Symptom · Periods & cycle
Heavy bleeding & flooding. When perimenopause turns the tap on.
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 is not something to put up with, and it is not something to be embarrassed about.
Educational · not medical advice
In late perimenopause, ovulation gets unreliable. Without ovulation there is no progesterone to balance the estrogen, so the uterine lining keeps thickening between bleeds and eventually sheds in one heavy, prolonged flood. Most of the time this is the hormonal picture and it is treatable. A smaller share of heavy bleeding is driven by fibroids, polyps, adenomyosis or — uncommonly — endometrial change that needs ruling out. The right move is almost never to wait it out: it's to track two cycles, name what you're seeing, and ask for the conversation.
Why this is happening now
A hormonal mismatch, often layered on top of a structural reason the uterus bleeds heavily anyway.
- 01
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 is more lining to lose — heavier flow, more clots, longer duration.
- 02
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.
- 03
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.
- 04
Iron stores drop quietly
Months of heavy bleeding deplete iron long before anyone calls you anaemic. Fatigue, breathlessness on stairs, restless legs at night, brain fog and air-hunger sighing are all classic low-ferritin signs and they all improve when iron is restored.
- 05
This is not your normal period getting heavier
Flooding through clothes, clots bigger than a 10-cent piece, soaking through a super product in under two hours, bleeds longer than seven days, or bleeding that's wrecking work, sleep and sex life — all of that meets the medical definition of heavy menstrual bleeding (HMB). It is treatable.
What tends to help
There is a real menu here — from over-the-counter, to the Mirena coil, to a same-day procedure. Most women 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 women. 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/HRT — 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
Ferrous bisglycinate or ferrous fumarate, every other day rather than daily, with vitamin C, away from tea and coffee. Get ferritin checked, not just haemoglobin — ferritin under 30 is depleted even if 'normal' on the report.
2 more practices, plus podcasts, books and research, live in Go deeper below.
03When to get help nowWhen it's not just perimenopause
Emergency red flags, same-week signs, and where to find a menopause-trained practitioner.
When it's not just perimenopause
5 more signs it needs a doctor this week
Bleeding after sex, between periods, or after menopause
Any bleeding more than 12 months after your last period, any post-coital bleeding, or persistent inter-menstrual bleeding wants a same-month appointment to rule out polyps, cervical change or endometrial change.
Soaking through, dizziness, fainting
Heavy bleeding plus light-headedness, breathlessness, racing heart or near-faint is an urgent (same-day) review — that's significant blood loss, not 'just a bad period'.
Bleeding that's running your life
Cancelling work, planning around bathrooms, avoiding sex, dreading the next bleed: that itself is a medical reason for treatment. You do not have to be anaemic to qualify.
Bleeding with severe pain that paracetamol won't touch
Deep, dragging, can't-stand-up pain alongside heavy bleeding points toward adenomyosis or fibroids and deserves an ultrasound and a real plan, not 'try ibuprofen and a hot water bottle'.
You've already asked once and been brushed off
A second opinion from a menopause-trained doctor or a gynaecologist is reasonable. Take two cycles of tracking, a ferritin result, and the words 'heavy menstrual bleeding' with you.
Go deeper
One place for everything else.
Practices to try this week, voices worth hearing, books worth your bedside table, rooms where members are talking, the candid tips Nila would share over a cup of tea, and the research the editorial team is watching.
Products per day on your heaviest day
More than six fully-soaked products, or doubling up pad + tampon, is heavy bleeding by any definition.
Time to soak-through
Soaking through a super product in under two hours, more than once, is the line for a same-month appointment.
Clot size
Clots bigger than a 10-cent piece (or a 50-pence piece) tell the doctor this is genuine HMB, not 'normal heavy'.
Cycle length and predictability
Bleeds closer than 21 days apart, longer than 7 days, or bleeding between periods — write the pattern down. It changes the conversation.
Energy and breath, not just bleeding
Stairs feel harder, you sigh a lot, restless legs at night, fingernails breaking — these are low-iron signals worth raising even if the period itself feels manageable.