Heavy periods: a common perimenopausal symptom

Why it's important to address heavy periods

One of the initial indicators of perimenopause for numerous women is the alteration in their menstrual cycle. These changes often involve adjustments in the frequency and flow of menstruation. Many of the women I see in my clinic find themselves grappling with the onset of heavier periods, which can become quite bothersome.

The prospect of heavy periods can be concerning due to heightened blood loss, discomfort, or the inconvenience of managing frequent changes to sanitary protection. The issue of heavy menstrual bleeding, also known as menorrhagia, can arise from various underlying factors.

One pivotal phase in a woman's life that could contribute to this condition is the hormonal upheaval that accompanies menopause. Gaining insight into the role menopause plays in heavy menstrual bleeding is crucial for accurately diagnosing and effectively managing this prevalent gynaecological concern.

Menopause typically occurring between ages 45 and 55, marks a significant stage in a woman's life when her ovaries produce less oestrogen and progesterone, resulting in notable hormonal fluctuations. These hormonal shifts can disrupt the regular menstrual cycle, leading to a range of menstrual irregularities, including heavy menstrual bleeding. The transition phase preceding menopause, known as perimenopause, can also be characterised by irregular periods and episodes of heavy bleeding, so in fact, heavy menstrual bleeding as a result of the perimenopause is often seen in our early 40’s.

In instances where women have been experiencing heavy periods for a prolonged period, it is advisable to undergo blood tests to evaluate iron levels or to screen for anaemia.

Underlying Causes of Heavy Menstrual Bleeding during Menopause

1. Hormonal Imbalance: The reduction in oestrogen and progesterone levels during menopause can cause the uterine lining to thicken, resulting in heavier and more extended periods.

2. Anovulation: As ovulation becomes less frequent during perimenopause, the lack of progesterone production can lead to unopposed oestrogen effects, contributing to heavy menstrual bleeding.

3. Uterine Fibroids: While fibroids can develop at any age, they may become more symptomatic during perimenopause due to hormonal fluctuations.

4. Endometrial Atrophy: The decrease in oestrogen levels during menopause can cause thinning of the endometrial lining, which may lead to irregular bleeding patterns and sporadic heavy bleeding.

5. Adenomyosis: Menopause does not always resolve adenomyosis, and in certain cases, the condition may persist, resulting in heavy bleeding.

6. Endometrial Polyps: Existing polyps or new growths can contribute to heavy menstrual bleeding during menopause.

Approaches to Managing Heavy Periods

There exist several treatment options, including hormonal, non-hormonal, or surgical interventions, for addressing heavy menstrual bleeding during menopause

Non-hormonal treatment options:

• Tranexamic Acid: This medication can be used to manage heavy bleeding episodes during menopause.

• NSAIDs (non-steroidal anti-inflammatory drugs)

Hormonal treatment options:

• Progesterone only contraceptives: may be prescribed to regulate hormonal imbalances, reduce heavy bleeding or even stop periods

• Cyclical progestogens

• Intrauterine Devices (Coils): Progestin-releasing IUDs can effectively control heavy bleeding, the Mirena coil is one of the most commonly used devices

• HRT: can help stabilise hormonal levels and regulate menstrual bleeding.

Surgical treatment options:

• Endometrial Ablation: For women who do not wish to retain fertility, endometrial ablation can be considered to reduce or eliminate heavy bleeding.

• Hysterectomy: In severe cases or when other treatments fail, a hysterectomy (removal of the uterus) may be recommended as a definitive solution.

Benefits to treatment

Treating heavy menstrual bleeding, or menorrhagia, offers a multitude of benefits, ranging from alleviating physical symptoms such as cramping and fatigue to preventing anaemia caused by excessive blood loss. Additionally, it enhances overall quality of life by minimizing disruptions to daily activities and social interactions, fosters emotional well-being by mitigating stress and mood fluctuations, and decreases the discomfort of heavy bleeding-associated pain.

By understanding the role of menopause in heavy menstrual bleeding, we can offer personalised treatment options to improve the quality of life for women experiencing this condition during the menopause.