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Heavy Periods During Perimenopause: Tips for Relief

Written by The Menopause Charity.

Perimenopause is a natural phase in a woman's life. It often begins a few years before menopause, which is one year after your last period.  During perimenopause, your body undergoes significant hormonal changes as your ovaries slow down and you run out of eggs.


The average age of perimenopause is around 45 years. However, everyone’s journey is different.  1 in 100 women under 40 and 1 in 1000 under 30 can experience premature menopause.  Some people experience menopause because of surgery, for example, when the ovaries are removed or due to treatment such as chemotherapy.  Menopause can also affect trans and non-binary people who may not identify as female.

The hormonal changes during perimenopause can affect various aspects of your health, including the menstrual cycle, fertility, and overall well-being. Heavy periods during perimenopause are often the result of these hormonal changes, as well as other factors.

Your periods are considered heavy if you need to change your period products every one to two hours. You may need to double on products together, or your periods may last more than a week. During perimenopause, you may also experience flooding, which is when you bleed through your clothes or bedding.

Understanding the link between perimenopause and heavy periods can help you manage the symptoms and navigate this phase with greater ease.

Can Perimenopause Actually Cause Heavy Periods?

Perimenopause can cause heavy periods for many women.

During perimenopause, the levels of oestrogen and progesterone fluctuate as the ovaries slow their hormone production. These changes can disrupt your normal menstrual cycle and lead to irregular or heavy periods. The decline in oestrogen levels during perimenopause can cause the uterine lining to become thicker, resulting in heavier menstrual flow. Additionally, fluctuations in progesterone levels can affect the stability of the uterine lining, leading to irregular and heavier bleeding.

Uterine fibroids are noncancerous growths that develop in the uterus and can contribute to heavy periods during perimenopause. These fibroids are more common in women aged 30-40 and tend to shrink after menopause. However, during perimenopause, when oestrogen levels fluctuate, fibroids may grow larger and cause symptoms such as heavy menstrual bleeding, pelvic pain, and pressure.

Changes in the endometrium, the lining of the uterus, can also contribute to heavy periods during perimenopause. Hormonal changes can disrupt the normal balance between oestrogen and progesterone, leading to excessive growth of the endometrial tissue. This abnormal growth can result in heavy periods and other menstrual irregularities.

Other factors that can contribute to heavy periods during perimenopause include stress, lifestyle factors, and medical conditions such as thyroid disorders or pelvic inflammatory disease.  These factors can exacerbate hormonal imbalances and contribute to heavier periods during perimenopause.

Tips And Treatments For Heavy Periods During Perimenopause.

Heavy periods, also known as menorrhagia, can be a challenging symptom for many women during perimenopause.  Fortunately, there are several tips and treatments available to help manage this condition and improve quality of life.

  • Maintain a Healthy Lifestyle:
    • Eating a balanced diet rich in iron and other essential nutrients can help support overall health and replenish lost nutrients during heavy periods. Incorporate foods like leafy greens, lean proteins, and iron-rich sources like beans and fortified cereals.
    • Regular exercise can also help alleviate menstrual symptoms and improve overall well-being. Aim for at least 30 minutes of moderate exercise most days of the week, such as brisk walking, swimming, or cycling.
  • Practice self-care:
    • Chronic stress can make menstrual symptoms worse, including heavy periods. Incorporating stress-reducing activities into your daily routines, such as yoga, meditation, or deep breathing exercises, can help promote relaxation and reduce cortisol levels.
    • Creating a calming bedtime routine and ensuring enough sleep can help manage stress and improve overall hormone balance.
  • Explore Hormonal Therapies:
    • Hormone replacement therapy (HRT) is a common treatment option for managing symptoms of perimenopause. HRT works by topping up the hormones (oestrogen and progesterone) that decline during menopause. HRT can help to regulate the menstrual cycle and reduce bleeding.
    • An intrauterine system (IUS), also known as a hormonal coil, can be fitted inside your womb by a doctor or nurse. It releases synthetic progesterone locally, which can make your periods lighter and shorter and often cause them to stop altogether. A hormonal coil also works as a form of contraception. Examples of hormonal coils include Mirena, Levosert and Benilexa.
    • Cyclical HRT treatments limit the growth of the lining in your womb, reducing the amount of blood helps to regulate your cycle and can reduce heavy bleeding. Oral contraceptive pills can also be used effectively to help manage heavy periods.
    • A personalised approach is key to finding the best treatment option for you. Your healthcare professional will assess your symptoms and help recommend the best course of action for you.
  • Consider Non-Hormonal Treatments:
    • Non-hormonal treatments may also be effective for managing heavy periods during menopause. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce menstrual cramps and ease heavy bleeding.
    • Tranexamic acid is another non-hormonal medicine that can be prescribed by your healthcare professional. It can help reduce menstrual blood flow by promoting blood clotting.
  • Surgical interventions:
    • In some cases, surgical interventions may be recommended for women with severe or persistent heavy periods during perimenopause. Procedures such as endometrial ablation, which involves removing or destroying the uterine lining, can help reduce menstrual flow and ease symptoms.
    • Hysterectomy, the surgical removal of the uterus, may be considered as a last resort for women who do not respond to other treatment options.

Addressing Blood Clots From Heavy Periods During Perimenopause.

Blood clots during heavy periods are a common occurrence for many women during perimenopause.

Hormonal fluctuations lead to irregularities in the menstrual cycle.  These hormonal changes can affect the uterine lining, making it thicker and more prone to shedding in clumps, which may appear as blood clots passed during your period.

Uterine fibroids and polyps are typically benign (non-cancerous) growths in a woman’s uterus.  They can contribute to heavy periods and blood clots by blocking the flow of menstrual blood.

Overcoming Heavy Periods In Perimenopause: When To See A Doctor.

Hormone changes during perimenopause can lead to many symptoms, including changes to your periods, difficulty sleeping and urinary symptoms. 

Heavy periods, or menorrhagia, are a common symptom experienced by many women during perimenopause. Persistent or severe symptoms should be checked by your healthcare professional. 

When to see a doctor:

  • Persistent or severe bleeding
  • Heavy bleeding or pelvic pain
  • Prolonged bleeding or bleeding between periods
  • Large or frequent blood clots

Your healthcare professional can perform a thorough assessment. This may include a physical examination, medical history review, and diagnostic tests if necessary, to determine the underlying cause of symptoms.  Your healthcare professional can recommend appropriate treatment options for you to consider.

It is important to track your menstrual cycle and act on any change.

Use The Menopause Charity symptom checker to help you and your healthcare professional work out whether you may be experiencing perimenopause or menopause. They can rule out any other underlying conditions and offer advice for further care.

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