Why Menstrual Periods May Become Heavier During Perimenopause

Perimenopause is a time of flux for women—hormones are changing, life presents new challenges, and you’re moving from one chapter of life to another. If this transition wasn’t busy enough, all these changing hormones can bring along a myriad of symptoms, like irregular menstrual cycles, hot flashes, night sweats, and mood swings, to name a few.

As your cycle becomes increasingly irregular, many women notice heavier menstrual periods as well. For some, this can be alarming, especially if your cycles have always been consistent.

In this post, we’ll delve into why menstrual periods may become heavier during perimenopause and other changes you might experience as a result.

For more on how to understand your hormones & holistic health, explore my community—The Superwoman Circle.

Heavy Periods During Perimenopause

Nearly one-third of women experience heavy periods during perimenopause, which makes this a common symptom during hormonal shifts (1). In addition to heavier bleeding, periods may also be accompanied by worsening cramps and last longer as well (2).

As hormone production by the ovaries becomes erratic, it can result in changes to menstrual cycle length, period duration, and flow. With perimenopause, your menstrual cycle will become increasingly irregular until your period stops happening altogether.

If your cycle has always been regular, this departure from predictable bleeding can be alarming and frustrating. But if your cycles and flow have a history of being irregular, you may not recognize the heavy bleeding as a sign that perimenopause is on the horizon.

Related: Tips to Find Relief from Perimenopause Symptoms

Why Heavy Bleeding Happens

Heavy bleeding during perimenopause comes down to erratic hormone production in your ovaries. During a regular cycle, your ovaries make estrogen to support the release of an egg and also thicken the uterine lining to prepare the uterus for its arrival. Then, once the egg is released, the ovaries also release progesterone, which stops the uterine lining from growing, or changes it’s structure if the egg is fertilized. 

If there’s no fertilized egg—that is, if you’re not pregnant—then the ovaries stop making progesterone which triggers a period. Progesterone is also responsible for stopping menstrual bleeding after a few days.

So let’s think of estrogen like the water for the grass in your garden (the uterine lining), and progesterone is the equivalent of cutting the grass every 28 days (when you have a period). During menopause we have decreasing progesterone, and erratic estrogen, which means some periods may have a thick uterine lining to shed, and lack the progesterone to pump the breaks on a heavy period. 

Hormones Become Erratic

During perimenopause, hormone production in the ovaries doesn’t generally decline at a slow, gradual pace. It can change drastically from month to month in an unpredictable fashion (3). 

What’s more, progesterone typically decreases at a higher rate than estrogen. The absence of progesterone leads to a buildup of the uterine lining, which can slough off at unpredictable times and trigger heavy periods. Smoking and a higher BMI are associated with heavier bleeding in perimenopause.

While heavy, painful periods are common during perimenopause, it doesn’t mean we should consider these changes “normal”. I’ll explain why in a moment.

Read: What to Expect with Perimenopause

More Perimenopause Symptoms

If you’re unsure whether or not you’re dealing with perimenopause, or another issue, it’s helpful to familiarize yourself with perimenopause symptoms.

The most common symptom of perimenopause is irregular periods.  Apart from heavy bleeding, women going through perimenopause may also experience:

  • Hot Flashes and Night Sweats: Changes in estrogen cause difficulties with temperature regulation.
  • Mood Swings: Hormonal shifts may impact mood stability, leading to emotional ups and downs.
  • Sleep Disturbances: Trouble falling or staying asleep, and 3 am wakings are some of the first signs of perimenopause changes.
  • Changes in Libido: Hormonal fluctuations may influence sexual desire.
  • Weight gain, especially around the midsection.

Read: Is It Perimenopause or a Thyroid Problem?

Other Factors Influencing Menstrual Flow

What if it’s not perimenopause causing changes to your period? While hormonal changes during perimenopause and menopause are the culprit behind heavier bleeding during periods, there are also other conditions that contribute to heavy menstrual flow:

Uterine Fibroids: Noncancerous growths in the uterus can cause increased bleeding.

Polycystic Ovary Syndrome (PCOS), which is characterized by irregular periods, cysts on the ovaries, and symptoms like hair loss & fatigue. Up to 12% of all women have PCOS.

Endometriosis: A condition in which uterine tissue grows outside of the uterus can also cause heavy bleeding during periods. One in ten women is estimated to suffer from endometriosis.

Endometrial Polyps: Also known as uterine polyps, these are growths on the uterine lining that can cause heavy or prolonged menstrual bleeding.

Stress: Chronic stress can disrupt hormone production and affect the regularity and intensity of periods.

Adenomyosis: When the tissue lining the uterus infiltrates the muscular wall, it can lead to excessive bleeding.

Estrogen dominance is also common during perimenopause and throughout the reproductive years too. Higher estrogen in relation to progesterone can cause heavy periods, mood swings, and tender breasts. 

Clearly, there is no shortage of things that can contribute to menstrual changes and heavier bleeding during your period.

For more on managing changing hormones naturally during perimenopause & menopause, check out my latest book, The Hormone Shift

When Should I Be Concerned?

While it’s normal for periods to change during perimenopause, it’s essential to pay attention to any significant changes in your flow. If you experience unusually heavy or long-lasting periods, it’s important that you rule out any underlying conditions, such as fibroids or endometriosis, that could be causing heavy bleeding.

Since some women can bleed heavily during perimenopause for as many as 10 days, this increases the risk of becoming anemic also (4). 

Your doctor can perform tests and exams to determine the cause of your symptoms and develop a holistic treatment plan accordingly.

Abnormal Bleeding During Perimenopause

Irregular periods are common during perimenopause. You can expect changes in cycle length, flow, and duration of your period.

Heavier bleeding can begin as little as a few months before menopause (which occurs on average at age 51), or as long as several years before.

However, not all changes in your period are benign. If you experience the following, consult a health professional:

  • Bleeding lasts longer than seven days
  • You’re using several pads or tampons every hour for more than two hours. This is extremely heavy bleeding and should be checked by a doctor who specializes in women’s hormones.
  • Intense cramping that isn’t relieved by over-the-counter pain medication
  • Spotting between periods
  • Bleeding after sex
  • Any bleeding post-menopause

If you experience any of these symptoms, it’s crucial to seek medical advice from a qualified holistic doctor. While perimenopause is a natural transition in a woman’s life, it’s always better to err on the side of caution when it comes to your health.

Managing Heavy Periods During Perimenopause

Managing heavy bleeding during perimenopause can be challenging, but there are ways to make it more manageable.

Here are a few tips that may help:

  • Use a menstrual cup or heavy flow pads if you’re experiencing heavier flows than usual. These methods allow for longer wear time and fewer leaks.
  • Consider supplements like adaptogens, maca root, and magnesium to alleviate cramps and manage inflammation.
  • Talk to a functional or integrative medicine doctor about bioidentical hormone therapy.
  • Eat a balanced diet, rich in quality proteins, healthy fats, and fruits & vegetables.
  • Increase your fiber intake, which can help reduce symptoms of estrogen dominance, like heavy bleeding during periods (5).
  • Reduce stress levels through practices like meditation, yoga, or counseling.

Managing heavy periods during perimenopause may require some trial and error, but with the help of your healthcare provider and a little self-care, you can find what works for you.

For more on managing changing hormones naturally during perimenopause & menopause, check out my latest book, The Hormone Shift.

Going With The Flow

Perimenopause is a natural part of every woman’s life, but that doesn’t mean we have to suffer through heavy periods without support. It’s essential to pay attention to your body and listen to what it’s telling you. If you experience any concerning changes in your period, speak with your doctor for proper diagnosis and treatment options. Remember, every woman’s journey is unique, and there are various ways to manage heavy periods during perimenopause. Trust your body and work with your healthcare provider to find what works best for you.