menstrual cup for heavy bleeding

Heavy Bleeding in Perimenopause

Heavy bleeding in perimenopause is a common occurrence. But common doesn’t mean normal. No one should have to suffer through heavy periods without support and treatment options. If heavy bleeding is impacting your life, get help.

Very heavy menstrual bleeding, often with clots and flooding, is called menorrhagia. Heavy periods can also be accompanied by more pain. Heavy bleeding is most common in the teen years and during perimenopause. Perimenopause describes the time leading up to, and the year following, the final menstrual period. Lasting an average of 4 to 8 years, perimenopause can start as early as age 35.

What is considered heavy bleeding?

  • Changing your soaking pad or tampon every one to two hours for a few hours (2-3).
  • Needing to wake up at night to change soaked sanitary protection.
  • Emptying your menstrual cup more often than recommended.
  • Needing multiple sanitary products at one time.
  • Flooding through your sanitary protection and clothes.
  • Passing clots that are larger than a grape.
  • Periods that last more than seven days.
  • Restriction of daily activities due to heavy menstrual flow.
  • Symptoms of anemia such as tiredness, fatigue, or shortness of breath.

heavy bleeding in perimenopause

What causes heavy bleeding?

Both adolescence and perimenopause are characterized by irregular hormone fluctuations. In both of these phases sometimes ovulation doesn’t happen. This is called anovulation.

In simple terms, estrogen builds up the lining of the uterus called the endometrium in the first half of your menstrual cycle. The release of an egg during ovulation half way through your cycle is what triggers progesterone to stop the lining growth. When this doesn’t happen the lining continues to grow in the second half of your menstrual cycle. This can lead to heavy, irregular, and uncontrolled menstrual bleeding.

Heavy bleeding can also be caused by others issues including: fibroids, polyps, adenomyosis, infections, and other medical conditions.

Why should you see a doctor?

Period changes are very common in perimenopause. Due to hormonal changes your periods may become highly unpredictable: shorter, longer, heavier, lighter, more frequent, and/or missed altogether – anything is fair game.

Keeping track of your cycles and symptoms, and checking in with your doctor when changes happen, is important. Here’s why:

  • If your periods are uncomfortable and inconvenient, get help. No one needs to dread, and suffer through, their period.
  • Heavy, lengthy, and/or frequent periods can make you iron deficient or even anemic.
  • As noted above there could be causes other than hormone fluctuations at play.
  • Any bleeding once you’ve achieved menopause requires a doctor’s visit.
  • There are solutions.

Potential Treatment Options

Once your doctor has ruled out other causes such those listed above, there are various options they may recommend to treat heavy menstrual flow.

Non-hormonal treatment options include:

  • Ibuprofen can help with heavy bleeding. According to the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), taking 200 mg of ibuprofen every 4-6 hours while awake when bleeding heavily can reduce the amount of your flow by up to 30% and reduce menstrual pain.
  • Prescription-only anti-inflammatory painkillers like naproxen can help with heavy bleeding.
  • Tranexamic acid is a non-hormonal prescription drug used to treat heavy menstrual bleeding.

Hormonal treatment options include:

  • Hormonal IUDs release progestin and help to control heavy bleeding, as well as prevent pregnancy.
  • Oral progesterone or a progestin may be prescribed. This may be dosed cyclically or daily. Progestins are a class of drug manufactured in a lab that act in the body like progesterone. Prescribed progesterone is also manufactured in a lab and is molecularly identical to the progesterone made in our bodies. Progestins have a different molecular structure. Progestins are stronger than natural progesterone and are said to be better for controlling heavy menstrual bleeding. You can read more about progestins and progesterone here.
  • Combined or progestin-only birth control pills may be an option.
  • Hormone therapy is not a regular treatment for heavy bleeding as the recommended doses for this therapy are too small to address heavy menstrual bleeding. In acute cases hormone therapy can be useful where a high dose of estrogen may help with hemorrhagic uterine bleeding. This type of treatment is only recommended for acute cases as per professional membership organizations like the American College of Obstetricians and Gynecologists (ACOG).

In severe cases, mostly if nonresponsive to medical treatment, surgical procedures may be the most suitable treatment option.

Depending on the underlying condition, surgical options include:

  • Endometrial ablation or resection where the lining of the uterus is surgically destroyed or removed to slow or stop menstrual flow.
  • Hysterectomy which is the removal of your uterus.
  • If polyps or fibroids are found to be causing your heavy bleeding, surgical removal of these tissues may be recommended.
  • Uterine artery embolization can be an option, primarily in cases of large fibroids.
  • Dilation and curettage is rarely used now, but can be done in some acute cases of heavy menstrual bleeding. Provides only a temporary reduction of bleeding.

pad for heavy bleeding in perimenopause

Managing heavy bleeding

  • Book an appointment with your doctor.
  • Track your cycles and symptoms and bring this information to your doctor’s appointment.
  • Increasing your fluid intake, particularly salty fluid like broth or tomato juice, can help manage loss of blood volume.
  • Consider increasing your iron intake through iron rich foods like beef, shellfish, egg yolks, dark leafy greens, mushrooms, and dried fruit.
  • You may also want to consider an iron supplement.

As with any supplement or medication, consult a qualified medical professional to understand the risks and benefits in the context of your health profile.

Other Resources

For more in-depth information on heavy bleeding check out these CeMCOR resources: Very Heavy Menstrual Flow and For Healthcare Providers: Managing Menorrhagia Without Surgery.


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.