Irregular Bleeding and Heavy Periods During Perimenopause

As women enter their 40s and 50s, the body begins to transition into perimenopause. One of the most noticeable perimenopausal symptoms is the alteration in menstrual cycles. For many women, this means experiencing irregular periods and, often, heavy menstrual bleeding. If you're experiencing new or worsening PMS symptoms, like heavy periods with clots after 40, this article is for you. Understanding the signs, causes, and management of heavy periods during perimenopause is crucial for maintaining overall well-being during this transition.

GP and menopause specialist Dr. Hannah Ward often sees rampant PMS symptoms, including menstrual cycle changes, among her perimenopausal patients. "I always say to my patients that it's like going through puberty in reverse. Those mood swings and hormone fluctuations that happened at that stage can return during perimenopause, and that can exacerbate PMS"(1).

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Signs of Heavy and Irregular Bleeding

What Is Considered Heavy Menstrual Bleeding?

Heavy menstrual bleeding, medically known as menorrhagia, refers to unusually heavy or prolonged bleeding. You may notice that:

• You need to change your pad or tampon more often than every 1–2 hours.
• Your period lasts longer than seven days.
• You pass large blood clots.

Common Symptoms of Abnormal Bleeding

In addition to heavier periods, irregular bleeding is common during perimenopause. You might experience:

• Bleeding between periods.
• Missed periods, followed by unusually heavy ones.
• Spotting or light bleeding outside of your usual cycle.
• Menstrual cramps accompanying or preceding bleeding.
• Painful periods.

These signs can vary from woman to woman, but they often indicate that your body is adjusting to fluctuating hormone levels.

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Causes of Abnormal Bleeding in Perimenopause

Fluctuating Hormones

During perimenopause, your body’s levels of estrogen and progesterone begin to fluctuate. These hormones play a critical role in regulating the menstrual cycle. As hormone levels fluctuate, the lining of the uterus (endometrium) can thicken excessively, leading to heavy menstrual bleeding. Fluctuating estrogen can cause unpredictable bleeding patterns, a hallmark of perimenopause.

Endometrial Thickening and Womb Lining Issues

The thickening of the uterine lining can also cause irregular bleeding. Without enough progesterone to balance estrogen, the womb lining can build up excessively. When the lining finally sheds, the result is often heavier bleeding(2).

Other Risk Factors: Stress, Age, and Medical Conditions

Increased stress levels, certain medications, and underlying conditions like fibroids, polyps, or thyroid issues can exacerbate heavy perimenopausal bleeding(3). It’s important to be mindful of how lifestyle and health changes can influence menstrual patterns during this phase.

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03

How to Manage Heavy Menstrual Bleeding

At-Home Diet and Lifestyle Adjustments

For some women, lifestyle changes can help manage perimenopause heavy periods. "While a balanced diet won't 'cure' moderate to severe PMS, it can certainly help symptoms." says Dr. Ward(1). Consider the following:

• Exercise regularly: Physical activity can help regulate hormones(4).
• Stay hydrated: Drink plenty of water to help reduce bloating and discomfort(5).
• Eat iron-rich foods: Heavy bleeding can lead to anemia, so boosting your iron intake with foods like spinach, lentils, and lean meats is key(6).

Medical Treatment Options: Hormone Replacement Therapy and Endometrial Ablation

If lifestyle changes aren’t enough, there are several medical treatments available for perimenopausal women:

• Hormone Replacement Therapy (HRT): Hormone therapy can help balance your hormones to alleviate symptoms and reduce heavy bleeding, but it’s not the right choice for everyone. HRT is highly effective for some women, but it’s essential to weigh the benefits and risks with a healthcare provider.
• Endometrial ablation: This procedure removes or destroys the uterine lining, offering a long-term solution for women experiencing severe heavy bleeding(7).

Non-Hormonal Options: Supplements, Birth Control, and Other Treatments

If you prefer to avoid hormones, there are non-hormonal options such as:

• Birth control pills: These can help regulate periods and lighten heavy bleeding(8).
• Natural remedies: Herbal remedies like Chasteberry, a key ingredient in Meno Essential +, can support women in managing symptoms naturally.

Track Your Periods to Spot Changes

"If you think that you might be experiencing PMS, start tracking your cycle and identify and common symptoms" says Dr. Ward. By logging symptoms and changes in your flow, you can identify patterns and share detailed data with your doctor.

Apps like Clue or Flo offer useful insights into bleeding patterns, making it easier to manage and address heavy or irregular periods early. "When you are aware of issues, you can consider what you can do about tackling them" says Dr. Ward.

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When to See a Doctor for A Heavy Menstrual Period

While heavy menstrual flow is often a normal part of perimenopause, it’s important to consult a healthcare provider if:

• You are experiencing extremely heavy bleeding that interferes with daily life.
• You experience symptoms of anemia (such as fatigue or shortness of breath)(8).
• You notice prolonged bleeding that lasts longer than 10 days(3).

Dr. Ward suggests that you "track your symptoms and your periods and bring that information along to your appointment. Think about the symptom(s) that affect you the most and be sure to mention those"(1). In addition to tracking your periods, note any other potential menopause symptoms like hot flushes, vaginal dryness, etc.

A doctor may ask for your medical history and recommend further tests, such as an endometrial biopsy or ultrasound, to rule out serious conditions like endometrial cancer and check your endometrial thickness(7). Regular check-ups can help you stay on top of your health during this transitional phase.

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Final Thoughts on Heavy Periods and Irregular Bleeding in Perimenopause

Navigating a heavy period and irregular bleeding can be challenging, but there are effective ways to manage symptoms and improve your quality of life. From at-home remedies to medical treatments, finding the right approach depends on your individual needs. Always speak to a healthcare provider to explore your options and ensure you get the right support as you transition through perimenopause.