The Bloody Truth About Irregular Bleeding in Perimenopause

Do you dread looking at your calendar every month, waiting for “shark week” to come?  If you’re a woman of a certain age (like me), you may already be experiencing the changes that come with perimenopause and menopause.  Shark week might be turning into shark month… Menstrual changes are one of the most common symptoms of these hormonal shifts.  Read on for a guide to what you can expect with irregular bleeding in Perimenopause.

Perimenopause: the transition period leading up to menopause, is when your body begins to produce less estrogen and progesterone, the two hormones that regulate the menstrual cycle.  These hormones can fluctuate up and down as we pass through this phase.  As the levels of these hormones fluctuate and eventually decrease, the menstrual cycle can become irregular, with periods that are shorter or longer than usual, and with heavier or lighter bleeding.

During menopause, the ovaries stop producing eggs and the levels of estrogen and progesterone drop significantly.  As a result, the menstrual periods stop altogether.  Menopause is the day that you have not had a period for one year.  This marks the end of the fertile phase of your life.  For some, it is a joyous day.  And others may feel it as a loss of their fertility and youth.

Irregular Periods in Perimenopause

One of the most common and reliable signs that you are entering perimenopause is an irregular menstrual cycle.  This means that your periods come at different times each month, often without warning.

The length of time between cycles may also vary—you might have two periods in one month or go several months without any bleeding at all.
It makes for a huge challenge in planning events like tropical winter vacations away where you’d rather not be attracting sharks while snorkeling. 😉

The flow itself may also change significantly during this stage in life.  Some women find they experience lighter flows while others report heavier flows than before.

Heavy menstrual flow, also known as menorrhagia, can have a significant impact on your physical and emotional well-being.  Menorrhagia is defined as more than 80ml (2.7oz), which unless you’re using a Diva Cup, is difficult to measure.  Other ways that heavy menstrual flow can be assessed are clots larger than 2.5cm (1inch) diameter, low ferritin, and changing pad or tampon more frequently than hourly.  Your periods can last longer as well.  These periods can last much longer than we are used to- longer than 7 days.

Some of the ways in which irregular bleeding in perimenopause can affect your health include:

• Anemia: Heavy bleeding can lead to a loss of iron and a decrease in red blood cells, resulting in anemia, which can cause fatigue, weakness, and shortness of breath.
• Physical exhaustion: Heavy bleeding can affect hemoglobin levels.  Low hemoglobin can be physically exhausting and can cause a loss of energy and motivation.
• Interference with daily activities: Heavy bleeding can make it difficult to participate in daily activities, including work, and can lead to absenteeism.
• Emotional well-being: Heavy bleeding can have a negative impact on your emotional well-being and can cause feelings of depression, anxiety, and embarrassment.
• Interference with sexual activity: Heavy bleeding can make sexual activity uncomfortable or impossible and can negatively impact your sexual relationships.
• Infertility: In some cases, heavy bleeding can be a symptom of an underlying condition such as endometriosis or fibroids, which can lead to infertility.  In Perimenopause fertility declines as estrogen and progesterone decline.

Many women will also notice their flow becomes much more unpredictable, with spotting occurring more frequently than before.  Cramps can increase in intensity as well, making for some unpleasant days each month.

It’s important to note that changes in cycles can be normal due to our hormonal changes, but it can also be indicative of other underlying issues such as fibroids, polyps, infection, cancer, and others.  So, if you have changes in your periods, it’s a good idea to discuss it with your medical practitioner.

 

Impact of Irregular Bleeding on Women’s Lives

These changes can be profoundly disruptive to many women’s lives and activities, especially when it comes to planning trips or other events around their period dates (which are no longer so predictable!).  It can be difficult to plan ahead if you don’t know when or how much your period will arrive each month!

Not only that, but dealing with cramps and unpredictable flow patterns can be taxing on us, mentally and physically—and these effects are magnified if we are also trying to cope with hot flashes or other menopausal symptoms as well.

Medical Therapies for Irregular Bleeding in Perimenopause

There are several medical treatments that can be used to manage heavy menstrual flow. Some of these include:

• Hormonal birth control and Hormone Replacement Therapy (HRT): Birth control pills, patches, and intrauterine devices (IUDs), estrogen and progesterone (pills, patches and injectables) can all help regulate the hormones responsible for menstruation and reduce the amount of bleeding.  Scientists are currently working on new drugs that could potentially provide an oral treatment for heavy menstrual bleeding.  These drugs, called selective progesterone receptor modulators, target specific areas in the uterus and help reduce heavy bleeding while also maintaining normal levels of estrogen, which reduces the risk of side effects.
• GnRH Agonists: There are certain medications called gonadotropin-releasing hormone agonists (GnRH agonists) that can help reduce heavy menstrual bleeding by slowing down the development of eggs in the ovaries and lowering hormone production.  This leads to a thinning of the lining of the uterus and can stop menstruation altogether.  Another type of medication, called non-peptide orally active GnRH antagonists, may also help reduce heavy bleeding caused by fibroids, but these medications are not yet approved for use by regulatory agencies.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications such as ibuprofen can be used to reduce heavy bleeding by decreasing the production of prostaglandins, which are chemicals that cause the uterus to contract and can lead to heavy bleeding.  They also work by decreasing the inflammation associated with increased menstrual blood loss.
• Tranexamic acid: This medication is used during very heavy bleeding episodes to reduce the amount of blood loss.
• Endometrial ablation: This procedure uses heat, electricity, or a laser to destroy the lining of the uterus, which can reduce heavy bleeding.
• Hysterectomy: In severe cases, a hysterectomy (removal of the uterus) may be recommended as a last resort.  There are also different types of surgery that can also be used to treat heavy menstrual bleeding, such as blocking the blood supply to the uterus, and using new techniques like using clamps, ultrasound and radiofrequency to decrease the blood supply to the uterus.

These medical therapies can have good effect on managing menorrhagia, although they do come with associated side effects and risks.  It’s important to consult with a healthcare provider to determine the best treatment option for your individual case, as heavy menstrual bleeding can be caused by many different conditions and factors.

Alternative therapies for Irregular Bleeding in Perimenopause

In addition to medical treatments, there are also several alternative therapies that may be used to manage irregular bleeding in Perimenopause.  Some of these include:

• Herbal remedies: Some herbal remedies such as passionfruit, punica granatum, evening primrose oil, black cohosh, valerian (for cramps), chaste tree/berry, ginger root, and red raspberry leaf, have been used traditionally to help reduce heavy bleeding during menstruation and perimenopause.
• Acupuncture: This traditional Chinese medicine technique involves the insertion of thin needles into specific points on the body to balance energy and regulate hormones.
• Yoga and meditation: Practicing yoga and meditation may help to reduce stress and balance hormones, which can in turn help to regulate menstrual bleeding.
• Nutrition: A healthy diet with enough iron and vitamin C can help to improve and/or recover from menstrual bleeding.  Avoiding caffeine and alcohol may also help.

 

 

It’s important to note that while alternative therapies may be effective, they can also interact with any other medications you’re taking and have side effects.  So it’s best to consult with a healthcare provider before trying any alternative therapies.  Also, alternative therapies may not be suitable for everyone and may not be as well-studied as medical treatments.

Perimenopause symptoms can vary:

Every woman’s experience with perimenopause and menopause is different and some women may experience more severe symptoms than others.  Studies have indicated that 20% of women experience severe symptoms of Perimenopause and Menopause, while around 20% do not experience any symptoms.  Women who have had a hysterectomy may not experience any menstrual changes and those who have only have their ovaries removed will have different symptoms.

It’s essential to keep track of any changes in your menstrual cycle and to consult with your healthcare provider if you have any concerns.  In the meantime, there are lifestyle changes you can make to help manage the symptoms of perimenopause and menopause.  Eating a healthy diet, getting regular exercise, and practicing stress-reducing techniques can help improve your overall well-being during this time.

Perimenopause brings about many changes in a woman’s body—not least of which being changes in her menstrual cycle!  Irregularity reigns supreme during this stage.  Your period could come at any time (or not at all!), and its flow could range from light spotting to soaking through multiple tampons per hour!  Thankfully there are medical treatments and alternative therapies available that can help manage irregular bleeding in Perimenopause.  And know that you don’t have to suffer through it alone!  Talk to your doctor about which options might best suit your needs so you can get back on track towards feeling like yourself again soon!

This blog post is for informational purposes only and is not intended to replace the advice of a healthcare professional.  If you have any concerns about your health, it is important to consult a healthcare professional.  Although I am a Registered nurse, I am not your nurse and the information provided in this blog post is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  I am not responsible for any actions taken based on the information provided in this blog post.  Please see my disclaimer here for more information.

 

Take care,

 

 

 

 

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