Before your periods stop completely, your body makes the transition to menopause in a phase called perimenopause, which could last 2 to 10 years. During this time, when hormone levels fluctuate and eventually drop, all kinds of changes in your cycle are fair game.

What You Can Expect

In your 40s — and maybe even in your late 30s — yo-yoing estrogen and progesterone can make periods unpredictable. They could come more frequently. Or they might happen less often. The flow might be very heavy or — preferably — very light. Sometimes, you’ll skip one or a few altogether. (But to be clear, it’s not menopause until you go 12 straight months without a period.) Other period symptoms, like cramps and crankiness, could become more intense. Or you may not get the telltale pain and moodiness that mean your period is on the way.

“Because it’s unpredictable, it can be very difficult for women because they don’t know exactly when it’s coming,” says JoAnn Pinkerton, MD, director of the Division of Midlife Health at the University of Virginia Health System in Charlottesville.

What You Can Do

A healthy lifestyle can help ease the transition into menopause. “Women who are able to maintain a regular exercise routine, eat healthy, and manage their stress — because stress can make perimenopausal symptoms worse — may find that the perimenopausal transition is a bit easier for them,” says Pinkerton.

Medical treatment could also ease your symptoms. Birth control pills or a long-acting intrauterine device can help relieve heavy bleeding and intense cramps and, sometimes, eliminate periods completely. A surgical procedure called endometrial ablation, which destroys the lining of the uterus, reduces or stops bleeding.

If heavy bleeding, cramps, or menstrual irregularity hurt your quality of life, talk to your doctor.

Ask Your Doctor

Menstrual irregularity in your 40s shouldn’t raise the same concerns it would in your 20s or 30s. Still, talk to your doctor if any of these are true.