The truth about periods during perimenopause

Perimenopause is the period before your periods completely stop for 12 months consistently. It’s a period that can last between 7 and 10 years, and for most women will start at any time from 35 and 45 years.

Perimenopause brings with it a plethora of symptoms, that often creep up and can take us by surprise – and unfortunately, cause confusion and a feeling of ‘what on earth is going on?’ which will be a relatable for a lot of us. There’s a misconception that as we draw closer to menopause that our periods will sort of ‘dry up’, and tail off, getting lighter each month.

Unfortunately, this is far from the truth – in fact, perimenopause can cause havoc with our monthly bleed so it’s important to know what to expect during this phase of our lives.

The link between heavy periods and perimenopause

As we start to experience perimenopause, you’ll notice familiar symptoms such as brain fog, hot flashes and night sweats. There are around 45 agreed symptoms of menopause, and one of these can be fluctuations in our menstrual flow and cramping. But if you start to experience heavy periods, and flooding, it can make you feel self conscious, anxious and concerned about what’s happening.

Emma, 42, started to experience flooding just after her 40th birthday. “It was sudden – my periods were always light before. I didn’t experience flooding, ever. So when I bled through my trousers onto the car seat I was worried I was haemorrhaging or something, and it was terrifying.” Emma started carrying spare pants and clothes around with her, but the anxiety of flooding affected her work. “Luckily this started just as we all went into Covid lockdown so I didn’t need to leave the house. Believe me, it would have really affected my life if I had had to get to grips with it in the office everyday.”

What Emma hadn’t realised was that this was an indication of her hormones imbalancing; especially estrogen levels declining. And what Emma really hadn’t realised is how little women talk about this, even amongst her close-knit group of friends. That left her feeling lonely, and even a bit ashamed.

So what causes this flooding to happen?

Estrogen, often referred to as the primary female sex hormone, exerts profound effects on the female reproductive system. It stimulates the growth and proliferation of the endometrial lining, preparing the uterus for potential implantation of a fertilized egg. In perimenopause, estrogen levels can fluctuate unpredictably, sometimes surging to disproportionate levels in relation to progesterone, a phenomenon known as estrogen dominance.

This imbalance sets the stage for a series of events that contribute to heavy and painful periods. Estrogen dominance prompts excessive growth and thickening of the endometrial lining, a condition known as hyperplasia. As the endometrium becomes increasingly thickened, it outgrows its blood supply, leading to inefficient shedding during menstruation. The result? Prolonged and heavy bleeding, accompanied by intense cramping and discomfort.

Moreover, estrogen dominance can exacerbate inflammation within the reproductive organs, further intensifying menstrual pain. Prostaglandins, hormone-like substances released during menstruation, stimulate uterine contractions to expel the uterine lining. Elevated estrogen levels can amplify prostaglandin production, leading to more intense and prolonged contractions, culminating in heightened menstrual pain.

The onset of perimenopause marks a pivotal juncture in a woman’s reproductive journey, characterized by the gradual cessation of ovarian function. The accompanying hormonal shifts, particularly fluctuations in estrogen and progesterone, play a central role in disrupting the delicate balance of the menstrual cycle. Estrogen dominance often emerges, resulting in hyperplasia of the endometrial lining and subsequently, heavier menstrual bleeding.

The ‘supersoaker event’ years

Dr. Jen Gunter, a Canadian gynecologist and author of “The Menopause Manifesto,” describes this phase for women as a “supersoaker event” – episodes of bleeding so intense that they can saturate clothing, overwhelm even the most absorbent tampons and pads, and necessitate iron supplementation or, in severe cases, confine individuals to their homes. The reality is that women rarely discuss this issue publicly – after all, menstrual blood is still viewed as ‘gross’ in western society, with women shamed for discussing periods in many circles. Despite public figures such as Michelle Obama sharing their menopause hot flushes, heavy bleeding continues to be a hush-hush taboo topic.

From debilitating cramps and bloating to fatigue and mood swings, the ramifications of heavy bleeding and these ‘supersoaker events’ extend beyond just menstrual discomfort. The occurrence of flooding episodes, characterized by sudden, copious bleeding, introduces additional challenges, both practical and psychological, for affected individual and often, with painful cramping combined it can stop women in their tracks and limit activities during their ‘time of the month’. Women grappling with unpredictable bleeding may find themselves contending with missed workdays, social engagements, and a pervasive sense of unease regarding potential public embarrassment. Such experiences underscore the need for a more nuanced understanding of menstrual health and empathy towards those navigating this phase of life.

Can it be managed?

Managing heavy flow might not seem particularly easy – and the truth is that unless the hormone imbalance is managed, it’s likely that the flooding will continue. From a nutritional standpoint, prioritizing a diet rich in essential nutrients, complemented by regular exercise and stress management techniques, can mitigate hormonal fluctuations and alleviate symptoms. Additionally, supplementation with vitamins and minerals known to support hormonal balance may offer supplementary relief.

Topical supplementation, such as Glow by Hormone University’s Menopause SOS and Period SOS, can offer relief to symptoms associated with perimenopause and hormone imbalance that is affecting your menstrual cycle.  With a powerful botanical blend, they offer a non-invasive approach to alleviating perimenopausal symptoms, including heavy bleeding and associated discomfort.

For individuals seeking comprehensive symptom relief, hormone replacement therapy (HRT) remains a viable option, albeit one that necessitates thorough consideration of potential risks and benefits in consultation with your doctor. Holistic modalities, including acupuncture, aromatherapy, and herbal medicine, offer alternative avenues for symptom management, catering to diverse preferences and needs

Have you experienced heavy bleeding, or flooding as you’ve entered perimenopause? Share your experiences with our Facebook community members and read more on our blog about symptoms of perimenopause. 

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