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If your period has you flashing back to middle school, when you were terrified of bleeding through your clothes and having to call your parents to pick you up, you\u2019re not alone. For some women, perimenopause can feel like learning to manage a period all over again. Your period shows up when it wants, lasts longer than expected and suddenly you\u2019re going through tampons, pads or period underwear at a rate you haven\u2019t experienced in decades.<\/p>\n
New York gynecologist Molly McBride, MD, calls perimenopause the \u201czone of chaos\u201d: Hormonal fluctuations can change both when you bleed and how much. But while heavier periods can be part of the transition, there\u2019s a point when the bleeding deserves a closer look.<\/p>\n<\/div>\n
Ahead, two gynecologists explain what\u2019s behind heavier periods, when to get checked and what can help.<\/p>\n
Perimenopause isn\u2019t necessarily a gradual, orderly decline in hormones. \u201cPerimenopause is defined by highly variable estradiol and progesterone with abrupt surges and drops,\u201d says Dr. McBride. \u201cThis variability translates directly into unpredictable cycle lengths and flow.\u201d<\/p>\n
Ovulation can become less regular, too. \u201cDuring perimenopause, hormone levels, particularly estrogen and progesterone, can fluctuate significantly, and ovulation may become less regular,\u201d explains Westlake gynecologist Maral Malekzadeh, MD.<\/p>\n
A changing cycle can be frustrating, but certain symptoms warrant a call to your doctor. \u201cThere is no single amount of bleeding considered \u2018normal\u2019 for every woman,\u201d says Dr. Malekzadeh. \u201cHowever, bleeding that lasts more than seven days, requires changing a pad or tampon every hour for several hours or involves frequent large clots is considered heavy bleeding.\u201d<\/p>\n
\u201cBleeding between periods or after sex should also be evaluated,\u201d she adds. Very heavy bleeding accompanied by dizziness, fainting, shortness of breath or chest pain warrants emergency care.<\/p>\n
Being in your 40s doesn\u2019t mean every change in your period can be blamed on hormones. \u201cNot all irregular bleeding is hormonal,\u201d says Dr. McBride. \u201cYou can\u2019t assume a purely hormonal cause.\u201d<\/p>\n
Fibroids, polyps and thyroid problems can also cause heavier or irregular bleeding. For new or worsening symptoms, Dr. McBride recommends looking for other causes with tests such as an ultrasound or a thyroid check.<\/p>\n
Age matters, too. \u201cAn endometrial biopsy should be done on women over 45 with irregular heavy bleeding to rule out hyperplasia or malignancy,\u201d she says. Hyperplasia is an abnormal thickening of the uterine lining, and a biopsy can also check for cancerous changes. <\/p>\n
If you\u2019re exhausted, weak or suddenly winded walking up the stairs, your period may be part of the equation. \u201cHeavy menstrual bleeding is one of the leading causes of iron deficiency and iron deficiency anemia and this risk actually peaks in the perimenopausal transition,\u201d says Dr. McBride.<\/p>\n
Dr. Malekzadeh says the effects can build over time. \u201cHeavy menstrual bleeding can gradually deplete the body’s iron stores and eventually lead to iron-deficiency anemia,\u201d she says. Other symptoms include headaches and dizziness. A blood count and, when appropriate, iron or ferritin testing can help identify the problem.<\/p>\n
Iron supplements alone won\u2019t address the bleeding behind a deficiency. \u201cTreating both the iron deficiency and the underlying heavy bleeding is important,\u201d says Dr. Malekzadeh.<\/p>\n
There are options beyond stocking every purse, desk drawer and glove compartment with period products. Treatment depends on the cause and severity of the bleeding, as well as your health and reproductive goals. Dr. Malekzadeh says options can include hormonal treatments such as a levonorgestrel IUD or birth-control pills, as well as nonhormonal medications such as tranexamic acid or certain anti-inflammatory medications.<\/p>\n
If fibroids or polyps are behind the bleeding, procedures may be recommended. Dr. McBride also points to procedures including endometrial ablation or radiofrequency treatment. \u201cThe right treatment is individualized based on the severity of bleeding, anemia, underlying cause, and whether the patient wants contraception or future pregnancy,\u201d says Dr. Malekzadeh. <\/p>\n
While you\u2019re figuring out what\u2019s behind the change, period underwear, overnight or high-absorbency pads and extra products kept nearby can make heavy days more manageable. Tracking your periods, flow, clots and other symptoms can also give your doctor useful information.<\/p>\n
\u201cExercise, a Mediterranean or anti-inflammatory diet, iron-rich foods and, when needed, iron supplementation are lifestyle tips that can help, too,\u201d says Dr. McBride. \u201cHeat and, when medically appropriate, NSAIDs such as ibuprofen may also help with cramping.\u201d<\/p>\n
Keep your doctor in the loop if heavy bleeding persists, even if you\u2019re managing it day to day. \u201cWomen experiencing persistent heavy bleeding should also ask about checking their iron levels rather than trying to manage the problem solely at home,\u201d says Dr. Malekzadeh.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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