How to Treat Heavy Periods in Perimenopause | Stella
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How to treat heavy periods in perimenopause

byDr. Katie Armstrong

Perimenopause heavy bleeding can have a real impact on your day-to-day, work, and personal lives. No one should have to go through this without support and help from their healthcare provider. Read on to find out which heavy period treatments are effective.

What you need to know about menopause and heavy periods

  1. You may experience heavy, irregular, and/or more frequent bleeding during menopause

  2. There are very effective treatments for heavy bleeding during perimenopause

  3. Heavy periods can make you iron deficient or even anemic and make you feel exhausted

  4. Heavy bleeding is absolutely a valid reason for consulting your health practitioner

  5. Heavy periods during menopause can be miserable and have a huge impact on life. You don’t have to put up with it!

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Taking action about perimenopause heavy periods

The first thing that I tell those who come to see me is that they are not alone and they do not have to put up with this.

For such a long time, heavy periods and their real impact on people’s lives have been taboo subjects. The expectation is for you to soldier on in silence. My rule of thumb is that you should be able to do whatever you normally do in your life without your periods getting in the way. So, if your period is getting in the way of how you live and your ability to get on with your regular day-to-day activities, then it’s time to do something about it and see your healthcare provider.

What are the signs of heavy periods during menopause?

  • Your period is getting in the way of your ability to get on with your regular day
  • Blood flooding through your sanitary protection and clothes during the day
  • Your bed clothes are soaked with blood during the night
  • You’re changing your tampon or pad more frequently, for example, every hour  
  • You’re experiencing unusually heavy and/or painful periods 
  • Your heavy period lasts longer than seven days
  • Doubling up on sanitary protection all the time
  • You’re passing large clots of blood during your period – the size of a quarter or larger
You can be at work and suddenly realize you are flooding through your clothes, affecting your confidence and getting in the way of your normal working day. Plus, you can often find yourself waking up in a blood-soaked bed during the night.

What heavy period treatment is available?

Once you’ve seen your healthcare provider and know that your perimenopause heavy periods are part of your menopause journey, there are a variety of very effective treatments available.

 Non-hormonal, taken when you are bleeding

  • Tranexamic acid (TXA) or mefenamic acid (Ponstan) taken during your period to reduce bleeding and cramping

Hormone treatment, taken all the time

  • Hormone-releasing IUDs, such as the Mirena
  • Combined (estrogen plus progestin) oral contraceptive pills, which most people can take up to age 50 safely
  • Depo-Provera, a long-acting progesterone injection
  • Oral progesterone, such as Aygestin or Provera
  • Progesterone-only contraceptive pills 

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Surgical options

Hysterectomy or endometrial ablation

My first suggested treatment will almost always be an IUD as it’s the most effective and lowest risk – even for those with more active medical problems. People worry about having it fitted but it’s normally straightforward – think of it as 20 minutes of discomfort for 5-8 years of benefit! 90% report improved bleeding but it can take 3-6 months before you see the full benefits. It is not uncommon for there to be some pain and even more irregular bleeding in the beginning.

Other treatments for women who do not want an IUD can also be incredibly effective. Your healthcare provider will discuss options with you so that you can choose the most appropriate treatments together. Surgery, such as hysterectomy or endometrial ablation, should be the last resort, as there are so many other non-invasive and effective treatments available but for some women, it is the answer.

Read about Alice’s experience with the Mirena IUD.

Can perimenopause cause heavy bleeding?

Yes indeed! The dramatic hormone fluctuations before menopause are a frequent culprit. From your early 40s and into your 50s, during perimenopause, you may find that your periods change and become erratic as your ovaries slow down and estrogen and progesterone levels start to fluctuate. It can be very common for your cycle to become highly unpredictable and for periods to be heavier, longer and more frequent.

There are a whole range of menstrual issues in perimenopause that are normal but if your period is getting in the way of your ability to get on with regular day-to-day activities, then it’s time to do something about it and see your healthcare provider. It is important to check if the abnormal bleeding is already making you anemic, and check that there isn’t an underlying cause other than menopause.

For example, several uterine problems can cause heavy bleeding including:

  • Fibroids – benign tumors of the uterine muscle that disrupt the lining of the uterus
  • Infection in the cervix, uterus or tubes
  • Polyps – benign outgrowths of the uterine lining
  • Cancer, which is rare

It’s really important that you see a healthcare provider. I would advise keeping a diary of what’s happening and when, how long the bleeding lasts, and how it is affecting you daily. That information can be really useful for you and your healthcare provider to see. 

What tests or investigations might you need?

Don’t be freaked out if your healthcare provider suggests having tests. You may not need them but, depending on your symptoms, they may be helpful.

There may be no further medical investigations after your initial consultation and that is fine and normal. However, if heavy bleeding has been persistent and long-term, your healthcare provider may be thinking about further tests. For example, a blood test is important if you have been bleeding excessively for a long time as you may be iron deficient.

Possible tests

  • An examination of your abdomen
  • An internal examination with swabs and a pap smear if you’re due
  • Blood tests, including a blood count, iron level, thyroid function, and sometimes tests to evaluate your blood clotting system
  • Hormone levels (FSH, estrogen) aren’t normally helpful
  • An ultrasound scan, including a transvaginal scan (internal ultrasound) to look for ovarian problems, fibroids, uterine polyps and check the lining of your uterus

If there are red flags such as an abnormal bleeding pattern or other risk factors such as being very overweight or having diabetes, you may need further investigations.

Persistent, heavy bleeding that is affecting your life is a valid reason to see your healthcare provider and you should not feel bad about asking for an appointment sooner rather than later.

Our top tips

If you’re experiencing abnormally heavy bleeding or excessively frequent or long periods and this is negatively impacting your life:

  • Keep a diary of your menstrual cycle and bleeding patterns and note any other possible perimenopausal symptoms
  • Make an appointment to see your healthcare provider
  • Consider an over-the-counter iron supplement if you have been bleeding heavily long-term
  • Be prepared! Always have extra tampons or pads with you. Being prepared will make you feel more in control of your situation and more able to cope
  • For more information and guidance visit the Cleveland Clinic and CDC 

Final thoughts

Menopause is a journey of hormonal change that begins for most women in their early 40s. If your periods become erratic or change, it’s worth thinking about whether you may be experiencing other symptoms that might be early signs of menopause, such as sleep disturbance, hot flashes, exhaustion, irritability, and depression. We all live busy lives and you can easily just pass off these symptoms as normal and unavoidable. But, when you put them all together, they may give you a picture of your perimenopause or menopause situation.

Remember, you don’t have to go through this alone and you do not have to put up with the impact of menopause symptoms on your life. There is support and treatment available.

Find out more about menopause on our blog or our symptoms library.

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