divaaLonger, shorter, heavier, lighter-change is the name of the game now as you head into perimenopause, the six to 10 hormonally haywire years that precede the end of menstruation. You may find that your periods are coming every three weeks or, conversely, arriving further apart. Then, bingo, you’re suddenly back on schedule for a few cycles-until you go off-track again. Your PMS symptoms could intensify, with some cycles worse than others. Same with cramps; you may now experience pain that radiates into your back and down your thighs, likely due to estrogen levels spiking and plummeting while ovulation becomes intermittent.

As you get older, you’re more likely to develop one of the annoying but generally benign conditions that subside after menopause. Adenomyosis occurs when the uterine lining grows into the uterus’s muscular wall; while it’s harmless, it may cause very painful, prolonged, heavy periods. It’s different from endometriosis but the two may co-exist, and both improve after menopause when the condition may stop progressing, eliminating symptoms. Adenomyosis is especially common among women who have had C-sections. If over-the-counter pain relievers and heating pads don’t help, seek medical advice.

One in four perimenopausal women has flooding-a heavy, gushing flow that is sometimes accompanied by clots. It’s a medical problem only if you’re soaking more than one pad or tampon every hour for several hours and if clots are larger than a loonie.

While about half of all women under age 50 have fibroids-benign growths in the uterus that are most common in your 40s, fibroids rarely cause heavy flow. In a study of 91 women who had had hysterectomies because of heavy bleeding, only six showed any evidence that fibroids may have been a contributor.

Causes for concern: If your bleeding persists in being unusually heavy, if you have any new or increased pain, or if your PMS overwhelms you, get medical advice.