Heavy bleeding & flooding

Periods that soak through a super tampon and a pad in under two hours, clots the size of a coin, bleeding that runs for ten days at a stretch — this is one of the most disruptive and most under-treated parts of perimenopause. It isn't something to put up with, and it isn't something to be embarrassed about.

A hormonal mismatch, often layered on top of a structural reason the uterus bleeds heavily anyway.

Unopposed estrogen thickens the lining. When cycles stop ovulating, progesterone disappears for that month. Estrogen keeps the uterine lining (endometrium) building. When it finally sheds, there's more lining to lose — heavier flow, more clots, longer duration.

Fibroids and polyps make it worse. Around 70% of women have fibroids by menopause and many have benign polyps. They don't cause heavy bleeding on their own in everyone, but layered on a perimenopause hormone shift they often become symptomatic for the first time.

Adenomyosis flares in midlife. Endometrial tissue inside the muscle wall of the uterus thickens with the same unopposed estrogen, which is why heavy bleeding with deep, dragging cramping is so common in the 40s.

Iron stores drop quietly. Heavy bleeding can contribute to iron deficiency and anemia. Fatigue or breathlessness can have other causes too. Ask whether iron assessment would help alongside the recommended blood count; symptoms alone don't establish a low ferritin result.

This isn't your normal period getting heavier. Flooding, frequent product changes, prolonged bleeding or disruption to work, sleep or everyday life deserve assessment. Heavy menstrual bleeding is judged by its impact, not one product count or clot size. Treatment options are available.

There's a real menu here — from over-the-counter, to the Mirena coil, to a same-day procedure. Most people never get offered most of it.

Tranexamic acid on heavy days. A non-hormonal prescription tablet taken only on the heaviest 3–4 days. Cuts blood loss by roughly a third for most people. Cheap, safe for most, easy first step to ask a doctor for.

The Mirena (levonorgestrel) coil. The single most effective treatment for heavy menstrual bleeding short of surgery. Reduces bleeding by ~90% within six months, doubles as contraception, and is licensed as the progestogen arm of MHT — so it can carry you straight into the hormone-therapy conversation.

Cyclical progesterone or the combined pill. If the coil isn't right for you, a cyclical oral progestogen for 10–14 days each cycle, or a combined pill (where safe), can regulate bleeding and protect the lining. Worth a real conversation, not a 'try ibuprofen'.

Iron, properly. Ask whether iron deficiency is contributing and whether ferritin testing or iron treatment would help. Agree on the preparation, follow-up and repeat tests with your doctor or specialist rather than using a single threshold or supplement plan for everyone.

Notice your bleeding without delaying care. Note dates, products or cup volume, soak-through intervals, approximate clot size and the impact on your day. Start with what you remember; you don't need a complete diary before asking for treatment.

Procedures, when meds aren't enough. Endometrial ablation (a day-case procedure that thins the lining), uterine artery embolisation for fibroids, hysteroscopic polyp or fibroid removal, and — for some — hysterectomy. None of these are 'last resort'; they're options on a real menu.