Have Your Periods Gotten Heavier in Your 40s? Understanding Heavy Menstrual Bleeding
Have your periods become so unpredictable that you’re never sure if you’ll experience spotting, flooding, or some combination of both?
Welcome to perimenopause. With oestrogen levels on a rollercoaster and progesterone on the decline, it’s no wonder periods can become heavier and more erratic during this time, often leading to increased blood flow.
Understanding the Hormonal Changes
In your 40s, oestrogen can sometimes rise to levels two or three times higher than ever before at certain points in your cycle (see diagram below).
This increase in oestrogen can lead to significant blood loss during menstrual periods. Combine this with declining progesterone, and you get oestrogen-dominant cycles, leading to heavier periods.
There are other contributing factors for heavy periods in perimenopause, which we’ll explore later in this blog.
Diagram showing how oestrogen can spike to high levels in perimenopause (see red dotted line and circled area).
Many people associate perimenopause with low oestrogen, but it actually starts with high and fluctuating oestrogen levels and ends with low levels at menopause.
Oestrogen Spikes and Dominance
In a regular menstrual cycle, oestrogen rises and falls in a relatively consistent manner, met by progesterone in the second half of the cycle.
However, in your 40s, the communication between the brain and ovaries changes, causing oestrogen to fluctuate more erratically.
This results in cycles that are often dominated by oestrogen, especially when ovulation (and thus progesterone production) does not occur as regularly.
These hormonal imbalances can cause heavy menstrual bleeding, making it important to consult a healthcare provider for proper diagnosis and management.
The Role of Low Progesterone in Heavy Periods
If you’ve read my previous blogs, you know that ovulation is the only way the body produces progesterone each month, and progesterone helps protect against heavy periods in perimenopause.
In the first half of the menstrual cycle, the brain releases follicle-stimulating hormone (FSH), encouraging the ovaries to release follicles (containing an egg) and increasing oestrogen levels to thicken the uterine lining.
Once ovulation occurs, the ovaries produce progesterone, which prevents further thickening of the uterine lining by oestrogen.
But if ovulation doesn’t occur, no progesterone is made to balance the stimulating effects of oestrogen, leading to “unopposed” oestrogen or oestrogen “dominance”.
This situation is more common in perimenopause and becomes increasingly frequent as you approach menopause.
Low progesterone can also contribute to blood clotting disorders, which may cause symptoms like easy bruising and necessitate consulting a doctor if periods change significantly.
Blood Clotting Disorders and Heavy Periods
Without progesterone, the result is an unusually thick uterine lining, leading to heavier, longer, and more intense periods. This excessive buildup of tissue also means that your body can’t keep up with anticoagulant activity, resulting in blood clots.
Supporting Progesterone Production
Even though ovulation becomes harder to achieve during perimenopause, it’s not impossible. There are daily practices you can adopt to support ovulation.
Supporting progesterone production can also help alleviate painful periods, which can be a symptom of underlying conditions like endometriosis.
Stress is a major factor preventing ovulation.
The brain senses any kind of stress, including modern-day chronic stressors such as financial worries, emotional burdens, and dysfunctional relationships, and doesn’t signal the ovaries to release an egg. Managing stress is vital in your 40s.
Additional Causes of Heavy Periods in Perimenopause
1. High Intake of Hormone-Disrupting Chemicals
Hormone-disrupting chemicals mimic oestrogen in the body, causing hormone imbalances and increasing your body’s total oestrogen load. These chemicals can contribute to PMS, heavy periods, and the growth of fibroids and cysts. They are found in products like plastics, personal care products, household cleaning products and detergents, air fresheners, and perfumes.
What can you do?
- Filter your water (e.g., Brita jug filter or Berkey)
- Use glass, ceramic, or stainless steel for cooking, heating, storing, and drinking
- Switch to cleaner skincare brands like Green People, Antipodes, Sukin, Jason, Ren, Neal’s Yard, Tropic, and others
- Choose cleaner household cleaning and detergent brands such as Bio-D, Method, and Attitude.
Additionally, the combined oral contraceptive pill can be an option for managing hormone levels, helping to control menstrual bleeding and period pain.
2. Iron Deficiency
What’s important to know is that heavy periods can cause iron deficiency and iron deficiency can also make your periods heavier.
What can you do?
- Get a full iron panel checked with a serum (blood) test that includes iron, total iron-binding capacity (TIBC), and ferritin. Doctors may also order blood tests to diagnose potential underlying causes of heavy menstrual bleeding, such as anemia, thyroid issues, or bleeding disorders.
- Increase iron-rich foods (heme iron) or take an iron supplement. Chelated iron is gentle and doesn’t cause gut issues like other forms of iron supplements
3. Inefficient Breakdown and Clearance of Oestrogen
Properly metabolising (breaking down and detoxifying) oestrogen is essential to prevent it from building up in your blood.
This process primarily occurs in the liver, as well as the gallbladder and the gut. You can read more about oestrogen detoxification here.
What can you do?
- Reduce and limit alcohol, as the liver prioritises alcohol detoxification over oestrogen breakdown
- Support a healthy gut and ensure daily bowel movements
4. Chronic Inflammation
Inflammation can be caused by many things, including inflammatory foods, poor sleep, alcohol, stress, blood sugar imbalance/high insulin, gut bacterial imbalances, chronic bacterial or parasitic gut infections, and autoimmunity.
What can you do?
- Remove inflammatory foods like processed seed oils, refined carbohydrates, sugar, alcohol, and cow’s dairy. Goat and sheep milk products are usually fine
- Manage stress
- Support better sleep
- Optimise gut health
5. Insulin Resistance / Blood Sugar Dysregulation
Blood sugar imbalances can lead to insulin resistance and chronic inflammation, which is a big block to ovulation.
6. Under- or Over-Active Thyroid
Get a comprehensive thyroid check, including T4, T3, Reverse T3, and thyroid antibodies, as thyroid disease can be an underlying cause of heavy prolonged periods.
7. Endometriosis or Adenomyosis
You can read more about this here.
Final Thoughts
I hope this blog post has been informative and helpful. If you’ve identified any of the areas that apply to you, you now have a starting point to address heavy periods in your 40s.
It is crucial to seek appropriate treatment to manage and treat heavy period bleeding to improve your quality of life and alleviate associated symptoms.
