Heavy Periods During Perimenopause: What’s Normal and When to Seek Help

As your hormones fluctuate, so do many of the body’s normal functions, including your menstrual cycle. For many women, this period is marked by heavy periods, among other symptoms like hot flashes, irritability, and fatigue. But how much bleeding is too much? And when should you seek medical advice?

According to a 2019 study in the Journal of Obstetrics and Gynaecology, up to 40% of women experience heavy menstrual bleeding as they approach menopause. However, what most women don’t realize is that this isn’t always due to hormonal changes alone. There’s a range of conditions that can cause—or exacerbate—menorrhagia. These include uterine fibroids, endometrial hyperplasia, and, in rare cases, even endometrial cancer.

Understanding Heavy Periods in Perimenopause

During perimenopause, your ovaries start producing less estrogen, which leads to changes in the menstrual cycle. These hormonal fluctuations can cause heavy periods, also called menorrhagia. In fact, a study published in Menopause Journal found that more than 60% of women experience heavy periods during perimenopause compared to their younger years. While heavy bleeding may be common during this time, it can be disruptive, uncomfortable, and occasionally even dangerous.

Heavy periods can mean different things for different women, but generally, it refers to bleeding that lasts longer than seven days or requires changing your tampon or pad every hour for several hours

For many women in their 40s and early 50s, heavy bleeding becomes the uninvited guest at the menopause party. And when it comes to your body, “heavy” is not always a subjective term. We’re talking soaking through pads and tampons every hour, clots the size of a lemon, and periods that last more than a week.

Heavy periods can mean different things for different women, but generally, it refers to bleeding that lasts longer than seven days or requires changing your tampon or pad every hour for several hours. This can lead to anemia, exhaustion, and decreased quality of life.

A lot of women think this is just par for the course during perimenopause. After all, who wouldn’t expect some discomfort when your body is winding down decades of hormonal activity? But in reality, the line between what’s typical and what’s concerning is thinner than you might think—and understanding where it lies is crucial.

Before you dismiss it as just another phase of perimenopause, let’s look at what counts as “normal” bleeding and what should be a red flag.

When Should You Seek Medical Attention?

It’s important to understand when to seek help for heavy periods, as this can sometimes signal underlying health issues. According to the American College of Obstetricians and Gynecologists (ACOG), you should consult a healthcare provider if:

• Your periods last longer than seven days or if the bleeding is so heavy that you need to change your tampon or pad every hour.
• You experience severe pain during menstruation or at other times of the month. Mild cramps are one thing, but intense pelvic pain or pain during intercourse could point to endometriosis or fibroids. These are conditions that require medical attention, especially if the pain is severe.
• Your periods suddenly change or become irregular when they had previously been normal.
• You have large clots. Large Clots: Passing clots larger than a quarter is not just a matter of inconvenience. It’s a sign that your body is struggling to control blood loss. Uterine fibroids, benign growths in the uterus, can cause these large clots. Though fibroids are common (affecting up to 70% of women by age 50), they can be the source of excessive bleeding.

Here’s the short version: If you’re soaking through pads or tampons every hour for several hours, or bleeding for more than seven days or experiencing sever pelvic pain, it’s time to talk to a doctor.

Why Heavy Periods Happen?

During perimenopause, your ovaries start producing less progesterone, a hormone that helps regulate your menstrual cycle. The decrease in progesterone allows estrogen to build up in your system, leading to thicker-than-usual uterine lining, which in turn causes heavier periods.

Normally, after ovulation, progesterone should signal your body to stop growing the uterine lining and prepare for shedding. But when progesterone is low and estrogen is still high, this process is disrupted. The lining can continue to grow and build up over time, and when it finally sheds, it can cause larger amounts of blood to flow out in a longer period of time than normal.

Thicker Lining = More Bleeding: The thicker your uterine lining, the more tissue has to be shed. As this lining breaks down and is expelled, it can result in heavier periods, sometimes with large blood clots, and often lasting longer than usual.

But it’s not just about hormones. Conditions like fibroids (non-cancerous growths in the uterus), polycystic ovary syndrome (PCOS), or endometriosis can contribute to the severity of your symptoms, leading to long, heavy, and painful periods.

Does Evening Primrose Oil Help with Heavy Periods?

A study in the Journal of Obstetrics and Gynaecology (2014) found that evening primrose oil supplementation could help improve menstrual irregularities in women with premenstrual syndrome (PMS) and menorrhagia (heavy periods).

However, it’s important to remember that no one-size-fits-all approach exists when it comes to managing perimenopausal symptoms. Evening primrose oil can be a helpful part of your toolkit, but if you’re dealing with extreme bleeding or other significant issues, medical evaluation and guidance are essential to ensure you’re addressing the root causes of your symptoms.

If you’re considering adding evening primrose oil to your routine, discuss it with your healthcare provider to ensure it’s the right choice for your unique health needs. Managing perimenopause can be a delicate balancing act, but with the right support, you can navigate it with confidence and care.

How Evening Primrose Oil Can Help

Hormonal Regulation: The gamma-linolenic acid (GLA) in evening primrose oil may help reduce the severity of hormone fluctuations during perimenopause, potentially decreasing the intensity and duration of heavy menstrual bleeding. By stabilizing estrogen and progesterone levels, evening primrose oil helps maintain a more regular cycle and may reduce excessive uterine lining buildup, one of the main causes of heavy periods.

Anti-inflammatory Effects: One of the reasons evening primrose oil is considered effective is due to its anti-inflammatory properties. By modulating the production of inflammatory substances in the body, it may help alleviate the pain and discomfort associated with heavy periods, such as cramps and pelvic pressure. This could potentially reduce the need for painkillers or other medications.

Reduction of PMS Symptoms: Evening primrose oil has long been used to help treat PMS symptoms, which can be exacerbated during perimenopause. A study published in the Journal of Reproductive Medicine found that regular evening primrose oil supplementation significantly reduced PMS symptoms, including bloating, irritability, and fatigue—issues that often coincide with menstrual irregularities during perimenopause.

Evening primrose oil, derived from the seeds of the evening primrose plant (Oenothera biennis), has been studied for its positive effects on hormone regulation, menstrual health, and inflammatory response. The oil is particularly rich in gamma-linolenic acid (GLA), an omega-6 fatty acid that plays a key role in regulating hormonal balance and reducing inflammation.

How to Dose Evening Primrose Oil

While evening primrose oil can offer some relief, it’s essential to use it correctly for maximum benefits. Scientific studies typically recommend 500 to 1000 mg per day for managing menstrual symptoms, including heavy bleeding and painful cramps. Here’s how you can incorporate it into your routine:

• Capsules: The most common form of evening primrose oil is in 500 mg capsules. For heavy periods, you can take 1-2 capsules per day, typically with a meal to improve absorption.
• Liquid Form: If you prefer liquid supplements, the typical dose is around 1 teaspoon (5 mL) per day. While effective, this form can be less appealing due to its taste.
• Topical Use: Evening primrose oil is sometimes used topically for breast tenderness or skin irritation, though the effectiveness for menstrual symptoms is less well-documented in this form.

Note: It’s essential to consult your healthcare provider before starting evening primrose oil, especially if you’re already on medications (particularly blood thinners) or have a medical condition like epilepsy or bipolar disorder, as evening primrose oil can interact with certain treatments.

The root cause of heavy periods during perimenopause is a hormonal imbalance, specifically the drop in progesterone and the subsequent rise in estrogen. This imbalance causes the uterine lining to become thicker than usual, leading to heavier bleeding when the lining is eventually shed. It’s important to note that while this is a natural process, the severity and discomfort of heavy periods can vary from woman to woman.

The key is knowing when your body is giving you a red flag. If your periods are causing significant disruption in your life, or if you’re concerned about the amount of blood loss or pain, don’t hesitate to talk to your doctor. With the right treatment, you can navigate perimenopause without being held hostage by your cycle. Heavy periods during perimenopause are common, but they don’t have to be the norm. It is important time to ask the right questions, and find the solutions that work for you—before your next period catches you off guard.