Amazingly, baby girls are born with millions of eggs, already preparing for the reproductive years. From around the age of 35, the number of fertile eggs drops and by midlife, women transition from their reproductive years to the natural end of monthly menstrual cycles.
Over our reproductive years, we come to expect a certain degree of predictability about our menstrual cycle. Whether it’s timing, length or amount of flow, there is generally not much variation from month to month. However, as we approach menopause the time known as perimenopause—the up to years leading up to menopause—all of this can change.
During this time, the hormones oestrogen and progesterone are in flux. Our levels will fluctuate from month to month. These shifts can be erratic, affecting ovulation and the rest of our cycle. We may notice anything from irregular periods to different bleeding patterns to missed periods. If you see some blood on your underwear between periods that don’t require the use of a pad or tampon, it’s likely spotting. Spotting usually results from your body’s changing hormones and endometrium build-up.
Many women spot before their period starts or as it ends. Mid-cycle spotting around ovulation is also common.
If you’re regularly spotting every two weeks, it may be a sign of hormonal imbalance. You may want to speak with your healthcare provider.
Consider keeping a diary to track your periods. Include information such as: when they start, how long they last, how heavy they are, and any in-between spotting. You can also log this information in an app, like Eve.
Heavier bleeding is caused when your oestrogen levels are high in comparison to your progesterone levels, your uterine lining builds. This results in heavier bleeding during your period as your lining sheds.
A skipped period can also cause the lining to build up, creating heavy bleeding. So many women are caught off guard by the many changes that occur during these premenopausal years. Women can suffer heavy bleeding and do nothing about it even though there are very effective and minimally invasive treatments for it.
Perimenopause and irregular bleeding – what causes it?
During perimenopause, our menstrual cycles may suddenly be different from those we have they have experienced throughout our life. The periods may be shorter or longer, and the flow may vary from light to heavy. As the ovarian function is declining, ovulation may not occur. The ongoing release of oestrogen may cause the uterine lining to thicken while the production of progesterone (to oppose the oestrogen) slows down. As a result, the lining continues to build up and may cause irregular bleeding. The thickening of the endometrium, the lining of the uterus, may represent a benign change, such as a polyp, or hyperplasia. Most hyperplasia is not a problem, but some forms can be precancerous. The bleeding can also represent endometrial (uterine cancer). Fortunately, this is the least likely possibility.
Uterine polyps and uterine fibroids, both of which are benign, may also cause changes in bleeding pattern. Polyps are benign growths composed of the endometrial glands and contain no muscle tissue. A fibroid is a fibromuscular type of tumour that often grows within the muscular layer of the uterus. If the fibroid juts out into the endometrial cavity, abnormal bleeding can result. Both fibroids and polyps can cause extra bleeding due to their location within the interior of the uterus.
Uterine fibroids are non - cancerous solid tumours formed by muscle tissue. They may vary in size, and some cases may cause swelling of the abdomen. If abnormal bleeding is affecting your quality of life, it is essential to get it checked out by your GP or gynaecologist. Be sure to be mindful of any excessive bleeding that saturates a pad per hour for 24 hours, or bleeding that lasts longer than two weeks. These are definite signs you need to be evaluated by a doctor. Very often finding out what is causing the problem can be accomplished by simple testing at the GP surgery.
Diagnosis of uterine bleeding disorders
A thorough medical evaluation will often include a review of your health history and a physical exam. Your doctor may order various tests to diagnose the cause of abnormal bleeding by testing for certain hormone levels and possibly blood tests. The tests might include thyroid function or coagulation studies to identify any clotting abnormalities. Most women will need to have the endometrial lining assessed as well. This is commonly performed during an outpatient appointment with minimal discomfort. If the diagnosis is still uncertain, vaginal pelvic ultrasound and hysteroscopy may be recommended.
Treatment for heavy bleeding in perimenopause
How heavy bleeding is treated will be determined by the diagnosis. If there is no pathologic cause for the bleeding (such as an abnormal uterine growth), continued observation and re-evaluation may be the best plan. By making some changes to diet and lifestyle heavy periods can become more bearable and less problematic.
Our recommendations include:
- Eat plenty of green leafy vegetables, red meat (organic/additive-free), free-range eggs and other foods rich in iron.
- Take an excellent strong multi-vitamin and mineral supplement, with extra B vitamins and magnesium
- Take at least 500mg of vitamin C with bioflavonoids together with an iron supplement to enhance its absorption.
- Avoid too much wheat and bran which contain phytic acid, a compound which inhibits iron absorption.
- Rest when the flow is heavy, and avoid critical social engagements until the bleeding has reduced.
- Try herbal medicine or homeopathy. If your periods are exceedingly heavy, we recommend that you consult an expert rather than attempting to self-treat.
For growths such as fibroid tumours or endometrial polyps, minimally invasive gynaecologic surgery such as hysteroscopic myomectomy, hysteroscopic polyp removal or endometrial ablation may be recommended. The ablation is a heat technique that removes the endometrial lining, causing bleeding to slow down or in some cases, stop altogether.
For persistent abnormal bleeding, hormone therapy may be an option. Hormone therapy can often help the bleeding problem while also alleviating the associated symptoms of perimenopause, such as hot flashes and night sweats. Oral contraceptives can be offered as a treatment in the appropriate patient. Oral progestins can be given cyclically or only when the flow is heavy.
Some women respond well to a progesterone-containing IUD. The IUD provides the endometrial lining with a boost in progesterone while not requiring a dose of hormones to the whole body. Placement of this type of IUD is done in a doctor’s office with no need for anaesthetics. One newer option is a medication called tranexamic acid, a nonsteroidal medication in the same family as ibuprofen. It only needs to be taken at the beginning of your period for three to five days, when there is a heavy flow.
Another side effect of heavy bleeding is iron-deficiency anaemia, which some women develop in perimenopause. Symptoms of anaemia include fatigue, dizziness and headaches.
If you think this is your issue, ask your doctor for a haemoglobin test if you’re experiencing these kinds of symptoms. It’s often difficult to get sufficient iron from diet alone when you’re bleeding heavily every month. A simple iron supplement can make a world of difference if you’re iron-deficient.
For persistent difficult bleeding, a hysterectomy may be an option for some women. This will undoubtedly correct the bleeding completely but involves a more aggressive surgery and a recovery period of three to six weeks. This decision is best made after thoughtful discussion with your gynaecologist.
Fluctuating hormones may also be to blame for a missed cycle. Your cycles may become so far apart that can’t recall the last time you bled. After you’ve missed 12 consecutive periods, you’ve finally reached menopause.
But if your cycles are still making an appearance — however, delayed — ovulation is still occurring. This means you can still have a period, and you can still get pregnant.
To help with your hormone fluctuation, you can self-help with the following recommendations.
- Follow a nutritious, well-balanced diet
- Take regular vitamin and mineral supplements.
- Introduce naturally occurring plant oestrogens, better known as phytoestrogens into your diet. Phytoestrogen rich foods are predominantly soya, linseeds and pulses. These compounds have a modulating effect on the body’s own supply of oestrogen, which is useful for
- treating any type of menstrual irregularities.
- Take a phytoestrogen-rich supplement like Promensil This provides 40mg of isoflavones which can be taken in conjunction with a phytoestrogen-rich diet to help balance hormones.
- Take the herbal supplement agnus castus which has been used for centuries for its ability to regulate the menstrual cycle. The first major clinical study on the use of agnus castus was published in 1954, showing positive results on women with menstrual irregularities and even amenorrhea. It is the fruit of the agnus castus which contains essential oils, glycosides and flavonoids.
- Get some help with sorting out any stressful situations
- If your weight is low for your height and frame, actively work to increase your weight to the optimum range.
Above all, be proactive about your well-being during your perimenopausal years. The changes to your menstrual pattern may not be welcome, but there are things you can do to improve your quality of life and the way you feel about your body during this time of transition.
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