This Bleedin’ Period!
Understanding Heavy Bleeding During Perimenopause
Heavy menstrual bleeding can begin with the onset of perimenopause. The clinical term for this is menorrhagia—defined as excessively heavy or prolonged periods. Signs of menorrhagia include passing blood clots larger than a quarter or bleeding that lasts more than seven days. Research shows that 27–54% of women will experience heavy bleeding during perimenopause.
In addition to heavy flow, you may notice spotting between periods, cycles that last more than 38 days, or bleeding at unpredictable times. These symptoms may fall under the broader category of Abnormal Uterine Bleeding (AUB).
Types of Abnormal Uterine Bleeding
Menorrhagia: Excessive menstrual bleeding—needing to change pads or tampons every two hours or less, passing large clots, or bleeding longer than seven days.
Metrorrhagia: Bleeding that occurs between periods or at irregular intervals.
Menometrorrhagia: A combination of both—heavy, prolonged bleeding that occurs irregularly and/or infrequently.
What to Do Next
Tracking your cycle with this Center for Disease Control (CDC) menstrual chart can help identify patterns and provide useful information for your healthcare provider. If you’re experiencing any form of abnormal bleeding, schedule an appointment with your provider. Diagnostic tools may include:
Blood tests
PAP smear
Pelvic exam
Ultrasound
Common Causes of Abnormal Bleeding
Hormonal fluctuations
Polyps
Endometriosis
Thyroid disorders
Polycystic ovarian syndrome (PCOS)
Treatment Options
Management depends on the cause and severity of symptoms and may include:
Hormone Replacement Therapy (HRT)
Iron supplements, especially if anemia is a concern
Medications to regulate hormones or reduce bleeding
Surgical options, such as endometrial ablation or hysterectomy
Key Questions to Ask Your Healthcare Provider
Is my bleeding considered abnormal?
What might be causing my symptoms?
Does this amount of blood loss put me at risk for anemia or other health conditions?
What treatment options do I have, and what are their pros and cons?
Will my care involve a team of specialists?
What surgical experience do you have in treating abnormal uterine bleeding?
Kelly Rigo is the creative force behind Menopause Evolution.