I was working in a coffee shop close to my house when I suddenly felt a warm, wet feeling down below. I knew immediately what had happened. The problem? In order to deal with it, I’d have to get up and walk across the busy cafe to the nearest loo.

This wasn’t the first time my period had leaked and soaked through my trousers, but it had never happened in public before. However, it’s become increasingly common since I entered my 40s. I knew that hormonal levels tended to shift as we hurtle towards perimenopause, but I wasn’t prepared for the very real physical and mental changes the journey would involve.

While 40 might not be significant for every woman, health expert Dr Shirin Lakhani says that for most of us, perimenopause can start any time between 40 and 45. Changes around this time tend to be down to hormone fluctuations. “Your oestrogen and progesterone levels drop, meaning that you can experience irregular periods that could be longer or shorter, heavier or lighter, as well as spotting between periods and changes in PMS symptoms,” she explains. 

GP and menopause specialist Dr Louise Newson says that new or more severe PMS symptoms can include “low mood, irritability, fatigue, headaches, muscle pains, urinary symptoms, memory problems, palpitations and anxiety”.

As ever, every woman’s experience will be different at this stage (my periods have become heavier, but others might start to have lighter bleeds), but however your period changes, that change can last for years, says GP and menopause specialist Dr Charlotte Iveson. It’s during this transition that some women consider starting hormone replacement therapy (HRT). “This can be very helpful for both the mental and physical symptoms of the perimenopause and menopause. You don’t need to wait for your periods to stop to start [HRT],” she says. Dr Newson also suggests exercising regularly and cutting down on processed foods, alcohol and caffeinated drinks, as this can all help with PMS symptoms.

After years of heavy periods or cumbersome cramps, Dr Iveson says that perimenopause can sometimes come as a sort of relief. She also flags that it needn’t be a negative sign of ageing: “In fact, in other cultures, menopause is thought of as the second spring – a new lease of life. You may have teenage children leaving home for university, so there may be more time for self-care and to start up new hobbies.”

To find out more about the way in which our periods can change as we enter our fifth decade, we spoke to several women who are going through – or have already gone through – that transition phase.  

“I feel more in tune with my body and less controlled by my periods”

Helen, 42

“I’ve historically had very heavy, painful periods, but since entering perimenopause, everything has felt so much better. I now have two-day bleeds that are much more manageable, which is something I put down to using castor oil packs, tracking my cycle (I try to cycle-sync my workouts) and taking good supplements to support hormonal health. I feel more in tune with my body and less controlled by my periods. It’s amazing.”

“I felt sad when a scan showed I didn’t have many follicles left”

Katie, 41

“My flow became lighter after I turned 40, which was unnerving. I started tracking to check that I was still regular (I am) but I’m now preoccupied by wondering when things will really change. I had a scan to find out why it felt like I was getting frequent UTIs and was told that I had a ‘quiet’ left ovary that didn’t have many follicles (small sacs that contain immature eggs) left. That made me feel a bit sad. This just feels like the start of a bigger change, which is daunting.”

“I feel positive about what comes next”

Dara, 46

“Since entering my 40s, positive changes for me have included a greater awareness of what my body needs and not being afraid to ask for help. There is power in entering your middle years and I feel positive about what comes next for me. I work as a women’s tailor, and I see many of my clients struggle with their changing bodies during this phase of life. Going through the same period has helped me to relate to them even better.  

“Period underwear has been an absolute lifesaver”

Carla, 44

“Using period underwear in my 40s has been an absolute game changer. Periods can become really irregular and, as a result, they sometimes take you by surprise. My period can now be really heavy, and instead of remembering to buy disposable products, it has been far more convenient to have a selection of different flow Wuka pants in my underwear drawer (as well as a pair in my bag for work) to alleviate any surprise bleeding as I manage the ups and downs of perimenopause. I have found that super-heavy flow underwear is an absolute lifesaver on my very heavy days. Heading into perimenopause is a lot to deal with, and being able to manage my erratic periods in comfort has been really positive.”

“Improving my diet was life-changing for my period health post-40”

Harriet, 53

“My periods had always been irregular, especially after spending years on the pill. A few months after I turned 41, I started to get vicious PMT with oceanic waves of rage and anxiety. My children were six and three at the time, and they were visibly scared of me. I even had a PMT episode that lasted for seven weeks. When the Mirena coil made no difference, I told my GP that I was going to try a month without refined sugar, alcohol and coffee because I had heard they might help.

“I started these dietary changes on the first day of my next period. Within two weeks, my moods levelled out, my energy skyrocketed and so did my self-esteem. The following period came 28 days later. Since that life-changing experiment in 2012, I had clockwork periods until my last ever bleed. 

“Speaking to other women helped me feel less alone”

Karen, 42

“My mum was post-menopausal by her mid-40s, so going through perimenopause in my late 30s didn’t really come as a shock. My periods have always been very regular, but since starting this new phase in my life, they have become erratic, very unpredictable, heavy and uncomfortable – which can make life challenging. I’ve become more conscious of what I wear and the holidays I take. I’m lucky that I work from home and run my own business; I don’t know how I’d have managed my symptoms in an office. 

“Things were so bad at one point that I had to go for a scan to make sure it wasn’t something more sinister. It’s hard to find a positive, but I know that soon, I’ll be through menopause and done with it all. What has helped has been speaking to other women at online and in-person events and realising that I’m not alone.” 

“The coil has been a revelation”

Laura, 42

“I didn’t start my periods until I was almost 16, but once they started, I was lucky to always have very regular bleeds. I suffered with a bit of secondary infertility in my 30s but then did manage to conceive again. Everything was fine until my 40s, when my periods got ridiculously heavy and very sporadic. I even called 111 at one stage as I was having to change my tampon or Mooncup every 20 minutes. My cycles could be anything from 21 to 45 days, and they were totally unpredictable. Then, I got the coil and it calmed everything down. It hasn’t stopped the bleeding completely, but it’s much more manageable.”

“I kept thinking I was pregnant every time I missed a period”

Janine, 42

“My periods became so irregular that I could go two months without a bleed. For the first year, I kept thinking that each missed period meant that I was pregnant, and then just before the bleed started, I’d get a 24-hour migraine. Occasionally, I’d get night sweats and suffer from insomnia. When my period came, it’d be extremely heavy but only last for three or four days. The only thing that has helped is going on HRT, which has also been a game-changer for other symptoms of perimenopause like brain fog.”  

“I feel like I’m carrying a heavy weight”

Minreet, 44

“I get a lot of pain these days, and that pain can start halfway through my cycle. Bleeding can be very light one day and so heavy the next that I’ve leaked through my clothes. I’ve always had painful periods but it’s definitely got more severe as I’ve got older. I love running, but it feels like I’m carrying a heavy weight in the centre of my stomach… and I’m not sure if that feeling’s going to stay until menopause or not.”

Dr Jan Toledano, founder of the London Hormone Clinic, is keen to stress that very heavy bleeding, bleeding after sex or irregular bleeding that doesn’t go away always needs to be discussed with a medical professional. “These symptoms may be caused by a gynaecological issue such as fibroids or polyps or more rarely, endometrial or cervical cancer,” she explains.

Speak to your GP if you have any concerns about your menstrual cycle or perimenopause symptoms. 

Images: Getty