A yellow sign reads, "Menopause Ahead."
Learn what signs to look out for, and when it’s time to see a doctor. (For Spectrum Health Beat)

The menopausal transition is similar to puberty—your body goes through an array of hormonal changes you don’t fully understand.

Your menstrual cycle becomes completely unpredictable.

Or worse, it comes with a vengeance.

While it often seems society does a great job of talking about puberty, it sometimes feels like everyone gets quiet when it comes to talk about signs and symptoms of menopause.

As an obstetrician/gynecologist, I’d estimate 40% of my patients see me for some sort of abnormal menstrual bleeding pattern.

For women who face irregular bleeding, it can completely disrupt their world.

Many women have predictable monthly cycles for the better part of their lives.

During the peri-menopausal timeframe, however—those years leading up to their final menstrual cycle—women commonly experience a significant change in their cycles.

The bleeding can become highly erratic, alternating between light and heavy or missing cycles completely.

This unpredictability is frustrating.

It causes women to tote around large bags with extra clothes and tons of supplies, just in case.

These changes may be the result of natural hormonal shifts, with the ovaries beginning a decline in function.

But there are also other possible causes of abnormal uterine bleeding. Anatomical changes such as polyps or fibroids can cause bleeding, as can infections, thyroid issues and precancerous and cancerous changes.

So how can you tell if it’s a normal process or cause for concern?

If your cycles last longer than seven days, or they come more frequently than every 24 days—measured from the start of one cycle to the start of the next—or if the bleeding is more than one heavy pad in an hour, it’s time to seek help.

If the bleeding leaves you severely fatigued, you should see seek help then, too.

If you haven’t had any bleeding for one year, congratulations! You have entered menopause—a wonderful, supply-free time.

If you have any further bleeding after menopause, this always needs further investigation, even if it’s just a little spotting.

Post-menopausal bleeding could indicate cancer or other hormonal, structural or precancerous changes.

Your provider may conduct blood tests, order an ultrasound or get a biopsy to help evaluate your condition.

The good news: You’re not alone.

There are many, many options to help you gain insight during this complex transition.

With help from the Spectrum Health Midlife, Menopause, and Sexual Health Clinic, you can expertly navigate these changes and take charge of your body and life.