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Q: Are these changes in my periods concerning?

Q: Are these changes in my periods concerning?

by Dr. Barb DePree MD

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! 


  • Constance, Yes. 98% of women will reach menopause between the ages of 40 to 58.

    Dr Barb on

  • Hi, can these symptoms happen in your early 40’s too?
    Constance on

  • Emma, A D&C is not therapeutic, in that it will not treat abnormal bleeding beyond the cycle that is happening. It is diagnostic, it gets a tissue sample to determine underlying possible causes of the bleeding. The management of perimenopausal bleeding is usually hormonal, because the cause is hormonal, disrupted hormone production is leading to the bleeding so that is usually the approach to managing. The treatment might include birth control pills, progesterone/progestins, or Mirena IUD. There are medications that lessen the bleeding at the time of a period, eg Lysteda. This usually isn’t worrisome but it is bothersome.

    Dr Barb on

  • I had to have a DNC in September due to MAJOR bleeding! Now here we are July of the same year, and it’s starting again. Been having a period since June 3. That’s been 35 days now. (Off/ on w/HUGE clots) I do have an apt but can’t get in for another week. BTW I am 53 1/2. Is this normal at all for this age? I have no other menopause symptoms such as hot flashes. Some weight gain that’s about it.

    Emma on

  • Thank you so much for this. My doctor suggested surgery right away when I told her about the clotting . I’m made to feel as if I have an emergency situation.

    Marlene on

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