Regular Ovulatory Cycles Before Perimenopause
A short placeholder overview of normal ovulatory cycling.
- 21–35d: Typical cycle length (Placeholder reference range)
- ~14d: Luteal phase length (Placeholder consistency)
- ~95%: Ovulation rate (Placeholder cycles ovulatory)
- <7d: Cycle-to-cycle variance (Placeholder variability)
Hormonal rhythm baseline
Placeholder: FSH, LH, estrogen, progesterone cycle predictably.
Follicular reserve context
Placeholder: ovarian reserve still supports regular ovulation.
First Anovulatory Cycles Appear
A short placeholder overview of emerging anovulatory cycles.
- ~20%: Anovulatory cycle rate (Placeholder early perimenopause)
- Rising: FSH trend (Placeholder hormone shift)
- Falling: AMH trend (Placeholder reserve marker)
- ~40–45: Typical onset age (Placeholder age range)
Follicle response decline
Placeholder: fewer follicles respond fully each cycle.
Progesterone deficiency
Placeholder: skipped ovulation means no luteal progesterone.
Widening Cycle-To-Cycle Variability
A short placeholder overview of increasing cycle variability.
- >7d: Cycle variance (Placeholder diagnostic threshold)
- Late peri: STRAW +10 stage (Placeholder staging marker)
- Rising: Skipped cycle frequency (Placeholder trend)
- Common: Symptom overlap (Placeholder vasomotor symptoms)
STRAW +10 staging criteria
Placeholder: variability of 7+ days defines late transition.
Tracking cycle variability
Placeholder: menstrual diaries help quantify true variability.
Heavy Bleeding and Skipped Cycles
A short placeholder overview of bleeding pattern shifts.
- ~30%: Heavy bleeding prevalence (Placeholder perimenopausal women)
- >60d: Skipped cycle threshold (Placeholder amenorrhea flag)
- Elevated: Iron deficiency risk (Placeholder with heavy flow)
- Possible: Endometrial thickening risk (Placeholder unopposed estrogen)
Unopposed estrogen effect
Placeholder: anovulation leaves estrogen unopposed by progesterone.
Bleeding severity spectrum
Placeholder: flow ranges from light spotting to menorrhagia.
When Irregular Bleeding Needs Evaluation
A short placeholder overview of red-flag evaluation criteria.
- Evaluate: Bleeding >7 days (Placeholder red flag)
- Evaluate: Post-coital bleeding (Placeholder red flag)
- Evaluate: Bleeding after 12mo gap (Placeholder postmenopausal rule)
- Evaluate: Soaking pad hourly (Placeholder acute flag)
Red flag bleeding patterns
Placeholder: certain patterns need prompt gynecologic workup.
Ruling out pathology
Placeholder: ultrasound and biopsy exclude structural causes.
Reassurance vs referral
Placeholder: most irregularity is benign perimenopausal transition.
Placeholder: seek care for unusually heavy or prolonged bleeding.