Understanding the Challenges of Heavy Menstrual Bleeding During Perimenopause

Menstrual irregularities are a common occurrence during perimenopause, with many experiencing changes in their bleeding patterns. These changes can include prolonged periods, unusually heavy bleeding, and the passing of large blood clots. These symptoms can significantly interfere with daily activities, demanding frequent changes of menstrual products and leading to fatigue. Hormonal fluctuations are often the underlying cause, with the brain attempting to stimulate ovarian response, sometimes resulting in increased estrogen levels and thickening of the uterine lining.

"Changes in menstrual bleeding are common in perimenopause," said Stephanie Faubion, MD, in an interview with Healthline. "Periods can become lighter or heavier. This relates to fluctuations in ovarian function and subsequently in brain neurochemicals, such that the brain is trying to get the ovary to respond."

Managing Heavy Menstrual Bleeding

To help manage heavy menstrual bleeding, various treatment options are available. Hormonal treatments can regulate bleeding, while non-hormonal medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce menstrual flow. Additionally, progestin-containing intrauterine devices (IUDs) provide another effective method for managing symptoms. In more severe cases, endometrial ablation, which removes the uterine lining, can help reduce flow.

Severe Treatment Options

For those experiencing extremely heavy bleeding that severely impacts their quality of life, surgical options may be considered. A hysterectomy, which involves the removal of the uterus, is a more drastic measure but can provide a permanent solution to chronic issues. This option is typically reserved for cases where other treatments have proven ineffective or when the bleeding poses a significant health risk.

The Role of Fatigue

Fatigue is a prevalent symptom among those experiencing heavy or prolonged menstrual bleeding during perimenopause. The increased loss of blood can lead to feelings of exhaustion and a decrease in energy levels. Research indicates that females in midlife are two to four times more likely to experience syndromic fatigue compared to other stages of life.

“When that happens, the ovary is being ‘flogged’ by the brain, which can result in higher levels of estrogen than a woman usually has in her reproductive years," explained Dr. Faubion. "This can lead to thickening of the uterine lining and heavier menstrual blood flow.”