Bleeding in Perimenopause

Written by cindi pearce
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Perimenopause is the opening act for menopause. It is a transitional period when a woman is gradually moving out of her reproductive mode to a time when she will no longer menstruate, ovulate or be capable of having a baby. Oestrogen and progesterone levels rise and fall unpredictably during perimenopause, and this is what causes erratic menstrual periods. This transitional period may last for several years, during which time ovarian function declines and then stops, which ultimately leads to menopause.

Erratic and Inconsistent

Erratic menstrual periods are likely to happen during perimenopause, according to the Mayo Clinic. Ovulation, too, will become inconsistent. The periods may be farther or closer apart and marked by heavy bleeding or, conversely, a scanty blood flow.

When to Consult a Doctor

Irregular menstrual periods during perimenopause are normal; however, if you experience bleeding in between periods, bleeding that lasts longer than eight days, periods that are regularly occurring less than three weeks apart or extremely heavy bleeding, you need to consult with your physician.


According to Jerilynn C. Prior, scientific director at the Centre for Menstrual Cycle and Ovulation Research, a menstrual period is considered menorrhagia if you soak 16 sanitary products/pads/tampons during the menstrual period. When oestrogen levels tend to be high and progesterone levels are low, as they are when an individual is a teenager or perimenopausal, Prior explains that this can cause a heavy menstrual flow. Even though you are menstruating, and perhaps even bleeding heavily, this does not necessarily mean that you are ovulating. Oestrogen makes the lining of your uterus, the endometrium, thicker so that it is more likely to shed whereas progesterone, which is made by the ovaries after ovulation, makes the endometrium thinner. Consequently, heavy blood flow is probably due to too little progesterone and too much oestrogen. When a woman stops ovulating, or is ovulating erratically, the lining in her uterus builds up and this results in heavier menstrual bleeding.


If your periods are too heavy during the perimenopausal years, Prior suggests that you take 100 milligrams of ibuprofen, which is an anti-prostaglandin, every four to six hours while you are awake. This will slow down the bleeding and will also relieve menstrual cramps. Eat more salt and drink more fluids during a heavy menstrual period so that you don't get dehydrated. If you stand up and get dizzy, this means that your blood volume is too low and that's because you've lost too much blood. Increase your intake of salty food and drink tomato juice or salty broths. Be sure that you're taking an iron supplement because heavy blood loss can lead to anaemia.

Alternative Remedies

According to Estrogen Matters, alternative remedies for reducing excessive bleeding caused by oestrogen overload during perimenopause include taking the herbal supplement Dong Quai, which suppresses oestrogen synthesis. Milled flax seed neutralises oestrogen. Oat bran absorbs excess oestrogen. If you take all three, the combination reportedly neutralises the effects of oestrogen dominance and your bleeding should slow down.

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