Symptoms
Periods changing in your 40s
A change in your cycle is usually the first sign of perimenopause — and it is the single most reliable way to tell which stage you're in. Two markers do most of the work: a persistent difference of 7 or more days in the length of consecutive cycles marks early perimenopause, and going 60 or more days without a period at least once marks late perimenopause. Variability itself is expected. What is never simply "just perimenopause" is very heavy bleeding, bleeding between periods, or bleeding after sex — those need a doctor.
Last verified: 10 July 2026 · cycle markers checked against STRAW+10 and NICE NG23 · re-verified quarterly
Are changing periods a sign of perimenopause?
Yes — and it's the clearest one. Long before hot flushes, most women notice their cycle stops behaving the way it used to: shorter one month, longer the next, heavier, lighter, or just less predictable. That shift is your ovaries' hormone output becoming irregular, and it is the change clinicians use to stage the transition. Symptoms like sleep, mood and energy can be blamed on a hundred things; the cycle is the one signal that's harder to argue with.
How do I read the change — which stage am I in?
The STRAW+10 staging system, which underpins UK NICE guidance, turns "my periods are all over the place" into two clean thresholds:
| What you notice | What it usually means |
|---|---|
| Cycles still regular, no real change | Premenopause — the baseline before the transition |
| Persistent ≥ 7-day difference in length between consecutive cycles (e.g. 26 days, then 35) | Early perimenopause — the cardinal early marker |
| You've gone ≥ 60 days without a period at least once | Late perimenopause — skipped cycles; symptom load usually peaks here |
| 12 full months with no period at all | You've reached your final menstrual period — known only in hindsight |
One irregular month isn't a diagnosis. The word that matters is persistent — a pattern of change over several cycles, not a single odd one. Tracking your dates for a few months is the most useful thing you can bring to a consultation.
How much change is normal in your 40s?
A lot of variability is normal-for-transition. Cycles that shorten, lengthen, lighten or skip are the expected texture of perimenopause, and on their own they usually don't need investigating. Your body isn't malfunctioning; it's changing gears. Recognising that is the difference between months of quiet worry and simply knowing what's happening.
But "variability is normal" is not the same as "any bleeding is fine." There is a specific short list that is not assumed to be just perimenopause, and it's worth knowing by heart.
See a doctor about bleeding if
Any of these warrant a review, even during perimenopause — they are often benign, but they are not automatically explained by the transition:
- Very heavy bleeding or flooding — soaking through pads or tampons, passing large clots, or bleeding that disrupts your day.
- Bleeding between periods.
- Bleeding after sex.
- Any bleeding after 12 full months with no period (postmenopausal bleeding) — this one is a firm rule: get it checked promptly, always.
Heavy bleeding can also quietly drain your iron, which then adds fatigue on top — another reason to raise it rather than tolerate it.
When should I see a doctor?
See a doctor for any of the bleeding patterns above, or simply if the changes are affecting your life and you want to understand them. In Malta, the first step is a health-centre GP (free for residents) or a private gynaecologist; there is no dedicated public menopause clinic, so menopause is handled inside general gynaecology via GP referral. Bring your tracked dates. Finding a menopause doctor in Malta walks through the public and private routes.
Your cycle tells you your stage. Let's read it.
The free quiz starts with exactly these two cycle questions and places you in one of the 7 stages in about 10 minutes.
Take the free quiz →The Malta Menopause Kit turns your stage into a sequenced plan, a GP conversation script and a named-clinic directory — see the kit.
Sources
- STRAW+10 staging system (Harlow et al., 2012) — cycle-length change and 60-day amenorrhoea as the cardinal markers of early and late perimenopause.
- NICE NG23: Menopause — identification and management (UK); cycle-based staging and red-flag bleeding — nice.org.uk/guidance/ng23.
- Gynae Outpatients & Ante-Natal Clinic, Mater Dei Hospital — public gynaecology entry via GP referral, Msida — materdeihospital.gov.mt.
- Well Woman Clinics, Primary Health Care Malta — first public women's-health touch-point — primaryhealthcare.gov.mt.