How Does Your Period Change as You Age? A Doctor Explains What’s Normal and What Needs Attention

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When you first start your menstrual period, it's often irregular. That also happens as women get into their 40s and 50s. In the years between, some women have periods that arrive like clockwork. For others, it's not as easy to predict. And if you use contraception, many forms contain hormones that may affect your period.

At times it's hard to know if changes in your period are something to be concerned about. Let's take a look at what's usual over the course of a woman's life. And some symptoms that are a good reason to check in with your primary care provider or gynecologist.

What is a usual menstrual period like at different times of life?

It's normal for your menstruation to change throughout the course of your life. Everyone is different, but below are the typical patterns associated with each decade.

The teen years

Most teen girls will have their first period between the ages of 10 and 16. The average age for a first period is between 12 and 13.

Menstrual cycles in adolescent girls usually happen every 21 to 45 days. And most periods last 7 days or less. But it's common for periods to be irregular. Especially in the first couple of years after your period starts.

Missing a period is common for adolescents, according to Dr. Jennifer Goedken, associate professor of gynecology and obstetrics at Emory University and chief of gynecology at Atlanta VA Medical Center. "It can take up to 2 years after a young woman's first cycle before her cycles become regular," she said.

20s and 30s

Periods often become more regular in your 20s and 30s. "This is the time of a woman's reproductive life when cycles are most predictable," Dr. Goedken said. The average time between periods is 28 days. But cycle lengths of 24 to 38 days can be normal. And menstrual bleeding usually lasts 2 to 7 days.

40s

Many women begin to notice changes in their period in their 40s. That's because perimenopause - the time before your period stops - can last from 4 to 8 years.

"It's common for women to notice their cycles getting closer together as menopause approaches," Dr. Goedken said. "And the length of bleeding often lessens by 2 to 3 days."

The average age for the start of early changes of perimenopause is 47. But some women notice them much earlier than that. Your periods might still be regular in your 40s. Or you might begin to miss cycles. Your period might also arrive earlier or later than you expect.

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What are your periods like during perimenopause?

Menopause is when you haven't had a period for 12 months or more. For most women, this happens between the ages of 40 and 58. The average age is 51.

The time before menopause is called perimenopause. Hormone levels tend to go up and down. So your periods may be shorter, longer, or more irregular. And blood flow might be heavier or lighter.

Some women experience heavier or longer menstrual periods during perimenopause. In one study of 1,320 women in midlife, 91% reported at least one period that lasted for more than 10 days. And 75% had three or more episodes.

Closer to menopause, you're more likely to start skipping periods. Sometimes for months in a row. This is also the part of perimenopause when you may start to experience symptoms like hot flashes.

Is vaginal spotting normal in older women?

For women who are in menopause, vaginal bleeding or spotting is not normal. "Even light spotting can be the first and possibly only sign of uterine cancer," Dr. Goedken said. She added that cancer or precancer is found in up to 15% of women with spotting after menopause.

Vaginal bleeding or spotting after menopause may be caused by:

• Endometrial/uterine cancer

• Endometrial hyperplasia (the lining of the uterus is too thick)

• Endometrial or vaginal atrophy (tissues that are thin from a lack of estrogen)

• Polyps

• A side effect of hormone replacement therapy

• A side effect of other medications

• Infections of the cervix or uterus

• Other types of cancer

Do period cramps get worse or better with age?

Period cramps and painful periods tend to be worse when women are younger. More women in their teens and 20s report having strong pain or cramps with their periods. In general, periods tend to be less painful with age. And symptoms may improve for some women after they have given birth.

If periods get more painful with age, or if you begin to have stronger cramps as you get older, talk with your healthcare professional. Health conditions that may cause painful periods as you get older include:

• Endometriosis

• Fibroids

• Having a copper intrauterine device (IUD), such as Paragard

• Sexually transmitted infections (STIs)

• Pelvic inflammatory disease (PID)

• Adenomyosis

Do other premenstrual symptoms change with age?

About 80% of women report having at least one premenstrual symptom in the week before her period, according to a large 2022 study. Some of these symptoms include:

• Food cravings

• Feeling tired or fatigued

• Bloating

• Bowel or digestion changes

• Breast tenderness

• Irritability or anxiety

• Mood changes

• Trouble concentrating

• Acne

• Cramps or belly pain

• Headaches

• Swelling

These symptoms may start in your teens or 20s. And they may get better or worse as you get older.

The same large study found that, on average, some premenstrual symptoms increase for women as they get closer to menopause. These may include:

• Feeling foggy or absentminded

• Lower sex drive

• Gastrointestinal changes

• Sleep trouble

• Weight gain

• Sweating or hot flashes

• Feeling tired

• Hair changes

• Swelling

"Many things can impact premenstrual symptoms," Dr. Goedken said. "It's not always easy to predict how premenstrual symptoms will change for each person over time."

How does birth control affect your period?

If your birth control contains hormones, there's a good chance it could affect your menstrual cycle.

"The majority of current contraceptive methods are hormonal," Dr. Goedken said. Many contraceptive pills, injections, implants, and IUDs contain hormones called progestins.

"Progestins thin the lining of the uterus," Dr. Goedken explained. That usually leads to lighter periods. But it could take 3 to 6 months to notice those changes. And there could be some irregular bleeding for the first few months after starting.

"With longer use, some hormonal contraceptives - especially Depo-Provera injections and progestin IUDs - result in the disappearance of a regular cycle," Dr. Goedken said. But there may also be some occasional and unpredictable spotting.

This is how nonhormonal contraception affects periods, according to Dr. Goedken:

• Barrier contraceptives (condoms, diaphragms, and sponges): There's no change in periods.

• Copper IUD: There's no change in cycles for most women. Some may have heavier periods or more cramping.

• Tubal ligation: There's no change to menstrual cycles for most women. But some may notice heavier periods or more cramping if they stopped their hormonal contraception at the time of the tubal ligation.

When should you see a healthcare professional for changes in your period?

Some changes in your period happen because of health conditions. Others are effects of contraceptives or other medications. Even stress can play a role in your period.

Talk with your healthcare professional about changes in your period. Especially anything that's new, persistent, or concerning. Experts in women's health make these recommendations for when to get help for period concerns:

Teens and younger women should get medical attention if their period:

• Has not started by the age of 15

• Has not started within 3 years of breast development

• Was regular, but now it's not

• Comes more often than every 21 days

• Comes less often than every 45 days

• Lasts more than 7 days

Teenagers should also see their primary care provider if they are 14 or older, don't have a period, and exercise a lot or try to stay very thin.

All women should get medical attention if they:

• Need to change a tampon or pad more than every 1-2 hours for heavy bleeding

• Need to wear more than one pad, or having to change pads or tampons at night

• Have a period that lasts more than 7 days

• Have a family history of problems with bleeding or blood clotting

• Feel faint, dizzy, or lightheaded

• Notice a significant change in the length, heaviness, or frequency of their period

• Have other physical or mental health symptoms that may be affecting their period

• Are unsure if they're pregnant

Women experiencing perimenopause should get medical help right away if they:

• Notice their periods are much heavier or last much longer than usual

• Soak through a pad or tampon every hour for several hours in a row

• Have clots that are as large as a quarter

• Are changing pads or tampons at night

• Feel dizzy, lightheaded, or faint

• Bleeding or spotting after sex

• Bleeding or spotting between periods

Women experiencing menopause should see their primary care provider or gynecologist for any vaginal bleeding or spotting.

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