IRREGULAR, ERRATIC OR HEAVY PERIODS
During perimenopause, ‘What’s going on?’, is a constant question as periods become frustratingly unpredictable or unusually heavy, bringing another meaning to text talk slang FOMO - ‘fear of menstrual overflow’ rather than missing out!
WHY IT HAPPENS
Oestrogen and progesterone, the hormones responsible for triggering ovulation and periods surge and dip in perimenopause ensuring that periods are all over the place. Timing can be an issue for many women but heavy bleeding can be more disturbing. Failure to ovulate causes changes in hormone levels and thickening of the uterine wall which can lead to heavy bleeding. Heavy blood loss is identified as more than 80ml during a menstrual period i.e. soaking a tampon or pad each hour (the usual amount in a typical period is between 10 to 35ml).
Things to be aware of as periods change:
Changes to periods in perimenopause can start up to 4 years before menopause.
Menstrual cycles can get shorter; periods can come very close together or be constant, becoming heavier and prolonged.
Periods may stop for 2-3 months or longer before starting again.
Spotting may take place between periods.
PMS type symptoms may be experienced for the first time.
Contraception is still important for 2 years after your last period(under 50) and one year (over 50) according to NHS Choices.
12 months after your last period you are in menopause. And the good news is…. Periods will eventually stop. Period!
The best ways to help with irregular periods Exercise, diet and lifestyle changes may help you to deal with this unpredictable stage of perimenopause, but there are medical options, too.
What to eat to help with irregular, erratic or heavy periods
Essential fatty acids: Omega-3 fatty acids help with menstrual cramps. Found in: freshly ground linseeds, and SMASH - salmon, mackerel, anchovies, sardines and halibut. (Better to eat in fish as supplements can increase bleeding).
Whole grains: Iron rich, low GI foods may help with hormonal imbalance, eat more: barley, oats, quinoa, brown and wild rice I
ron is lost in blood. Top up supplies, eat more: red meat, egg yolks, dark green vegetables and dried fruits.
Fruit and Vegetables containing Vitamins A,C & E, antioxidants recommended for heavy bleeding by Dr Christine Northrup (obstetrician-gynecologist). Eat more: tomatoes, leafy greens, peppers, broccoli, Brussels sprouts and squash, lemons, limes, berries and cherries.
What to avoid to help with irregular, erratic or heavy periods
Lifestyle triggers for irregular periods Periods are guaranteed to come to an end as hormones and eggs run low. Lifestyles can impact on periods, so avoid:
Drinking too much (alcohol can play havoc with hormones, making cycles longer).
Smoking (smokers may have shorter, more irregular cycles than non-smokers).
Excessive exercise (body perceives excessive exercise as stress which affects hormone production). Stress (can throw hormones out of whack, stopping periods, so find your own stress busting activity). Significant changes to weight (both loss and gain have an impact on ovulation).
Lifestyle & wellbeing to help with irregular, erratic or heavy periods
Keep a diary Dates and flow are important to know when seeking medical help. Make a note of when a period comes and how many times you change a pad or tampon (a ‘regular’ holds 5ml, a ‘super’10ml), whether or not, you felt dizzy and have any spotting between periods.
Stay hydrated Blood loss dehydrates, ensure you top up lost fluids. The Canadian Centre for Menstrual Cycle and Ovulation Research (CeMCOR) advises that if you feel dizzy or your heart pounds when you get up from lying down, you should increase fluid and salt intake as blood volume is low, drink vegetable juices.
Iron maiden Heavy blood loss may cause anaemia as iron lost in blood isn’t replaced quickly enough. NHS UK says that anaemia can cause tiredness and lethargy. Talk to your GP before taking iron supplements as too much iron can be toxic.
Supplements worth trying for irregular, erratic or heavy periods
Vitamins A & C: Female nutrition expert Dr Marilyn Glanville says studies show taking vitamin A and Vitamin C with added bioflavonoids, (which strengthen the blood vessel capillary walls), can reduce or even stop heavy bleeding.
Multivitamin & mineral supplement specifically for menopause.
Herbal supplements, can be taken as capsules or tinctures. For heavy bleeding, try: shepherd’s purse, yarrow, vitex and ladies’ mantle.
It’s essential to talk to your GP about supplements as they can interact with the effectiveness of other medications.
Alternative help for irregular, erratic or heavy periods
Acupuncture & Traditional Chinese Medicine (TCM) TCM’s long history of treating women with period issues in menopause, or Beng Lou, (‘flooding and trickling’) uses a combination of herbs and treatments to regulate fluctuating hormones.
Reflexology The Modern Reflexology site says that targeting certain pressure points may deal with ‘irregular’ periods and ‘menstrual problems’ in menopause. However, The Royal College of Obstetricians and Gynaecologists patient information leaflet into alternative treatments to HRT for menopause symptoms says that while reflexology is safe, there have been very few studies on whether it helps menopausal symptoms and more are needed. Reflexology may help your sense of wellbeing and promote stress reduction and relaxation – no bad thing!
When to see your doctor about irregular, erratic or heavy periods
If you have concerns about heavy bleeding or bleeding starts again after menopause, see your doctor to rule out fibroids, polyps or other underlying medical conditions.
What’s in the doctors’ bag for heavy periods?
Depending on your age, the stage of menopause you’re at and your health history, your doctor may suggest:
The Mirena Coil, a progesterone-releasing IUS (intrauterine system), which according to womens-health.co.uk decreases blood flow by 97% after 12 months, with periods stopping for about a third of women.
Period relief medication containing Tranexamic acid works by helping blood to clot in the womb. Available across the counter after a consultation with a pharmacist and on prescription.
Taking 200mg of Ibuprofen every 4-6 hours to reduce blood flow by 25-30% and deal with any nasty cramps say The Centre for Menstrual Cycle and Ovulation Research (CeMCOR).
Oral contraception, although CeMCOR say that this is a less effective option for women in perimenopause.
Norehisterone tablets, available on prescription, can be taken to stop a period. Especially useful if you’re going to be travelling or on holiday.
And then there’s always HRT….
HRT tackles hormonal imbalance for those able to take it. You and your doctor should discuss the best option for you, with any side effects. If you’re still having periods or have just finished, HRT will regulate bleeds so they occur every 28 days. If periods have stopped you’ll be prescribed continuous combined HRT which may cause irregular bleeding in the first 3-6 months.
As usual the usual caveat, there are pros and cons to taking HRT.