Heavy periods in perimenopause: causes and when to get help

Heavy menstrual bleeding becomes more common in perimenopause, when cycles without ovulation can let the uterine lining build up. It can also come from fibroids, polyps, bleeding disorders or other conditions. Heavy bleeding is treatable and should be evaluated, especially because it can lead to iron-deficiency anemia.

Signs bleeding may be heavy

• Soaking through one or more pads or tampons every hour for several hours in a row
• Needing to change protection overnight, or using double protection
• Passing blood clots the size of a quarter or larger
• Bleeding lasting longer than 7 days
• Tiredness or shortness of breath that may signal anemia

Possible causes

• Hormonal changes and cycles without ovulation
• Uterine fibroids or polyps
• Adenomyosis
• Bleeding disorders or certain medicines, such as blood thinners
• Less often, thickening of the uterine lining (endometrial hyperplasia) or cancer

How it's evaluated and treated

A clinician may ask about your bleeding history, examine you and order blood tests or an ultrasound. Treatment depends on the cause and may include hormonal or nonhormonal medicines, or procedures.

When to talk with a healthcare professional

• Symptoms are affecting your sleep, work, relationships or daily life.
• You want to know whether a treatment fits your personal and family health history.
• Your periods are heavy, long, or you feel unusually tired or breathless.

When to get prompt care

• Any vaginal bleeding after menopause (12 months without a period) should be checked by a clinician.
• Soaking a pad or tampon every hour for several hours, or bleeding with dizziness or faintness, needs prompt care.

How Dot can help

Logging flow, pad or tampon changes and fatigue in Dot gives you a factual record to share. Dot doesn't assess whether bleeding is dangerous — use the urgent signs above.

How Dot works · Kindr Care clinical care

Related topics

• Irregular periods
• Perimenopause
• Progesterone
• Menopause

Sources

1. American College of Obstetricians and Gynecologists. Heavy Menstrual Bleeding (patient FAQ).
2. American College of Obstetricians and Gynecologists. Perimenopausal Bleeding and Bleeding After Menopause (patient FAQ).
3. American College of Obstetricians and Gynecologists. Abnormal Uterine Bleeding (patient FAQ).

This page is educational and not medical advice. Dot does not diagnose or prescribe. See our editorial policy.