Menorrhagia During Menopause Transition

During perimenopause, ovulation may become less predictable. This can make periods closer together, further apart, longer, or heavier. Heavy bleeding can also be associated with fibroids, adenomyosis, polyps, or changes in the womb lining, so age or cycle changes should not be used as the only explanation.

Repeated blood loss may lead to iron deficiency anaemia. Tiredness, dizziness, headaches, breathlessness, or a pounding heartbeat deserve attention, especially when they affect work, sleep, or activity.

Keep a record of dates, flow, clots, pain, bleeding between periods, and any bleeding after sex. Arrange a medical appointment if flow is newly heavy, lasts longer than usual, or keeps returning. Mention contraception, hormone treatment, medicines, and whether pregnancy is possible.

A clinician may recommend blood tests, a pregnancy test, examination, or imaging. Treatment can include bleeding-reducing medicine, hormonal options, iron replacement, or treatment for a structural cause. The right choice depends on your health and whether you still want pregnancy.

Get urgent help if you feel faint, severely weak, short of breath, confused, or have chest pain, severe pelvic pain, or rapidly heavy bleeding. Any bleeding after menopause should be checked promptly, even if it happens once.

Does this pattern fit perimenopause, or should another cause be checked? Do I need an iron test? Which treatment suits my symptoms and contraception needs? What bleeding pattern should trigger urgent review?