What is a heavy period?
A heavy period, called heavy menstrual bleeding, is when you have blood loss during your period that seriously interferes with your life. During your 40s, when you enter perimenopause, your periods can become erratic and heavy.
Your periods typically get shorter, lighter, and more regular as you age. But during your 40s, when you enter perimenopause, your periods can become erratic and heavy.
Why are your periods so heavy? It could be a sign of perimenopause, but other conditions can also cause heavy menstrual bleeding.
Sometimes your period changes, and you have more blood than usual, but it’s not necessarily a problem. It’s simply a change from what you’re used to. Minor shifts are common.
These changes in flow can happen when you go on or off birth control, after you have a baby, and as you get older and your hormones change near menopause. Your period can also be heavy on some days and lighter on others.
A heavy period, called heavy menstrual bleeding, is when you have blood loss during your period that seriously interferes with your life. You can’t keep up your daily activities because you have too much cramping and bleeding. It’s sometimes called menorrhagia or abnormal uterine bleeding and is a sign of a problem.
Signs and symptoms of heavy menstrual bleeding are:
- Bleeding that lasts longer than seven days
- Bleeding that soaks through a pad or tampon in 1 to 2 hours
- Changing pads or tampons during the night
- Doubling up your pads or wearing a tampon plus a pad to control bleeding
- Blood clots the size of a quarter or bigger
- Feeling tired, dizzy, and short of breath from blood loss
If your period is so heavy it makes you feel weak or it physically stops you from doing your everyday activities, there might be a problem.
Can perimenopause cause heavy bleeding?
Perimenopause is a natural process and probably the most obvious reason for heavy bleeding as you age. The bleeding happens because of fluctuating hormone levels.
As you age and enter perimenopause during your 40s and 50s, your hormone levels change as your body gets ready to stop menstruating. Your ovaries shrink and make less estrogen, causing your hormone levels to rise and fall unevenly. These uneven hormones lead to unpredictable periods.
You can have heavier or lighter periods, and you might also skip periods. Uneven hormones during this time also cause shorter or longer periods and other symptoms, like hot flashes and vaginal dryness. The changes can happen slowly over time, so you might not notice them at first.
In most cases, the bleeding fluctuates and can be lighter one time and heavier than usual the next. Fluctuation and an occasional heavy period are normal signs of perimenopause and not a cause for concern. But if you’re in perimenopause and regularly have heavy periods, or they are extremely heavy, talk to your doctor.
Why are my periods so heavy?
There are many other reasons for heavy periods as you age, too. During an average period, the lining of your womb builds up and sheds over the month in response to hormone changes. Your womb muscles contract to help stop bleeding and get rid of the lining, which causes some cramps you feel.
Sometimes the muscles in your womb can’t contract properly, which is the most common cause of heavy bleeding. Growths and birth control devices like an intrauterine device, or IUD, can cause muscle problems in your womb. Other problems like adenomyosis, hormone imbalances, and other conditions can also cause heavy periods.
Two types of womb growths are especially common in your 30s and 40s: fibroids and polyps. Fibroids are growths in the muscle layer made of muscle cells and connective tissue. They’re widespread; about 77 percent of women get fibroids during their fertile years.
Polyps are overgrowths in the uterine lining, called the endometrium. They grow inward into the womb and extend from a stalk. Both fibroids and polyps can get in the way of muscle contractions, leading to heavy menstrual bleeding. They can also cause bleeding between periods.
Uterine fibroids and polyps are noncancerous growths in most cases. Some people can also develop cancerous growths in the uterus or cervix that cause heavy bleeding, but these are rare.
Another common cause of heavy periods as you age is adenomyosis. In this condition, glands from your womb lining grow into the muscles of your womb wall. Your uterus gets bigger and sometimes doubles or triples in size, which causes pressure, painful periods, and heavy bleeding. Adenomyosis is common in women aged 35 to 50.
Hormone imbalances can disrupt ovulation when your ovaries release an egg. If you don’t ovulate regularly, your womb lining builds up and becomes too thick. This can happen with an underactive or overactive thyroid and lead to heavy periods. Even a mild case of underactive thyroid causes heavy bleeding in about 20 percent of women.
Other causes of hormone imbalance include:
Other common conditions that can lead to heavy periods include bleeding disorders, kidney disease, liver disease, cancer, infections, and some medications, including blood thinners.
How do you stop heavy menstrual bleeding?
Heavy periods might be a typical sign of perimenopause, but they can also be a sign of a problem. You should talk to your doctor to rule out other issues and for treatment.
Treatment for heavy menstrual bleeding depends on the cause. It might be as simple as stopping or changing your prescription if you take hormone medications. Other medications can help lower blood loss or help balance hormones, including:
Your doctor might recommend surgery or other procedures if medications don’t help. These can include:
- Removing your ovaries, uterus, and cervix
- Laser to destroy womb tissue
- Blocking off arteries that supply blood to the uterus
- Removing womb lining or growths
Heavy bleeding is common as you age. It can be a normal part of your transition into menopause, or it can be a problem with your uterus or hormones. If heavy periods are interfering with your life, talk to your doctor.
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Medically Reviewed on 5/9/2022
American College of Obstetricians and Gynecologists.
Cleveland Clinic: “Is My Period Normal? How Menstrual Cycles Change With Age.”
InformedHealth.org: “Heavy Periods: Overview,” “Uterine Polyps.”
JOHNS HOPKINS MEDICINE: “Fibroids,” “Polycystic Ovary Syndrome (PCOS).”
Main Line Health: “Nearing 40? Expect changes to your period.”
Mayo Clinic: “Menorrhagia (heavy menstrual bleeding),” “Perimenopause.”
Merck Manual Consumer Version: “Adenomyosis.”