Heavy periods during the perimenopause: what you need to know

Practical advice on managing heavy periods

The perimenopause is the time directly before the menopause, when you still have periods, but the fluctuating and low hormone levels – especially estrogen – can trigger a whole host of symptoms, including heavy periods.

Let’s take a closer look at the signs, causes and ways to manage heavy periods.

What are ‘heavy’ periods?

If you have heavy periods, medically known as menorrhagia, you will well know the disruption, distress and difficulties it can cause.

One in three women describe their periods as heavy, so if this is something you experience you are not alone.

It can affect every area of your life, including work, exercise, your social life and your sex life.

What is classed as a heavy period?

As it is difficult to measure the blood lost during your period, they are considered heavy if you need to change your pad or tampon every one to two hours, or empty your menstrual cup more often than is recommended.

If you regularly need to double up on sanitary products, such as using a pad and a tampon together, if your periods last more than seven days, or you bleed through clothes or bedding, this can also suggest heavy periods.

Other signs include passing blood clots larger than the size of a 10p coin, avoiding daily activities like exercise, or taking time off work due to your periods and feeling tired or short of breath.

Heavy periods don’t necessarily mean painful periods, but they can bring you pain and discomfort.

Why do I have heavy periods during the perimenopause?

Changes to your periods are often an early sign of the perimenopause.

Estrogen and progesterone, the hormones which regulate your menstrual cycle, are fairly predictable before perimenopause.

But in perimenopause, the fluctuation and decline in estrogen and progesterone means your cycle can become unpredictable and irregular.

This can lead to longer cycles, or shorter ones with more frequent periods, and can make your periods heavier or lighter.

Sometimes, and this often becomes more common during the perimenopause due to the changes in hormones which control your cycle, the ovaries may not release an egg (anovulation).

Normally the release of an egg triggers the production of progesterone, which controls the development of your womb lining. This doesn’t happen in anovulation, and can lead to heavier, longer and irregular periods.

I’m worried about my heavy periods. What should I do?

The most important thing is you shouldn’t put up with it. Make an appointment with your healthcare professional, as the cause needs to be looked into, and there are treatments to help.

Your healthcare professional will ask about your bleeding, whether you bleed between periods and whether your periods are painful or come with a feeling of pressure.

They are likely to examine you, and you could be referred for further tests to rule out other conditions.

This may include an ultrasound to look at your womb, biopsies to study a sample of the lining of your womb, a hysteroscope (where a thin telescope is passed through your cervix to check look at your womb) and internal swabs to check for infections.

What treatment options are available?

Your healthcare professionals may suggest the Mirena coil.

This is fitted into your womb by a doctor or nurse where it releases a type of synthetic progesterone. This can make periods lighter and shorter, and usually causes them to stop altogether. It is also a form of contraception for up to five years.

Other treatments include the drug tranexamic acid, which can reduce bleeding, and prescription-only anti-inflammatory painkillers, such as mefenamic acid or naproxen, which can also reduce heavy bleeding.

Then there are hormonal options taken as a tablet. This can be the combined hormonal contraception pill, or cyclical oral progestogens, which are a hormone tablet can be taken in different ways.

The hormone treatments limit the growth of the lining of your womb (which is what is shed during a period). A thinner lining means less blood. Oral progestogens can stop your periods altogether.

What about HRT?

You may find cyclical HRT, which involves taking estrogen every day, and adding in progesterone some of the time, helps regulate your cycle and reduces heavy bleeding. HRT would also ease any other perimenopause symptoms you may be experiencing.

In addition there are surgical options, including hysterectomy, the removal of your womb, or endometrial ablation, when the lining of your womb is surgically destroyed. However, these options can both end your fertility.

Do any other conditions need to be ruled out?

In more than half of cases the exact cause of your heavy periods are not known.

Potential causes could be:

Fibroids, which are benign enlargements of muscle in the wall of your womb, or endometrial polyps, benign outgrowths of the lining of your womb
Endometriosis, when cells similar to the lining of your womb grow elsewhere in the body, and adenomyosis, when these cells grow in the muscular walls of the womb, can both cause heavy periods. You can read more about endometriosis here
Heavy bleeding can be a sign of pelvic inflammatory disease, an infection which can affect your womb, fallopian tubes and ovaries
A sexually transmitted disease or by bacteria that normally live in your vagina
Polycystic ovarian syndrome (PCOS)
If you have a copper coil, this can also lead to heavy periods
Auto-immune conditions including diabetes and some thyroid disorders can put you at higher risk of heavy periods

Doctors may also want to rule out cancer of your womb lining, called endometrial carcinoma, and some other rare conditions which can cause heavy periods.

Your doctor is also likely to carry out a blood test to see if you are anaemic. Anaemia can be caused by blood loss from heavy periods, leaving you feel tired, lacking in energy, feeling breathless and your skin looking pale.

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What else can help me manage heavy periods?

Keeping a period diary may help you and your doctor to understand the pattern of your menstrual period and decide what test or treatment may be helpful. The periods section in the journal area of our free balance app is designed with this in mind.

You can also use the balance app to log any medication you are taking.
Using double protection, such as tampon and towels, or also using period pants can help with heavy unpredictable flow and give some extra peace of mind.
Switching to higher frequency absorption such as night-time products during the day, can also help you withstand heavy days.
While anyone can be affected by heavy periods in perimenopause, maintaining a healthy weight can help reduce the risk of some conditions that can contribute to heavy bleeding, including anovulation and PCOS.

But more than anything, you should make an appointment to see a healthcare professional. They will help you find the best approach to minimise the impact of heavy periods on your life.

References

NICE (2018): Heavy menstrual bleeding: assessment and management

Seeking support and care from a healthcare professional

If you need menopause treatment advice, seek help from your healthcare professional or book an appointment with Newson Health.

Newson Health offers evidence-based treatment and care for women going through the perimenopause and menopause. With clinics nationwide we offer in-person and virtual consultations. We are also able to see patients who reside outside the UK following a first appointment either face-to-face in one of our clinics or virtually while in the UK.* All follow-up consultations can then be held virtually in the country you resided in.

Our team of menopause specialist doctors, nurses and pharmacists will take time to listen to you, discuss your symptoms and offer a comprehensive treatment plan, tailored to your needs and preferences.

Use the button below to find out more and book your appointment.

*This doesn’t currently apply to residents of the US and Canada. All medication will need to be sent to a UK postal address; this includes PO Box addresses.

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