Have you noticed your periods are heavier in your 40s? Heavy bleeding during perimenopause is common, but that doesn’t mean it is normal or inevitable.

Once you figure out the cause of your heavy bleeding, you can take steps to reduce or even reverse the problem. So let’s take a look at the most common causes of heavy bleeding during perimenopause.

What is a normal bleed vs a heavy bleed?

A normal menstrual bleed is less than 80ml over the course of your period.

A heavy bleed is defined as more than 80ml AND/OR a bleed longer than 7 days duration. You may also experience flooding during a heavy bleed – where you move and experience a sudden gushing of blood into your tampon/pad/cup/period undies.

It can be hard to estimate your blood loss, and we tend to overestimate it. You may like to try using a menstrual cup for a few cycles, as it makes it easier to gauge your losses.

If you use pads or tampons, you can still get a rough idea. Super tampons and pads hold 10ml and regular tampons and pads hold 5ml. So note down how many you go through over the course of your period.

Common triggers for heavy bleeding during perimenopause

Heavy bleeding during perimenopause is common, but it’s not an inevitable result of going through perimenopause! There are 6 triggers that I see all the time in my clients.

Oestrogen imbalance

You can call it oestrogen excess or oestrogen dominance, but whatever the name, it’s a recipe for heavy bleeds. Oestrogen stimulates the lining of the uterus. As a result, your lining becomes thicker, meaning you lose more blood during your period.

During perimenopause, you can experience the rollercoaster of oestrogen – sometimes it’s low and sometimes it’s sky-high. These peaks make heavy bleeding more common.

Another big contributor during this time is fat stores around the tummy area. Your fat cells are their own endocrine organs (that’s right, they don’t just make a comfy pillow for the kids to lounge on!) So the more fat around the belly you have, the more oestrogen your body produces.

Low progesterone

The other piece of the hormone equation is progesterone. Progesterone production drops throughout perimenopause. Some of this is natural, as progesterone relies on ovulation. But stress also drops your progesterone levels, as does excess oestrogen and/or testosterone.

How does low progesterone lead to heavy bleeding during perimenopause? Put simply, low progesterone makes the uterine lining unstable. As a result, it sheds quickly instead of a steady loss over several days. That’s why we look for flooding and sudden heavy losses when assessing for low progesterone levels.


You knew this one was coming! Stress is one of the biggest factors when it comes to any peri-related symptom because most women in their 40s are swamped with stress. But let’s have a quick look at why it affects your bleeds.

Firstly, stress contributes to lower progesterone and increased oestrogen. But it also influences other glands including the hypothalamus, pituitary, adrenal and thyroid glands. This can lead to issues such as hypothyroidism that also contribute to heavy periods (not to mention weakness, depletion and overwhelming fatigue!)

Oh and if that wasn’t enough, stress also makes you more insulin resistant and therefore more likely to reach for unhealthy foods that further throw off your hormone balance and increase inflammation – eek!

5 things to investigate for heavy bleeding during perimenopause

Low iron

Our bodies are amazing, well-tuned machines with fantastic feedback mechanisms in place… except when it comes to iron!

When your iron levels are low, you lose more blood (and therefore more iron) during your period. This becomes a vicious cycle, as your levels will drop and your periods will get heavier. You’ll feel exhausted and struggle to get through the day, and you’ll have no energy to feel motivated to do something about it!

Whenever I work with clients who experience heavy bleeding during perimenopause, getting iron and ferritin checked is a must. If you go to your GP and let them know you’re experiencing heavy bleeds, they will refer you for a blood test to get it checked out.

Uterine-related issues

Sometimes, the cause of heavy bleeding is the uterus itself. This can include health concerns such as:

  • Fibroids
  • Endometriosis
  • Adenomyosis
  • Uterine polyps
  • Issues with an IUD
  • Infection
  • Uterine cancer

If you’re concerned, I highly recommend speaking to your healthcare provider about getting investigations done.

Unfortunately, it does take women longer to get diagnosed with a health condition, particularly if it’s related to the reproductive organs. Trust your instincts and persist until you get the answers.

What can be done about heavy bleeding during perimenopause?

Your doctor might offer you something like synthetic hormones e.g. The Pill, ablation or surgery. But these don’t resolve the underlying issues that led to the problem in the first place. So even if it alleviates your heavy bleeds, you may see other symptoms pop up.

My approach with clients is:

  • Address any deficiencies playing a role
  • Support the detoxification and elimination pathways to rebalance hormones
  • Nourish the body with personalised anti-inflammatory nutrition
  • Tweak the lifestyle to reduce stress (physical, mental and emotional)
  • Add supportive herbs if necessary

You can see a big difference in your periods in just a few cycles with this type of approach.

Sick of settling for feeling blah?

Let’s face it – heavy bleeding sucks, especially if you’ve battled it for a while. You feel blah, you have zero energy, and you dread your period because it gets worse every time!

If you are suffering from heavy bleeding during perimenopause, know that you don’t just have to feel crappy for the rest of your life. There are ways that we can address the underlying issues and get you feeling fabulous again.

Book in for a free discovery call today, and we can explore how I can help you to reboot your body, rebalance your hormones and feel energised every day.