen menopause symptoms, from mood swings to weight gain. Try deep breathing, meditation, or yoga to keep stress levels in check. Even a few minutes a day can make a difference. One study showed that mind-body practices like yoga had a positive impact on symptoms—like fatigue, anxiety, and poor sleep quality—which often come with menstrual cycle changes during the menopause transition. 
• Prioritize quality sleep: Menopause can make it harder to get a good night’s rest. In fact, studies have shown that perimenopausal women experience more sleep disturbances due to the hormonal shifts that come with menstrual cycle changes. Blackout curtains, breathable bedding, and keeping the room around 65°F (18°C) can help create an ideal sleep environment. Also, try to go to bed and wake up at the same time every day. Avoid screens before bedtime, and swap late-night scrolling for a calming bedtime routine, like reading or gentle stretching. 

The right mix of nutrition, stress relief, and sleep adjustments can help ease menopause symptoms and improve overall well-being. What works for one person may not work for another, so be patient with yourself and experiment to find what helps you feel your best. Even small, consistent changes can lead to big improvements in how you feel each day.

Can herbal and alternative therapies help?

Many people turn to herbal supplements and alternative therapies for relief, but research on their effectiveness is mixed. Some show promise, while others lack strong scientific support. Let’s take a look at some of the more popular choices:

• Blue cohosh: The root of this herb, usually taken as a tincture by mouth, is thought to help regulate menstrual flow. Studies have shown that it can act as a uterine tonic that regulates your period and the amount of flow. More research is needed to confirm its effectiveness. It’s important to note that blue cohosh can have significant side effects, including potential risks during pregnancy.  Therefore, it should be used with caution and under the guidance of a healthcare professional.
• Black cohosh: Black cohosh is available as a capsule, liquid tincture, or tea, and some people use it for hot flashes and other menopause symptoms, but studies show conflicting results on its effectiveness for irregular bleeding. If you’re experiencing menstrual irregularities, check in with your doctor first to rule out other causes and find the right treatment.

Dos and don’ts for natural menopause remedies

If you’re exploring natural remedies to manage menopause symptoms, it’s important to go in with the right expectations—and a little caution. Here are some key dos and dont’s:

• Do talk to a healthcare provider before trying any new supplement, as some may interfere with medications.
• Do choose supplements, if recommended by your doctor, from well-known companies that have their products checked by independent organizations. Look for labels that mention ‘third-party tested’ or certification symbols from groups like USP, NSF, or ConsumerLab. These independent checks help ensure what’s on the label is actually in the bottle and that the supplements don’t contain harmful ingredients.
• Don’t expect herbal supplements to work like prescription treatments—many have inconsistent results.
• Don’t assume that “natural” means safe. Some herbs may have side effects or interact with medications.
  

While some natural remedies may provide relief, not all have strong scientific backing. Combining evidence-based treatments with lifestyle adjustments is the best way to navigate menopause with confidence.

Managing menopause-related menstrual changes 

Menopause brings a host of cycle changes, but with the right approach, you can stay in control and feel your best. From adjusting your diet and staying active to exploring HRT and other treatments, small changes can make a big difference. Finding the right strategies can help you navigate this transition with confidence.

At Noom, we know menopause is a major life transition that affects both your physical and emotional well-being. Our personalized, science-backed approach helps you build sustainable habits, whether that means balancing your meals, managing stress, improving sleep, or considering hormone therapy.