What do heavy periods look like in perimenopause?
In your 40s you may notice your periods changing. Some months the bleeding is heavier than usual, pads or tampons are not enough, your period lasts a few days longer, and you see large clots. Other months your period is late or very light. According to the NHS, in perimenopause periods may come more or less often, and bleeding may be heavier or lighter (NHS, Menopause symptoms).
Perimenopause is the transition before your last period. Menopause is a definition given 12 months after the last period. For this transition and its signs, you can also read irregular periods at 45.
Heavy bleeding is not only a physical problem. Having to get up in the middle of a meeting, avoiding going out for fear of leaking onto your clothes, and waking several times a night can seriously affect daily life and self-confidence. So you do not have to put up with it, thinking “I’m going into menopause anyway, it will pass.” The Office on Women’s Health notes that women with heavy bleeding sometimes have periods so painful and heavy that ordinary daily activities become difficult (womenshealth.gov, Period problems).
Why does bleeding get heavier before menopause?
According to The Menopause Society, period changes in perimenopause come from the ovaries’ hormone production becoming irregular and ovulation becoming less frequent. In this time bleeding can be heavier or lighter, and the number of bleeding days can also change (The Menopause Society, Perimenopause).
In plain terms: in cycles without ovulation, the lining of the womb (endometrium) keeps thickening under the effect of estrogen, but the hormone that balances this thickening is not released in sufficient amounts. The Office on Women’s Health notes that hormone imbalance and lack of ovulation can cause the lining of the womb to become too thick and lead to heavy bleeding. The same source adds that hormone changes in perimenopause can cause longer and heavier periods (womenshealth.gov, Period problems).
When does period bleeding count as “heavy”?
The NHS lists the signs of heavy periods as follows (NHS, Heavy periods):
- Needing to change your pad or tampon every 1–2 hours
- Your period lasting more than 7 days
- Clots larger than about 2.5 cm (about 1 inch)
- Needing to use two products at the same time (for example, a pad and a tampon)
- Often feeling tired or short of breath
The NHS also notes that heavy periods can happen as you approach menopause (NHS, Heavy periods). But “can happen” does not mean it does not need assessment. And the measure is not only the number of pads: if bleeding is affecting your daily life, that alone is reason enough to see someone.
What other causes of heavy bleeding are there?
Other conditions that can cause heavy bleeding are also common at perimenopause age. This is why heavier bleeding should not be put down to menopause straight away.
- Fibroids. Common non-cancerous growths in the womb. The NHS lists fibroids among the causes of heavy periods (NHS, Heavy periods).
- Polyps. Small growths in the lining of the womb; they can cause irregular or heavy bleeding (womenshealth.gov, Period problems; Cleveland Clinic, Perimenopause).
- Adenomyosis. Tissue from the lining of the womb growing into the muscle wall of the womb; it is linked to heavy and painful periods (NHS, Heavy periods).
- Overgrowth of the lining of the womb. This can develop in cycles without ovulation (womenshealth.gov, Period problems).
- Thyroid problems. An underactive thyroid gland in particular can cause heavy bleeding (womenshealth.gov, Period problems).
- Bleeding disorders and some medications. Inherited conditions that affect blood clotting and some blood-thinning medications can increase bleeding (NHS, Heavy periods).
The NHS notes that, rarely, womb cancer can also cause heavy bleeding (NHS, Heavy periods). This is an uncommon cause, but it is one of the reasons assessment matters.
What might the change you notice point to?
| What you notice | May be linked to perimenopause | Suggests another cause / see a doctor |
|---|---|---|
| Periods sometimes heavier, sometimes lighter | Yes, common | Tell your clinician if bleeding is clearly heavier than before |
| Period lasts more than 7 days | Possibly | A sign of heavy bleeding according to the NHS; needs assessment |
| Clots larger than 2.5 cm | Possibly | See a doctor to check for causes such as fibroids or polyps |
| Bleeding between periods or after sex | Usually not | Other causes need to be looked into; see a doctor |
| Weakness, shortness of breath, dizziness | Indirectly (due to blood loss) | Could be anemia; get a blood test |
| Bleeding 12 months after the last period | No | Must be assessed |
Can heavy bleeding cause anemia?
Yes. The NHS lists heavy periods as one of the most common causes of iron deficiency anemia (anaemia in the UK). Symptoms of iron deficiency anemia include tiredness and lack of energy, shortness of breath, palpitations, pale skin and headaches (NHS, Iron deficiency anaemia). The Office on Women’s Health notes that dizziness, weakness, tiredness, chest pain or shortness of breath can be signs of anemia (womenshealth.gov, Period problems).
Because these symptoms can also have other causes in perimenopause, they are easy to miss. If you are tired all the time, see menopause fatigue for the possible causes.
What can you observe yourself?
Your clinician often understands how heavy your bleeding is from what you tell them. Describing it with numbers rather than saying “I bleed a lot” makes their job easier. Things you can note:
- How many pads or tampons you change each day and how full they are
- How many days the bleeding lasts
- Whether there are clots and roughly how big they are (for example, the size of a coin)
- The number of days between periods
- Whether there is bleeding between periods or after sex
- Symptoms that come with it, such as tiredness, dizziness or shortness of breath
The Menopause Society notes that changes in your bleeding pattern should be discussed with a health professional, and that tracking bleeding in a calendar helps with this assessment (The Menopause Society, Perimenopause).
Heavy bleeding before menopause: when to see a doctor, and what to ask
The NHS suggests seeing your GP if heavy periods are affecting your life, have been going on for a while, if you have severe pain during your period, or if you bleed between periods or after sex (NHS, Heavy periods). Cleveland Clinic also lists periods coming less than 21 days apart and lasting several days longer than usual among reasons for an assessment (Cleveland Clinic, Perimenopause).
Bleeding after menopause is a separate topic. If you have any bleeding, however light, more than 12 months after your last period, read bleeding after menopause and see your clinician.
Questions you could ask at the appointment:
- Could my bleeding have a cause such as fibroids or polyps?
- Do I need a blood test for anemia?
- Do I need a test such as an ultrasound?
- Would it be a good idea to have my thyroid checked?
This page does not cover treatment options. Talk through the options for heavy periods with your clinician.