Are Heavy Periods and Blood Clots Common in Perimenopause?

Marked by changes in hormones and menstrual cycles, perimenopause is a phase women most-often enter into during their mid-40s – although it can begin for some women in their 30s.¹

It’s also during this time when many women may start to notice perimenopause period changes, which can include heavy bleeding, blood clots, and other related symptoms such as skipped periods or irregular cycles. With more than 78% of women ages 42 to 52 reporting a heavier than normal menstrual flow during perimenopause, periods during this transitional time may no longer resemble those experienced prior to the menopausal shift.²

Here we talk more about periods during perimenopause, common perimenopause period changes, and when to worry about changes in bleeding during perimenopause menstruation.

Are Changes in Perimenopausal Bleeding Normal?

If you’re among those experiencing unfamiliar forms of perimenopausal bleeding, you can rest assured you're not alone.

As mentioned, heavy bleeding, in addition to longer periods, are not uncommon among those transitioning into menopause, with one study demonstrating that more than 90% of perimenopausal women report periods lasting 10 days or more.³ But what exactly causes heavy bleeding and other perimenopause period changes?

As you approach menopause, your ratio of reproductive hormones, including estrogen, progesterone and testosterone, can fluctuate significantly and as frequently as month to month.⁴ Because of these specific hormonal shifts, the uterine lining may become thicker, which can lead to a change in flow as it can take more time for the uterine lining to shed.⁵ It’s also been noted that some women aren’t creating enough progesterone – sometimes referred to as “estrogen dominance” in select literature. This everchanging see-saw of hormones may not only cause heavier, longer periods, but it might also contribute to unpredictable cycles.⁶

It may also be helpful to know that in many cases, it’s not uncommon for your periods to change as you near menopause.⁷

In fact, one in three women over the age of 50 report having heavy periods, medically recognized as blood loss of more than 80 milliliters, often including blood clots during this time.⁸ So, if you’re noticing heavier or more irregular menstrual cycles, you’re likely among a majority of women experiencing a similar set of symptoms.

Common Perimenopause Period Changes     

Given the above statistics, perimenopause period changes are clearly not unusual, however they still may be disconcerting. A few differences that may be more commonly noticed can include:^9,10

• Irregular, unpredictable periods
• Spacing of 60 days or more between periods
• Skipped periods
• Shorter or longer periods
• Heavier or lighter periods

When to Worry About Perimenopausal Bleeding

Most cases of perimenopause heavy bleeding can be considered to be part of the menopause transition— but that doesn’t mean you should ignore certain changes.

If you experience the following period changes, it’s important to schedule an appointment with your healthcare provider: ^{11, 12}

• Spotting or bleeding experienced after your period
• Periods occurring closer together (more often than 21 days apart)
• Spotting after sex
• Passing blood clots the size of a quarter or larger
• Needing to change your pad or tampon after less than 2 hours

Unrelated to typical hormonal changes, potential causes of heavy menstrual bleeding, blood clots, and other period changes can range from pregnancy and miscarriage, to infection, polyps, and some cancers.¹³

That’s why it’s important to stay well-connected with your gynecologist or other, trusted healthcare provider during every stage of your reproductive life, especially when experiencing changes to your cycle and hormones that could be due to perimenopause.

How to Manage Heavy Bleeding, Blood Clots, and Perimenopause Period Changes

While you may not be able to simply erase a heavy flow or any other of the abovementioned changes, it may be helpful to gain clarity regarding what’s going on with your cycle by tracking your period using an app or calendar. This way, you may be able to identify new patterns or notice when you’ve officially reached menopause (as a reminder, menopause is defined as 365 consistent days without experiencing a menstrual period).

Other options for preparing for or managing heavy periods and other menstruation changes during perimenopause, include:¹⁴

• Always keeping pads, tampons, or menstrual cups on hand
• Getting plenty of rest
• Using heating pads for cramps
• Trying over-the-counter pain relievers
• Considering hormonal birth control
• Asking your provider about hormonal therapy
• Consuming a diet rich in iron and vitamin C

Don’t just feel like you need to struggle through perimenopause period changes. If you’re finding that heavy bleeding, cramping or longer than normal cycles are interrupting your daily quality of life, be sure to contact your healthcare provider to determine what is going on and what you can do about it.

Resources

1. https://www.mountsinai.org/health-library/report/menopause.
2. https://www.webmd.com/healthy-aging/heavy-bleeding-after-50#1-1
3. https://www.webmd.com/healthy-aging/heavy-bleeding-after-50#1-1
4. https://www.verywellhealth.com/perimenopause-periods-5190945#citation-3
5. https://www.verywellhealth.com/perimenopause-periods-5190945#citation-3
6. https://my.clevelandclinic.org/health/diseases/22363-high-estrogen
7. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
8. https://www.webmd.com/healthy-aging/heavy-bleeding-after-50
9. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
10. https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause
11. https://my.clevelandclinic.org/health/diseases/21608-perimenopause#:~:text=Irregular%20periods%20are%20common%20and,or%20accompanied%20by%20blood%20clots.
12. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html   
13. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html
14. https://www.medicalnewstoday.com/articles/325965#lifestyle-changes