You’re in your mid-50s, and while you’ve always had light and regular periods, you’re now menstruating every three weeks with a quite heavy flow, including some clots. You’re wondering whether you should be concerned.
These are very typical changes in periods in perimenopause. Classically periods will get closer and heavier, and eventually they will get lighter and further apart—and ultimately stop! Unpredictability is the norm for perimenopause.The periods reflect the relative production of ovarian hormones of estrogen and progesterone.
When the bleeding is excessive and prolonged, contributing to anemia, we look to options to lessen the bleeding. We have prescription options that are very effective at reducing blood loss; tranexamic acid (Lysteda) works very well. Insertion of an IUD (e.g., Mirena IUD) or oral contraceptives are also options; surgery is rarely needed.Fortunately, most healthy women can tolerate intermittent blood loss and have no ill effects. If lessening the bleeding is required, it can be done with simple options like Ibuprofen (800 mg every 8 hours), which, when started right away at the onset of the period can reduce blood loss by up to 30 percent. Usually, within two or three days the bleeding is less and you can discontinue the Ibuprofen.
Clots per se are not worrisome, reflecting that there is heavier bleeding at that time. Your body is doing what it is well designed to do, and clotting is important.
Take care of yourself as you navigate this transition!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.