Now the fun really begins.
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 close to four decades. Call it what you will — a curse, a burden, a crimson ode to your femininity — but you’ll probably be dealing with it until around age 52, which is the average age for American women to reach menopause.
Despite its inevitability, you will experience some changes in your menstrual cycle throughout the decades, especially since your period is directly tied to your hormones. And when you turn 40? That’s when your body really starts to shake things up. Whether you're approaching the big 4-0 or want to know what can happen to your flow when you do, here's what ob-gyns say to expect.
Your periods could become less frequent
Before you reach menopause, your body goes through perimenopause, a transition time between normal periods and full menopause (defined as 12 straight months without a period), which can last one to five years, says Rebecca Dunsmoor-Su, MD, an ob-gyn in Seattle. “Perimenopause is a time that’s characterized by irregular menses, which are usually more spaced out.” As your hormones start to fluctuate, “it can lead to scanter, lighter periods,” adds Adeeti Gupta, 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,” says 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 a full 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 women might actually experience more periods post-40. In some cases, “estrogen and progesterone surges during the menstrual cycle become shorter and higher,” says 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,” says 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 an 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 at 40 can do a number on 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,” says Dr. Dunsmoor-Su. “Some women get very depressed as the hormonal fluctuations become more significant.”If you find yourself becoming significantly depressed, don’t be afraid to reach out to your doctor. “Anti-depressants are very helpful in this kind of depression, and if left untreated, it can become very severe during the menopausal transition,” she says.
Your cramps could become more painful
Well this sucks: Even though your periods might come less frequently or might be lighter than before, you’ll still experience those gut-churning cramps—and they might actually be worse. “Cramps can get worse in the beginning of perimenopause due to the closer and stronger surges of estrogen and progesterone,” says 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, she says.You might start breaking out before your period
Once you hit 40, “it’s like going through puberty again,” says Dr. Gupta, who warns women that they might start breaking out again, just like in high school. "I call it the second wind of the dying female hormonal machine,” she adds. Women also start to get hot flashes and night sweats during perimenopause, but these symptoms tend to come and go as hormones fluctuate, says 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 absolutely get pregnant in this decade, says Dr. Dunsmoor-Su. “There is an ovulation (egg release) 14 days before each period as long as you have your period,” she explains. “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.” If you don’t want to get pregnant in your forties, you should still be using birth control.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,” suggests Dr. Dunsmoor-Su. Otherwise, just enjoy the fun.
