A hallmark of perimenopause is a change in menstrual cycles. Periods may become irregular in length, heavier, or lighter as hormones levels begin to decline and fluctuate during the menopause transition.

If you are still having a regular menstrual cycle, it's not uncommon to experience a change to your cycle upon starting an HRT treatment plan. Having a longer or shorter period or having an extra period or a missed period within the first month of starting HRT is usually not a cause for alarm. Spotting is also a common occurrence as the body adjusts to the influx of hormones.

However, if abnormal bleeding continues on a regular basis, it's recommended to have an in-person evaluation to rule out any underlying issues. The same general rule applies if you are postmenopausal and HRT triggers a period within the first month.

Abnormal bleeding should not continue past the first month, and any irregular bleeding should be reported to your Winona doctor.