by WV Marshall
Because hormone levels are in a state of flux during perimenopause, you may experience irregular bleeding or spotting. Sometimes your periods may be longer or heavier, or conversely, shorter and lighter. The number of days between periods also may increase or decrease.
You get the idea: All bets are off when it comes to predict cycle normalcy during perimenopause.
That being said, even though menstrual periods may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause, the American College of Obstetricians and Gynecologists said.
Most women lose less than five tablespoons during their period, with the average being between two or two-and-a-half tablespoons, the U.K.’s National Health Service said. **Heavy menstrual bleeding is defined as losing at least five and a half tablespoons each period, periods lasting longer than seven days, or both. **
ACOG recommends that you contact your healthcare provider if you notice any of the following changes in your monthly menstrual cycle: Very heavy bleeding (also known as hypermenorrhea, menorrhagia or flooding). Bleeding that lasts longer than normal. Bleeding that occurs more often than every 3 weeks. Bleeding that occurs after sex or between periods.
Heavy periods are common and can have a big effect on a woman’s everyday life. They may not always have an underlying cause, NHS said, but could occur as the result of fibroids or endometriosis.
However, heavy bleeding during perimenopause, ACOG said, can be caused by polyps that have attached to the uterine wall or develop on the endometrial surface. These may cause irregular or heavy bleeding. (Polyps that grow on the cervix or inside the cervical canal can cause bleeding after sex.)
Heavy bleeding could be caused by endometrial hyperplasia in which the uterine lining thickens, causing irregular or heavy bleeding. Endometrial hyperplasia typically is caused by too much estrogen without enough progesterone. Heavy bleeding also can be caused by endometrial atrophy, in which the endometrium may become too thin as a result of low estrogen levels.
ACOG notes that in some cases of endometrial hyperplasia, the lining cells become abnormal, creating a condition called atypical hyperplasia, which could lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause.
After menopause, the endometrium may become too thin because of a decrease in estrogen levels, resulting in endometrial atrophy. Abnormal bleeding may occur as the lining thins.
ACOG notes, however, that bleeding after menopause is not normal and should be reported to your healthcare provider.
Our Bodies Ourselves says about 25 percent of women experience heavy bleeding during perimenopause and warns that repeated heavy bleeding may lead to anemia due to the blood loss.
When diagnosing what’s behind abnormal perimenopausal bleeding or bleeding after menopause, your healthcare provider will review your personal and family health history, give you a physical exam and possibly one or more tests. How abnormal bleeding is treated depends on its cause.