In my last post on the topic of heavy periods after 40 I explained why they're such a common occurrence in perimenopause (if you’d like to read my last post you can click here to catch yourself up).

I made some suggestions in that post that may help reduce the symptoms of heavy bleeding, prolonged bleeding, and painful periods.

These highlighted the importance of prioritising and improving sleep and optimising your lifestyle (exercise, stress management etc.), and I mentioned some herbs and supplements that may help support your body through the transition.

The hormonal workings of your body is like a symphony orchestra - lots of different parts working together to create something truly amazing (you). But an orchestral performance becomes great through practice.

Similarly, your body also needs time to practice in order to perform at its best. Most of us have been forcing our bodies to operate under crappy conditions for years (late nights, lots of stress, lots of coffee, skipping breakfast, a little too much booze … you get the idea).

We need to give it a grace period while we provide better operating conditions.

The general rule when trying to influence the hormones is to adhere to the treatment plan for 3 cycles before expecting to see significant changes.

So, when should you see your doctor about heavy bleeding?

You should see your doctor as soon as you start to experience a change to your bleeding patterns, even if you think it’s just perimenopause.

Now, some of you may be wondering why I didn’t say that in my previous post on this topic? And it’s a fair question.

Often when women present to their doctor with these symptoms they’re made to feel crazy and dramatic. They report feeling as though the doctor didn't really listen to them, fobbed them off, and told them they're "too young" to be in perimenopause.

They'll also usually be *offered (*read: pushed into) synthetic hormones (in the form of birth control) that doesn't address what is actually going on, and a lot of the time the doctor will suggest they throw in an antidepressant.

The pill or hormonal IUD control symptoms in a very simple way: they shut down or limit the function of your own naturally cycling hormones. These hormones that we naturally produce, they’re good for us. Turning them off may deal with the symptoms, but this comes with consequences.

For some women who are experiencing significant blood loss and protracted bleeding, a Mirena IUD might actually be their best option. But I frequently hear that an IUD or the Pill has been put forward as the ONLY option, and without a clear explanation of how they work or the inevitable side effects and potential for rebound symptoms.

I want women to know the information from my last post before they present to their doctor.

I want women to know that if you’re in your mid to late 30s or early 40s you’re NOT too young for it to be perimenopause.

I want women to know that increased bleeding is very normal at this stage, but not something you simply have to suffer through because “it’s just part of womanhood”.

I want women to have the confidence to push back when your doctor offers you synthetic hormones in the form of birth control, and tells you it’s the only option to help you.

All that being said, an increase in bleeding needs to be investigated and this usually involves an internal ultrasound to check the vagina, uterus and ovaries. It could also be beneficial to get a comprehensive blood test to check iron studies, reproductive hormones, thyroid and liver function and insulin resistance.

However keep in mind these blood tests are to rule out any serious disease or issue with an organ and not to tell you if you’re in perimenopause. (Click here to watch a video where I explain the problem with blood tests and why being told “your blood work is normal” doesn’t mean everything is fine).

Hormone levels vary significantly, not just day-to-day but even hour-to-hour, so a blood test may or may not be helpful when assessing for perimenopause. As a practitioner it’s often far better to listen to the lived experience of the person in front of you to help you make your diagnosis. Still, if its been a while since your last blood test it doesn't hurt to pop the hood and take a look underneath.

Other causes of increased vaginal bleeding include fibroids or polyps (which are masses or benign tumors in the lining of the uterus), endometriosis, and even potentially uterine cancer.

It’s important to get an assessment because some of these conditions can lead to serious complications if left untreated.

If your investigations rule out anything significant, then you may be offered the Pill or the Mirena IUD to manage your symptoms.

Depending on the severity of bleeding and your personal circumstances this may be something you want to consider. But before you do please take some time to listen to this podcast that I recorded with my friend, sex educator Freya Graf where we discuss how synthetic hormonal birth control actually works and talk about some of the (shocking) side effects.

Click here to listen on Apple Podcasts.

Instead of birth control, you can try implementing the suggestions in my previous blog post. If you make the changes and find that you’re still struggling a few months later, it may be time to make an appointment with a women’s health practitioner to guide you through the process.

A special word on endometriosis…

Endo is a complicated condition and currently has a diagnostic delay of 7-9 years. That’s fancy speak for saying that it takes almost a decade for a person living with endometriosis to be diagnosed.

Endometriosis is oestrogen dependent, which means symptoms may worsen during the time of perimenopause where oestrogen levels can be at all time highs, as well as *relatively* higher in the presence of declining progesterone.

Endometriosis cannot be diagnosed via ultrasound. It requires a surgical procedure called a laparoscopy.

Ideally the procedure should be performed by an advanced trained laparoscopic surgeon who has undertaken more extensive training than a general surgeon, and who has developed the complex skill set required to successfully perform an endometriosis laparoscopy.

As always - thanks for reading, I hope you found something helpful in this post and if you think it could help a friend please don’t hesitate to share it.

Interested in working together? Contact me here and let’s get you on the path to feeling and living at your best!