8 Changes in Your Menstrual Cycle After 40

How period frequency, flow, and PMS can change as hormones shift.

Perhaps from the very first day you got your period, you've been able to count on it coming back month after month (except during pregnancy) for nearly four decades. You'll probably be dealing with it until you reach menopause, which happens around age 52 on average, according to the Office on Women's Health.

Despite its inevitability, you will experience changes in your menstrual cycle throughout the decades, especially since your period is directly tied to your hormones. And after you turn 40? That's when your body starts to shake things up. Whether you're approaching 40 or want to know what can happen to your flow after you do, here's what ob-gyns said to expect.

Your Periods Could Become Less Frequent

Before you reach menopause, your body goes through perimenopause, a transition time before menopause (defined as 12 straight months without a period) that lasts about seven years on average, according to the National Institute on Aging. "Perimenopause is a time that's characterized by irregular menses, which are usually more spaced out," said Rebecca Dunsmoor-Su, MD, an ob-gyn in Seattle. As your hormones start to fluctuate, "it can lead to scanter, lighter periods," added Adeeti Gupta, MD, an ob-gyn and founder of Walk In GYN Care in New York City.

You Might Start Skipping It Here and There

Don't freak out (or start celebrating) if your period goes entirely MIA one month. "A skipped period is the first sign of deteriorating egg quality," said Dr. Dunsmoor-Su. "Some months, the eggs just don't reach a point where they release, and so a period gets missed." Remember: You're not in menopause until you go an entire year without a period, so skipping a month doesn't necessarily mean you can toss all your pads and tampons.

Your Periods Can Come Closer Together

Because there's no "normal" when it comes to your menstrual cycle, some individuals might experience more periods during perimenopause, according to the Office on Women's Health. In some cases, "estrogen and progesterone surges during the menstrual cycle become shorter and higher," said Dr. Gupta. "That means your periods could come closer together."

Your Flow Might Get Heavier

As your ovaries start their normal pre-menopause wind-down, your period schedule will get a little wonky. "Some months, the egg makes it to release on time, and everything's fine," said Dr. Dunsmoor-Su. "Some months, it's a bit behind, and your period will be late, and some months, it doesn't make it at all, and you skip a month or two. When you miss ovulation, the lining of the uterus continues to grow so that when you finally bleed, it tends to be heavier."

Your PMS Can Feel Even Worse

All those hormonal ups and downs that start after 40 can affect your mood and emotions before your period begins. "As the hormones fluctuate more dramatically, those women who have mood symptoms with their periods tend to see more fluctuations in those moods," said Dr. Dunsmoor-Su. "Some women get very depressed as the hormonal fluctuations become more significant."

If you are becoming significantly depressed, don't hesitate to reach out to your healthcare provider "Anti-depressants are very helpful in this kind of depression, and if left untreated, it can become very severe during the menopausal transition," Dr. Dunsmoor-Su said.

Your Cramps Could Become More Painful

Even though your periods might come less frequently or be lighter than before, you'll still likely experience those gut-churning cramps—and they might be worse. "Cramps can get worse in the beginning of perimenopause due to the closer and stronger surges of estrogen and progesterone," said Dr. Gupta. The good news, however, is that as you close in on menopause, your flow shows up less often and is lighter—hence, less cramps, Dr. Gupta said.

You Might Start Breaking Out Before Your Period

Once you hit 40, "it's like going through puberty again," said Dr. Gupta, who warns you might start breaking out again, just like in high school. You also begin to get hot flashes and night sweats during perimenopause, but these symptoms tend to come and go as hormones fluctuate, said Dr. Dunsmoor-Su.

You're Less Fertile, but You Can Still Get Pregnant

Your chances of getting pregnant decrease as you move through your 40s. But you can get pregnant in this decade, said Dr. Dunsmoor-Su. "There is an ovulation (egg release) 14 days before each period as long as you have your period," Dr. Dunsmoor-Su explained. "However, eggs at this time of life tend to be of poor quality with a lot of genetic 'mistakes,' and miscarriage rates are very high." You should still use birth control if you don't want to get pregnant in your forties.

Changes in your cycle over time are normal, but they could signal abnormalities, and sometimes it's hard to tell the difference. Don't immediately assume the worst if you experience one month of period weirdness. But "if you have significant sudden changes in your cycle, you should see an ob-gyn for evaluation for possible structural causes (like fibroids or polyps) or pre-cancer syndromes," suggested Dr. Dunsmoor-Su.

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