Irregular Periods & Heavy Bleeding

What It Is

Irregular periods are one of the first and most common signs of perimenopause. Your previously predictable cycle becomes unpredictable:

• Shorter cycles: Period every 21-24 days (instead of 28+)
• Longer cycles: 35-60+ days between periods
• Missed periods: Skipping one or more cycles
• Variable cycles: No pattern—short one month, long the next

Heavy bleeding (menorrhagia) means:

• Soaking through pads/tampons every 1-2 hours
• Bleeding for 7+ days (when you used to bleed 3-5)
• Passing large clots (quarter-size or bigger)
• Flooding or gushing
• Nighttime leaking despite protection

90% of women experience menstrual changes during perimenopause. For many, it's the first sign that "something is different."

Why It Happens

Normal Menstrual Cycle (Pre-Perimenopause)

Follicular phase (days 1-14):

• Estrogen rises as follicles develop
• Uterine lining thickens

Ovulation (day 14):

• Egg is released
• Progesterone production begins

Luteal phase (days 15-28):

• Progesterone dominates
• Stabilizes uterine lining, prepares for pregnancy
• If no pregnancy, estrogen and progesterone drop → period starts

Perimenopause: Hormonal Chaos

Progesterone declines first (before estrogen):

• Ovulation becomes irregular or absent (anovulatory cycles)
• Without progesterone, uterine lining isn't stabilized
• Lining continues to thicken (estrogen dominance)
• When lining finally sheds, bleeding is heavy and prolonged

Estrogen fluctuates wildly:

• Can spike very high (estrogen surges)
• Causes excessive lining buildup
• Then crashes → heavy, irregular bleeding

FSH (follicle-stimulating hormone) increases:

• Brain tries harder to stimulate ovulation
• FSH spikes → estrogen spikes → erratic cycles

Result:

• No predictable pattern
• Cycles can be 20 days or 60 days
• Heavy, light, or absent bleeding
• Flooding, clots, prolonged periods

Why Bleeding Gets Heavier

Estrogen dominance (high estrogen, low progesterone):

• Thicker uterine lining = more tissue to shed
• Lining is unstable without progesterone
• Sheds irregularly, heavily

Anovulatory cycles (no ovulation):

• No progesterone to stabilize lining
• Lining builds up for weeks or months
• Eventually breaks down in heavy, unpredictable bleeding

Common Experiences

Pattern Changes

Shorter cycles:

• Period every 21-25 days
• Feeling like you "just had a period"
• Constant PMS, never feeling good

Longer cycles:

• 35-60+ days between periods
• Uncertainty: "Am I pregnant? In menopause?"
• Relief when period finally comes

Skipped periods:

• Miss one or more cycles
• Then period returns (sometimes with a vengeance)
• Not menopause yet—just erratic ovulation

No pattern:

• 25 days, then 45 days, then 30 days
• Impossible to predict
• Can't plan trips, events, intimacy

Heavy Bleeding Experiences

Flooding:

• Soaking through super tampons in 1-2 hours
• Gushing when standing up
• Accidents, leaks, embarrassment

Clots:

• Large clots (grape, plum, golf ball-size)
• Can be alarming and painful
• Indicator of heavy flow

Prolonged periods:

• Bleeding for 7-10+ days (used to be 3-5)
• Exhausting, disruptive
• "Will this ever stop?"

Nighttime challenges:

• Waking to change protection
• Leaking through overnight pads
• Anxiety about sleeping

Impact on Life

Anemia (iron deficiency from blood loss):

• Fatigue, weakness
• Shortness of breath
• Dizziness, lightheadedness
• Pale skin, cold hands/feet

Disruption:

• Can't plan travel, events, exercise
• Fear of accidents in public
• Avoiding white clothing, intimacy
• Work absences

Emotional toll:

• Frustration, anxiety, loss of control
• "When will this end?"
• Grief over loss of predictability

What Helps

1. Tracking

Track cycles to identify patterns (even if chaotic):

• Period tracking app (Clue, Flo, etc.)
• Note: start date, length, flow heaviness, symptoms
• Helps identify anovulatory cycles, estrogen dominance
• Useful information for your clinician

2. Hormonal Birth Control

Combined oral contraceptives (estrogen + progestin):

• Regulate cycles (predictable withdrawal bleeds)
• Lighten periods
• Prevent ovulation (stops hormonal chaos)
• Safe for most healthy, non-smoking women up to age 50-55

Progestin-only options:

• Progestin-only pill (mini-pill)
• Nexplanon (implant)
• Depo-Provera (injection)
• Lighten or stop periods
• Safe for women who can't take estrogen

Hormonal IUD (Mirena, Kyleena, Liletta, Skyla):

• Most effective for heavy bleeding
• Releases progestin locally in uterus
• Thins uterine lining dramatically
• Periods become very light or stop entirely
• Lasts 3-7 years (depending on brand)
• Can stay in place through menopause

Effectiveness: Hormonal IUD reduces bleeding by 90%+ for most women.

3. Cyclical Progesterone (Non-Contraceptive)

For women who can't or don't want birth control:

Oral micronized progesterone (Prometrium):

• Take days 14-28 of cycle (or last 2 weeks of each month)
• Stabilizes uterine lining
• Prevents excessive buildup
• Reduces heavy bleeding
• Doesn't prevent pregnancy (use backup contraception)

Dosing: Typically 200mg nightly for 12-14 days/month

4. Non-Hormonal Medications

Tranexamic acid (Lysteda):

• Reduces bleeding by 40-50%
• Take during period only (not all month)
• Helps clotting, slows blood loss
• Non-hormonal option

NSAIDs (ibuprofen, naproxen):

• Reduce bleeding by 20-30%
• Also reduce cramping
• Take during period

5. Iron Supplementation

If bleeding is heavy, test for anemia:

• Ferritin (iron storage): should be >70 for optimal energy
• Hemoglobin/Hematocrit: if low, you're anemic

If low, supplement:

• Ferrous sulfate 325mg daily (or as directed)
• Take with vitamin C for absorption
• Avoid taking with calcium, coffee, tea
• May cause constipation (increase fiber, water)

6. Procedures (If Medication Doesn't Work)

Endometrial ablation:

• Destroys uterine lining (so it can't build up and bleed heavily)
• Outpatient procedure
• 80-90% of women have lighter periods or no periods after
• Not reversible: Can't get pregnant after
• Good option for women done with childbearing

Hysterectomy (last resort):

• Surgical removal of uterus
• Permanent solution (no more periods)
• Major surgery, longer recovery
• Consider if other treatments fail and bleeding is severe

7. Lifestyle Support

Manage estrogen dominance:

• Limit alcohol (liver processes estrogen)
• Maintain healthy weight (fat tissue produces estrogen)
• Cruciferous vegetables (broccoli, cauliflower) support estrogen metabolism
• Fiber (helps eliminate excess estrogen)

Stress management:

• Chronic stress worsens hormonal imbalance
• Prioritize sleep, rest, boundaries

When to See a Doctor

Always investigate:

• Bleeding through a pad/tampon every 1-2 hours
• Bleeding lasting 7+ days
• Bleeding after menopause (12+ months without a period)
• Severe pain with periods
• Bleeding between periods or after sex

Why:

• Rule out other causes: fibroids, polyps, endometrial hyperplasia, cancer (rare but possible)
• Diagnose and treat anemia
• Discuss treatment options

What to expect:

• Pelvic exam: Check for structural abnormalities
• Ultrasound: Visualize uterus, ovaries, lining thickness
• Blood tests: Check for anemia, thyroid, hormones
• Endometrial biopsy (if indicated): Sample uterine lining to rule out cancer or hyperplasia

Bleeding Patterns by Phase

Electric Cougar / Early Wild Tide:

• Shorter cycles (21-25 days)
• Heavier periods
• "I just had a period!"

Mid-Wild Tide:

• Erratic cycles (short, long, skipped)
• Very heavy bleeding episodes
• Anovulatory cycles common

Late Wild Tide / Henapause:

• Longer gaps between periods (45-60+ days)
• When period comes, often heavy
• Nearing menopause

The Pause (menopause):

• 12 months without a period = official menopause
• Any bleeding after this requires evaluation (could be benign, but must rule out cancer)

Duration

Irregular periods typically last:

• 4-8 years on average (range: 2-12+ years)
• Begin in early-mid perimenopause
• Continue until menopause (final period)

Heavy bleeding:

• Often peaks in mid-perimenopause (Wild Tide)
• Improves as periods space out (Henapause)
• Ends at menopause

The Emotional Toll

Irregular, heavy periods are:

• Disruptive: Can't plan life, constant vigilance
• Exhausting: Physical and emotional drain
• Invalidating: "It's just a period, deal with it"
• Isolating: Hard to explain the impact

But they're also:

• Normal (for perimenopause)
• Treatable (many effective options)
• Temporary (will end at menopause)

Myths and Misconceptions

Myth: "Irregular periods mean I'm in menopause." Truth: Irregular periods mean you're in perimenopause (the transition). Menopause is 12 months with no period.

Myth: "I can't get pregnant if my periods are irregular." Truth: You CAN still get pregnant during perimenopause. Ovulation is erratic, but possible. Use contraception if you don't want pregnancy.

Myth: "Heavy bleeding is just part of aging; nothing can be done." Truth: Heavy bleeding is treatable. Don't suffer unnecessarily.

Myth: "A period every 3 weeks is normal." Truth: While common in perimenopause, it's worth treating—you don't have to live with constant periods.

The Bottom Line

Irregular periods and heavy bleeding are:

• Common (90% of perimenopausal women)
• Hormonal (progesterone decline, estrogen fluctuations)
• Treatable (hormonal IUD, birth control, progesterone, procedures)
• Temporary (end at menopause)

You don't have to accept flooding, anemia, and unpredictability. Treatment is safe, effective, and life-changing for most women.