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Heavy Bleeding

Period Changes and when to seek help

As you move into your 40s and perimenopause begins, you’re likely to notice some changes to your periods. You realize they’ll stop when you reach menopause, but why are they becoming so irregular on that journey? Is what you’re experiencing normal? Should you worry about especially heavy bleeding during this time?

We have answers to these questions and more. Keep reading to learn about why and how your period changes during perimenopause, what you can do to cope, and when you should seek medical attention.

Hormone Therapy Illustration

Changes to Your Period During Perimenopause and Menopause

During perimenopause, your body produces less estrogen and, as a result, your periods start to change. There’s no way to predict exactly how your periods will change during this time of fluctuation. You may experience the heavy bleeding we’re focusing on here, but any of the following could also occur:

Irregular Cycles

As your ovaries start to use up all their eggs and estrogen production ramps down, you can experience a longer time between each cycle, with periods coming around 38 days apart. You may miss your period completely.

Part of the irregularity results from your uterine lining becoming thinner as estrogen levels decline and ovulation occurs more quickly. There’s not as much blood to discharge, so your period may become several days shorter than you’re used to. Your cycle may also become shorter, starting again after just two to three weeks.

But as you stop ovulating, you may find your entire cycle becoming longer. This is also due to a hormonal imbalance, but in this case, it’s the balance between your body’s production of estrogen vs. progesterone. If this occurs, you may find that you experience lighter bleeding.


Because your hormone levels fluctuate during perimenopause, you can end up spotting between periods. The spots are usually brown or dark as the uterine lining (endometrium) builds up, sometimes becoming quite thick before it sheds. Regular spotting is a sign of hormonal imbalance, so it’s not surprising to see it occur during perimenopause. However, it’s worth mentioning to your doctor during regular gynecological visits.

Brown or Dark Blood

While you’re probably used to bright red blood during your periods, you already know that blood can start turning darker by the end of each month’s period. That’s because you’re seeing old blood now leaving the body. Since the blood has been waiting in your uterus for a longer-than-usual period of time, it becomes oxidized, which turns its color darker. You can also expect to see changes in texture, which are nothing to worry about.

Missed Cycles

You can expect to miss some cycles during perimenopause, thanks to those hormone fluctuations. You might even lose track of your last period. If you do miss a period, prepare for an extra heavy period in the next month — though this isn’t predictable. However, no matter how long it takes, you’re still ovulating (and you can still get pregnant), meaning you’re still having a period.

Heavy Bleeding During Perimenopause

Heavy bleeding technically occurs when you lose more than 80 milliliters of blood during menstruation, or when your menstrual cycle lasts longer than a week. While you’re probably aware of a longer period, you’re also probably not measuring your discharge. Nevertheless, most women know they’re experiencing heavy bleeding because they need to change pads or tampons more often or they require both to stem the flow.

If you pass large blood clots or bleed through your bedding or clothes, you’re probably experiencing a period with heavy bleeding. Some women even experience other physical symptoms besides more cramping, including dizziness, shortness of breath, and an irregular heartbeat. This occurs if you experience anemia due to the excessive bleeding.

This heavy bleeding can happen during perimenopause because of (you guessed it) hormonal imbalances. As you approach menopause, your body tries to maintain normal ovulation by releasing more FSH, or follicle-stimulating hormone. This, in turn, thickens your uterine lining, which means there’s more to get rid of when your period comes.

If your cycle becomes so irregular that you’re missing periods, blood may start building up in the uterine lining, resulting in heavier bleeding than usual. When your estrogen production is out of balance compared to your progesterone production, you’ll also experience extra heavy bleeding.

If you experience heavy bleeding regularly, you should see a doctor, as you’re possibly at risk of anemia or iron deficiency. In rare cases, heavy bleeding is a sign of endometrial hyperplasia or endometrial cancer, both of which require swift medical attention.

Postmenopausal Bleeding

Some women experience bleeding after menopause — that is, after they’ve gone 12 months without a period. Whether light or heavy, this amount of bleeding isn’t normal and requires investigation. Typically it’s a result of endometrial polyps, which are benign growths that are often easy to remove. But in about 10% of cases, postmenopausal bleeding is a sign of uterine or endometrial cancer. A doctor will want to examine your reproductive system, perform a Pap smear and/or ultrasound, and possibly do a biopsy to ascertain the cause of the bleeding.

Managing Heavy Bleeding

Even when heavy bleeding is normal and nothing to worry about, the experience is still aggravating, unpleasant, and even embarrassing. There’s not much you can do to stop the flow, but there are some steps you can take to manage an unexpectedly heavy period:

  • Take ibuprofen, which not only alleviates cramps but may lessen your flow by up to 40%
  • Take iron supplements to prevent anemia
  • Track your periods in a journal or using an app to see if you notice a pattern (make notes about any unusual symptoms or pain)
  • Use super-sized tampons and pads designed for a heavier flow
  • Wear panty liners or pads with your tampons to protect against leakage
  • Call your doctor if you notice any foul odors, which may indicate an infection
  • Consider trying a menstrual cup or blood-wicking underwear

Would you like to learn more?

Feel free to call us or take our short women's health questionnaire.

Womens Hormone Therapy

Treatment for Heavy Bleeding

The appropriate treatment for heavy bleeding depends largely on the cause of the bleeding. If your heavy bleeding is a result of the hormonal imbalances that occur during perimenopause, hormone replacement therapy is often the most comprehensive solution. It’s especially indicated if you’re dealing with several of other uncomfortable symptoms that accompany perimenopause for most women, including hot flashes, night sweats, mood swings, and weight gain.

Women whose heavy bleeding is due to entrometrial hyperplasia (essentially an overgrowth of the uterine lining) also typically turn to hormone treatment, taking progestin, which is synthetic progesterone. Bleeding that occurs as a result of uterine polyps typically requires hysteroscopy, a procedure that involves sending a camera through the cervix and into the uterus to remove any growths.

When to See a Doctor

In most cases, heavy bleeding in your 40s is a symptom of perimenopause. However, it can indicate other conditions that require medical treatment, so you should see a doctor if your heavy bleeding lasts more than seven days or occurs more often than every three weeks. You should also make a doctor’s appointment if it’s been more than a year since your last period and you’re experiencing heavy bleeding, or if you experience bleeding after intercourse.

If your heavy bleeding is related to the hormonal imbalances of menopause and you want to do something about it, we can help. At Hormonally Balanced, we believe every woman deserves to go through perimenopause and menopause with comfort and hope. Call us to see how we can help with your menopausal symptoms and get you on a path to health and well-being.

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