Periods & Bleeding

Experiencing Irregular, Erratic or Heavy Periods?

During perimenopause, ‘What’s going on?’, is a constant question as periods become frustratingly unpredictable or unusually heavy, bringing another meaning to text talk slang FOMO - ‘fear of menstrual overflow’ rather than missing out!

Why do periods become irregular in perimenopause?

Oestrogen and progesterone, are the hormones responsible for triggering ovulation and periods surge and dip in perimenopause ensuring that periods are all over the place. Heavy periods (also called menorrhagia) may just be normal for some women. However, the timing of unpredictable periods can be an issue for many women and heavy bleeding can be more disturbing.

Failure to ovulate causes changes in hormone levels and thickening of the uterine wall which can lead to heavy bleeding. Heavy blood loss is identified as more than 80ml during a menstrual period i.e. soaking a tampon or pad each hour (the usual amount in a typical period is between 10 to 35ml).

Things to know about perimenopause period changes

Things to be aware of as your periods change in perimenopause:

• Changes to periods in perimenopause can start up to 4 years before menopause.

• Menstrual cycles can get shorter; periods can come very close together or be constant, becoming heavier and prolonged.

• Periods may stop for 2-3 months or longer before starting again.

• Spotting may take place between periods.

• PMS-type symptoms may be experienced for the first time.

• Contraception is still important for 2 years after your last period(under 50) and one year (over 50) according to NHS Choices.

• 12 months after your last period you are in menopause.

• Heavy bleeding during the transition is more common in overweight and obese women.

Can medical conditions affect periods and bleeding in menopause?

There is evidence to suggest that medical conditions also impact menstrual cycles in menopause, the burden of heavy periods can be a double whammy when the possibility that chronic illness could increase during the menopause transition.

Endocrine disorders such as diabetes have been linked to going into menopause at an earlier age and premature ovarian failure. Diabetes may also be associated with longer menstrual cycles and heavier bleeding.

Thyroid dysfunction has also been linked with abnormal periods and women with a history of Grave’s disease are more likely to report long cycle lengths. A study of women with hyperthyroidism found the more severe the disease, the less menstrual blood flow they experienced. The same study found that women with hypothyroidism had higher frequencies of menorrhagia. Fibroids have been associated with a shorter menstrual cycle length, but longer bleeding duration and heavier bleeding episodes.

Anaemia caused by perimenopause heavy bleeding

It can be common to have heavy bleeding leading up to menopause, and the symptoms of fatigue can be associated with perimenopausal anaemia, if you are feeling tired all the time you should have a blood test to check if you have iron deficiency anaemia (IDA).

If the blood test shows your red blood cell count is low, iron tablets will be recommended to replace the iron that's missing from your body. Iron tablets may cause side effects, the NHS recommend that drinking orange juice after you've taken a tablet may help your body absorb the iron. It’s important that you follow the GP’s advice about how to take iron tablets.

What about bleeding post-menopause?

Women can experience bleeding after they have gone through menopause. Post-menopause bleeding can be caused by conditions such as fibroids or polyps. It may also be a sign of other gynaecological symptoms such as ovarian cancer, or endometrial which is more common post-menopause and affects around 3% of women. 

Medical treatment for irregular, erratic or heavy periods

Heavy bleeding and irregular period cycles are common in women over 50. If you have concerns about heavy bleeding and it’s interfering with you day to day life, or bleeding starts again after menopause, see your doctor to rule out fibroids, polyps or other underlying medical conditions. 

What can a doctor prescribe for menopause period changes?

Depending on your age, the stage of menopause you’re at and your health history, your doctor may suggest:

• The Mirena Coil, a progesterone-releasing IUS (intrauterine system), decreases blood flow by 97% after 12 months, with periods stopping for about a third of women.

• Period relief medication containing Tranexamic acid works by helping blood to clot in the womb. Available across the counter after a consultation with a pharmacist and on prescription.

• Take 200mg of Ibuprofen every 4-6 hours to reduce blood flow by 25-30% and deal with any nasty cramps say The Centre for Menstrual Cycle and Ovulation Research (CeMCOR).

• Oral contraception, although CeMCOR says that this is a less effective option for women in perimenopause.

• Norethisterone tablets, available on prescription, can be taken to stop a period. Especially useful if you’re going to be travelling or on holiday.

Perimenopause, HRT and periods!

If heavy bleeding is interfering with your well-being, don’t put up with it, talk to your doctor. You may be a good candidate for hormone replacement therapy (HRT) that tackles hormonal imbalance (for those able to take it).

HRT helps to balance your oestrogen and progesterone levels, easing heavy bleeding and other perimenopausal symptoms. You and your doctor should discuss the best option for you, with any side effects. If you’re still having periods or have just finished, HRT will regulate bleeds so they occur every 28 days. If periods have stopped you’ll be prescribed continuous combined HRT which may cause irregular bleeding in the first 3-6 months. 

The usual caveat applies, there are pros and cons to taking HRT. We don’t take a view. It’s for you to decide whether it’s for you or not.

And the good news is…. 

Periods will eventually stop. Period!

Exercise, diet and lifestyle changes are also really beneficial and affordable self-help strategies to help you deal with this unpredictable stage of perimenopause.

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