How to Treat Heavy Periods in Perimenopause | Stella
Your body

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 woman should have to go through this without support and help from her doctor. There are heavy period treatments available that are effective, says Dr Katie Armstrong, general practitioner and clinical advisor to Stella.

Find out more about the stages of menopause.

What you need to know about menopause and heavy periods

  1. You may experience heavy bleeding during menopause

  2. There are very effective treatments for heavy bleeding

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

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

  5. Heavy periods during menopause are miserable and have a huge impact on life, don’t put up with it!

Start your free online menopause assessment to see if HRT is right for you

Taking action about perimenopause heavy periods

The first thing that I tell women 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 women’s lives have been taboo subjects, with women expecting 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 doctor,” says Dr Armstrong.

Read Amanda’s story on how a sub-total hysterectomy helped the exhaustion and pain of perimenopause heavy bleeding.

What are classed as heavy periods during menopause?

  • 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 sanitaryware more frequently, for example every hour or so or doubling up on sanitary protection as standard
  • You’re experiencing unusually heavy or painful periods (or both)
  • Your heavy period lasts longer than seven days
  • You’re doubling up on sanitary protection as standard
  • You’re passing large clots of blood during your period (50p size or larger)
  • Your periods may also become more painful
Women can be at work and suddenly realise they are flooding through their clothes, affecting their confidence in themselves and getting in the way of their normal working day. Plus, they often find themselves waking up in a blood-soaked bed during the night”

What heavy period treatment is available?

Once you’ve seen your doctor and know that your perimenopause heavy period is 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

Hormone treatment, taken all the time

  • Hormone releasing coils, such as the Mirena, Kyleena or Jaydess
  • Combined oral contraceptive pill (you can take this up to age 50)
  • Depo Provera – long acting progesterone injection
  • Oral progesterone, such as Norethisterone and Provera
  • Progesterone only contraceptives, eg cerazette or the implant can be effective for some women
  • Some forms of HRT may also help

Start your free online menopause assessment to see if HRT is right for you

Surgical options

Hysterectomy or endometrial ablation

“My first suggested treatment will always be a hormone-releasing coil as it’s the most effective. Women worry about having it fitted but it’s normally straightforward – think of it as 20 mins of discomfort for 5-7 years of benefit! 90% of women report improved bleeding but it can take three to six months to settle.”

“Other treatments for women who do not want a coil can also be incredibly effective. Your GP will discuss options with you so that you can choose the most appropriate. Surgery 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,” says Dr Armstrong.

Read about Alice’s experience with the Mirena coil.

Can perimenopause cause heavy bleeding?

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 oestrogen levels start to fluctuate. It can be very common for your cycle to become highly unpredictable and periods to be heavier and longer.

“There are a whole range of menstrual issues in perimenopause that are normal but if it impacts your life, consult your doctor for treatment and to exclude iron deficiency, anaemia and check there isn’t an underlying cause other than menopause.

“There are also a number of other conditions of the womb that can cause heavy bleeding including fibroids (growths in the womb that increase the surface area of the lining of the womb), a pelvic infection, polyps and, rarely, cancer, so it’s really important that you see a doctor.

“I would advise keeping a diary of what’s happening and when, how long the bleeding lasts and how it is affecting you on a daily basis, as that can be useful for your doctor to see,” says Dr Armstrong. 

What tests or investigations might you need?

Don’t be freaked out if your GP 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 doctor 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
  • Occasionally, an internal examination with swabs (and a smear if you’re due)
  • Blood tests, including a blood count, iron level and thyroid function (hormone levels aren’t normally helpful)
  • An ultrasound scan, normally a transvaginal scan (internal ultrasound) to look for fibroids, polyps and check the lining of your womb

“If there are red flags such as an abnormal bleeding pattern or examination, or risk factors, such being very overweight or having diabetes, you may be referred to a specialist for further investigations.

“It’s been difficult during the Covid pandemic because consultations have changed dramatically but do not be put off – persistent, heavy bleeding is a very valid reason to see your doctor and you should not feel guilty.”

Dr Armstrong’s top tips

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

  • Keep a diary of your menstrual cycle and heavy bleeding during menopause and note any other possible perimenopausal symptoms
  • Make an appointment to see your doctor
  • Consider an iron supplement if you have been bleeding heavily long-term
  • Be prepared! Always have extra sanitaryware with you. Being prepared at all times will make you feel in control of your situation and more able to cope
  • Check out Stella for a personalised plan to manage menopause symptoms
  • Visit NICE for current evidence-based guidance and Patient

Final word

“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 indicate menopause, such as sleep disturbance, hot flushes, exhaustion, irritability and depression. We all live busy lives and you can easily just pass off these symptoms but put them all together and they may give you a picture of your perimenopause/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,” says Dr Armstrong.

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

Try our menopause clinic

  • Online doctor’s appointments
  • Personalised treatment recommendations
  • Fast HRT delivery, if right for you