Are heavy periods normal in perimenopause?

Heavier periods are common as you get closer to menopause, and for many women there’s no underlying problem. The NHS lists “approaching menopause” as one of the times periods can become heavy. But common doesn’t mean you have to put up with it. If heavy bleeding is affecting your life, or your periods have changed noticeably, it’s worth seeing your GP: there are effective treatments, and a GP can rule out other causes and check you’re not low in iron.

Why periods change in perimenopause

Perimenopause is the time before your periods stop for good, when your hormone levels rise and fall less predictably. The NHS says irregular periods are common just before the menopause, and “irregular” can mean several things: periods coming early or late, lasting more or fewer days, and being heavier or lighter than you’re used to.

So you might go months with light or skipped periods, then have one that’s much heavier. That pattern on its own is often part of perimenopause, but it can also have other causes, which is why it’s worth mentioning to your GP if your periods have become heavier.

How do I know if my periods are heavy?

Bleeding varies a lot from woman to woman, and the HSE points out that what’s heavy for one woman may be normal for another. These are the signs the HSE and NHS use. Your periods may be heavy if you:

• need to change your pad or tampon every hour or two
• pass blood clots bigger than about 2.5cm (roughly the size of a 50 cent coin or a 10p coin)
• bleed through to your clothes or bedding
• need to use two types of period product together, such as a tampon and a pad
• have periods lasting more than 7 days
• avoid things like exercise, or take time off work, because of your period
• feel tired or short of breath a lot

An NHS England decision guide for heavy periods adds a few more: getting up in the night to change period products, sudden “flooding”, or simply periods that interfere with your normal routine.

Feeling tired or breathless matters because heavy bleeding over time can lead to iron deficiency anaemia, where your body doesn’t have enough iron to make healthy red blood cells.

What else can cause heavy periods?

For many women there’s no particular cause. The NHS England decision guide says that in about half of people with heavy periods there’s no medical reason at all. Where there is a cause, the HSE and NHS list:

• fibroids (non-cancerous growths in or around the womb) and polyps (small growths on the womb lining)
• adenomyosis, where tissue from the womb lining grows into the wall of the womb
• endometriosis, polycystic ovary syndrome (PCOS) and pelvic inflammatory disease
• an underactive thyroid, or a bleeding disorder such as von Willebrand disease
• some medicines, including blood thinners and some chemotherapy
• a copper coil (IUD), which the HSE says can make periods heavier for the first 3 to 6 months after it’s fitted

The NHS says that, rarely, heavy periods can be a sign of womb cancer. That isn’t a reason to panic; it’s a reason not to ignore a change and to let your GP check.

What your GP may do

Your GP will ask about your bleeding, how your periods have changed and any other symptoms. According to the HSE, you may then have:

• a blood test to check for iron deficiency anaemia
• a physical examination
• an ultrasound scan
• a hysteroscopy, where a doctor looks inside your womb with a thin camera

The NHS England guide makes two reassuring points: you can say no to any test, and you don’t have to wait for results to start treatment. It also says most people don’t need to be referred to hospital for heavy periods.

Treatments for heavy periods

The NHS says heavy periods don’t always need treating, but there are options if they’re affecting your daily life. Which one suits you depends on the cause, your general health and what you prefer, so this is a conversation to have with your GP. The options the HSE and NHS describe include:

• An intrauterine system (IUS), a small device placed in the womb that releases a progestogen hormone. The HSE says it’s often the first treatment offered. The NHS England guide notes you may have irregular bleeding for up to 6 months after it’s fitted.
• Medicines without hormones, such as tranexamic acid, which helps your blood clot and is taken only during your period, or anti-inflammatory painkillers such as mefenamic acid or naproxen.
• Hormonal medicines, such as the combined contraceptive pill or progestogen tablets.
• Procedures if medicines don’t help or there’s a specific cause, such as removing fibroids or polyps, removing the lining of the womb (endometrial ablation), or, less often, a hysterectomy.

The NHS England guide suggests giving a treatment about 3 months and, if it hasn’t helped, going back to try something else. Some of these options are also contraceptives, which matters because you can still get pregnant during perimenopause. Ask your GP or pharmacist which options fit your health and plans; don’t start or change any medicine without talking to them first.

When to see your GP

The HSE and NHS suggest seeing your GP if:

• heavy periods are affecting your life, or you’ve had them for some time
• your periods have become heavier
• you have severe period pain
• you bleed between periods or after sex
• you have heavy periods along with other symptoms, such as pain when peeing, pooing or having sex

The NHS England guide adds: see a healthcare professional if you faint during your period, or have to stay in bed because of pain or heavy bleeding.

Bleeding after menopause always needs checking. If you’ve gone a year or more without a period and then have any bleeding, the HSE says to contact your GP even if it’s only spotting, pink or brown discharge, or has only happened once. It’s not usually serious, but it can rarely be a sign of cancer, which is easier to treat when found early.

What to do next

• Track your next two or three periods. Note the dates, how many days you bleed, how often you change pads or tampons, any clots or flooding, and how tired you feel. A period-tracking app or a notebook both work.
• Book a GP appointment if your periods tick any of the boxes above, or have simply changed in a way that worries you. Bring your notes and ask whether a blood test for anaemia makes sense.
• Ask about the full range of treatments, including ones without hormones and ones that also work as contraception, and what to expect from each.
• Don’t ignore bleeding between periods, after sex or after menopause. Ring your GP.