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  • A recent study found that abnormal menstrual bleeding during perimenopause is associated with fatigue.
  • If left untreated, heavy menstrual bleeding can lead to iron deficiency anemia, a well-known cause of fatigue.
  • Females should report midlife menstrual changes like prolonged or heavy bleeding to their doctor to discuss treatment to help ease discomfort.

Irregular menstrual cycles during midlife, or changes in the amount and duration of menstrual flow, is often a telltale sign of perimenopause.

This phase before menopause, known as the menopause transition, typically affects females in their mid to late 40s and early 50s, though the age of onset may vary significantly.

Unlike menopause, which is confirmed when a person has gone 12 months without a period, perimenopause is often characterized by abnormal menstrual bleeding.

Heavy menstrual bleeding during perimenopause can significantly impact quality of life.

Insights into Perimenopausal Fatigue and Midlife

A recent investigation has linked heavy and prolonged menstrual bleeding during midlife to increased fatigue, shedding light on why women are significantly more prone to experience debilitating fatigue during this stage.

Published in Menopause, the journal of The Menopause Society, on March 12, the study reports that one in three women in perimenopause have abnormal uterine bleeding.

Despite its commonality, the connection between abnormal bleeding in the menopause transition period and symptoms of fatigue or lowered quality of life has been under-researched.

Anemia due to iron deficiency, a treatable condition, is frequently caused by heavy bleeding and is a well-known contributor to fatigue.

“This study underscores the importance of increased clinical awareness about abnormal uterine bleeding, especially due to its frequent occurrence during the menopause transition and its link to symptoms of fatigue,” commented Stephanie Faubion, MD, director of the Mayo Clinic Center for Women’s Health and medical director for The Menopause Society.

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“It’s crucial to educate women on the potential for extended or intense menstrual bleeding during this time and the possible health implications,” she added.

Commonality of Abnormal Bleeding During Perimenopause

The onset of perimenopause is marked by a decline in ovarian function and shifts in reproductive hormones, resulting in decreased estrogen production and various symptoms akin to menopause, including:

  • hot flashes
  • sleep disturbances
  • chronic pain
  • depression and mood swings

In a recent study, researchers tracked the menstrual cycles of 2,300 midlife women over six months to assess instances of heavy or prolonged bleeding.

The study also measured fatigue-related symptoms such as feeling tired, worn out, or low in energy.

After accounting for other potential causes of fatigue, a strong correlation was found between excessive and prolonged menstruation and fatigue.

“More awareness and understanding of abnormal uterine bleeding during perimenopause are necessary,” noted Faubion in a discussion with Healthline. “Menstrual changes, including lighter or heavier periods, are common during this phase due to fluctuations in ovarian function and subsequent changes in brain neurochemicals.”

“Such changes can stimulate the brain to push the ovary into producing more estrogen than usual, leading to a thicker uterine lining and more intense menstrual flows,” she explained.

Indicators of midlife menstrual alterations, like heavy or prolonged bleeding, include:

  • irregular menstrual cycles
  • periods lasting over a week
  • exceptionally heavy flows that require frequent change of menstrual products
  • large blood clots
  • bleeding that disrupts daily activities

While often associated with hormone shifts during perimenopause, abnormal bleeding can also stem from other causes unrelated to the menopause transition, such as uterine cancer, according to Faubion.

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“It’s crucial that any abnormal bleeding be thoroughly examined as it could indicate a more serious underlying issue,” Faubion advised.

Addressing Heavy Menstrual Bleeding During Perimenopause

Authors of the study suggest that healthcare providers should evaluate energy levels in patients reporting changes in bleeding to determine the best treatment approach, particularly if anemia is a concern.

“Assessment and treatment are essential for women experiencing significant menstrual bleeding in perimenopause,” stated Faubion.

If you are worried about changes in your menstrual cycle during midlife, it’s important to seek advice from your doctor to manage this transition effectively.

Possible treatments for severe menstrual bleeding might include:

  • hormonal therapies (e.g., combined oral contraceptives)
  • non-hormonal medicines (e.g., NSAIDs)
  • progestin-based IUDs
  • endometrial ablation (a procedure to reduce menstrual flow by removing the uterine lining)
  • hysterectomy (only in extreme cases)

Your healthcare provider may also recommend self-care measures to alleviate discomfort, such as:

  • monitoring menstrual changes
  • using products designed for heavier flows
  • taking iron supplements
  • practicing stress reduction techniques
  • maintaining a nutritious diet
  • regular physical activity

“There are several options available to manage bleeding during this period. Women should not have to simply endure it,” Faubion concluded.