Is heavy bleeding simply a sign of perimenopause, or could it point to something else? At Cherokee Women’s Health Specialists, we’re here to help you sort through the confusion and get answers you can trust.
Your 40s can feel like a decade of change. Careers, families, and personal goals often keep women busier than ever, but it’s also a time when your body might start sending new signals, especially from your reproductive system. One of the most common and frustrating symptoms women report in their 40s is heavy menstrual bleeding.
What is Perimenopause?
Perimenopause is the transitional phase leading up to menopause, when your ovaries gradually produce less estrogen and progesterone. This transition can begin as early as your late 30s, but for many women, symptoms become more noticeable in their 40s.
During perimenopause, hormones can fluctuate wildly from month to month, leading to:
- Irregular periods
- Skipped cycles
- Longer or shorter cycles
- Heavier or lighter flow
- New or worsening PMS symptoms
So yes, heavy bleeding can absolutely be part of perimenopause. But it’s not the only possible cause.
When Heavy Bleeding Might Mean Something Else
Not all heavy bleeding in your 40s is just hormones. Sometimes, it can signal an underlying condition that needs treatment.
Here are other possible causes:
Uterine Fibroids: Fibroids are non-cancerous growths in the muscle of the uterus. They’re very common in women in their 40s and can cause:
- Heavy or prolonged bleeding
- Pelvic pressure or fullness
- Frequent urination
- Pain during sex
Polyps: Polyps are small, benign growths on the lining of the uterus or cervix. They may cause:
- Heavy periods
- Spotting between periods
- Bleeding after sex
Endometrial Hyperplasia: This is an overgrowth of the uterine lining, sometimes due to excess estrogen without enough progesterone to balance it. It can cause:
- Heavy or prolonged periods
- Irregular bleeding
Important: In some cases, endometrial hyperplasia can become precancerous and should be evaluated.
Bleeding Disorders: Though less common, some women may have an underlying bleeding disorder that wasn’t diagnosed earlier in life, causing heavy periods to worsen with age.
Endometrial or Cervical Cancer: Most heavy bleeding has benign causes, but cancer must be ruled out, especially if bleeding:
- Occurs between periods
- Happens after sex
- Occurs after menopause
Early detection is key, so don’t ignore unusual bleeding patterns.
How Heavy is “Heavy”?
It can be hard to know what qualifies as “heavy bleeding.” Signs that your period might be abnormally heavy include:
- Soaking through a pad or tampon every hour for several hours
- Needing double protection (pad + tampon)
- Passing large clots (bigger than a quarter)
- Bleeding lasting longer than 7 days
- Fatigue or symptoms of anemia (like weakness, shortness of breath, or dizziness)
Tests to Find the Cause
If you’re experiencing heavy bleeding, your doctor may recommend:
- Pelvic exam
- Ultrasound
- Blood tests to check hormone levels or anemia
- Endometrial biopsy (sampling the uterine lining)
- Hysteroscopy (a small camera inside the uterus)
These tests help determine if your heavy bleeding is hormonal or due to another cause needing treatment.
Treatment Options for Heavy Bleeding
Treatment depends on the cause. Possible options include:
- Hormonal therapies – Birth control pills, hormonal IUDs, or other medications to regulate bleeding
- Minimally invasive procedures – Removing fibroids or polyps, or performing endometrial ablation to reduce bleeding
- Iron supplements – If anemia has developed
- Surgery – In severe cases, a hysterectomy may be considered
When to Give us a Call
See your doctor if:
- You’re soaking pads/tampons hourly
- You’re passing large clots
- Periods are lasting longer than 7 days
- You feel weak, dizzy, or short of breath
- You have bleeding between periods or after sex
Heavy bleeding may be a normal part of perimenopause, but it should never be ignored. Heavy bleeding in your 40s can disrupt your life, but you don’t have to wait it out. At Cherokee Women’s Health Specialists, we’re committed to helping women feel their best through every stage of life. If heavy periods are affecting your daily routine, we’re here to find answers and relief. Call us today at 770.720.7733 or simply schedule an appointment online.
