Did you know that perimenopause is the period before your periods completely stop for 12 months consistently? It’s a period that can last between 7 and 10 years, and for most women will start at any time from 35 and 45 years.What you likely don’t know is that menopause actually is no longer than one day as it is the state where you have ceased menstruation, and then become ‘post-menopausal’ thereafter. But when it comes to our periods and the menopause, what does this mean?
Perimenopause brings with it a plethora of symptoms that often creep up and can take us by surprise – and unfortunately, cause confusion and a feeling of ‘what on earth is going on?’ which will be a relatable for a lot of us. There’s a misconception that as we draw closer to menopause that our periods will sort of ‘dry up’, and tail off, getting lighter each month.
Unfortunately, this is far from the truth – in fact, perimenopause can cause havoc with our monthly bleed – for some women they experience irregularity and unpredictability, and for others they find themselves prone to flooding. The disparity in symptoms shows us the importance of knowing what to expect during this phase of our lives.
Why are our periods often heavier in perimenopause?
As we start to experience perimenopause, you’ll notice familiar symptoms such as brain fog, hot flashes and night sweats. There are around 45 agreed symptoms of menopause, and one of these can be fluctuations in our menstrual flow and cramping. But if you start to experience heavy periods, and flooding, it can make you feel self conscious, anxious and concerned about what’s happening.
Clara, 43, started to experience flooding just after her 40th birthday. “My periods were always light before, I didn’t experience flooding, ever. So when I bled through my skirt onto the dining chair I was worried I was haemorrhaging or something, and it was terrifying.” Clara started carrying spare pants and clothes around with her, but the anxiety of flooding affected her work. “Luckily this started just as we all went into Covid lockdown so I didn’t need to leave the house. Believe me, it would have really affected my life if I had had to get to grips with it in the office everyday.”
What Clara hadn’t realised was that this was an indication of her hormones imbalancing; especially oestrogen levels declining. And what Emma really hadn’t realised is how little women talk about periods and the menopause, even amongst her close-knit group of friends. That left her feeling lonely, and even a bit ashamed.
So what causes this flooding to happen?
Oestrogen, often referred to as the primary female sex hormone, exerts profound effects on the female reproductive system. It stimulates the growth and proliferation of the endometrial lining, preparing the uterus for potential implantation of a fertilised egg. In perimenopause, oestrogen levels can fluctuate unpredictably, sometimes surging to disproportionate levels in relation to progesterone, a phenomenon known as oestrogen dominance.
This imbalance sets the stage for a series of events that contribute to heavy and painful periods. Oestrogen imbalance can prompt excessive growth and thickening of the endometrial lining, a condition known as hyperplasia. As the endometrium becomes increasingly thickened, it outgrows its blood supply, leading to inefficient shedding during menstruation. The result? Prolonged and heavy bleeding, accompanied by intense cramping and discomfort. Periods and the menopause can be a tricky duo, indeed.
Oestrogen dominance can also exacerbate inflammation within the reproductive organs, further intensifying menstrual pain. Prostaglandins, hormone-like substances released during menstruation, stimulate uterine contractions to expel the uterine lining. Elevated oestrogen levels can amplify prostaglandin production, leading to more intense and prolonged contractions, culminating in heightened menstrual pain.
The onset of perimenopause marks a pivotal juncture in a woman’s reproductive journey, characterised by the gradual cessation of ovarian function. The accompanying hormonal shifts, particularly fluctuations in oestrogen and progesterone, play a central role in disrupting the delicate balance of the menstrual cycle. Oestrogen imbalance often results in hyperplasia of the endometrial lining and subsequently, heavier menstrual bleeding.
The ‘supersoaker event’ years
Dr. Jen Gunter, a Canadian gynaecologist and author of “The Menopause Manifesto,” describes this phase for women as a “supersoaker event” – episodes of bleeding so intense that they can saturate clothing, overwhelm even the most absorbent tampons and pads, and necessitate iron supplementation or, in severe cases, confine individuals to their homes. The reality is that women rarely discuss this issue publicly – after all, menstrual blood is still viewed as ‘gross’ in western society, with women shamed for discussing periods in many circles. Despite public figures such as Michelle Obama sharing their menopause hot flushes, heavy bleeding continues to be a hush-hush taboo topic.
From debilitating cramps and bloating to fatigue and mood swings, the ramifications of heavy bleeding and these ‘supersoaker events’ extend beyond just menstrual discomfort. The occurrence of flooding episodes, characterised by sudden, copious bleeding, introduces additional challenges, both practical and psychological, for affected individual and often, with painful cramping combined it can stop women in their tracks and limit activities during their ‘time of the month’. Women grappling with unpredictable bleeding may find themselves contending with missed workdays, social engagements, and a pervasive sense of unease regarding potential public embarrassment. Such experiences underscore the need for a more nuanced understanding of menstrual health and empathy towards those navigating this phase of life.
Can it be managed?
Managing heavy flow might not seem particularly easy – and the truth is that unless the hormone imbalance is managed, it’s likely that the flooding will continue. From a nutritional standpoint, prioritizing a diet rich in essential nutrients, complemented by regular exercise and stress management techniques, can mitigate hormonal fluctuations and alleviate symptoms. Additionally, supplementation with vitamins and minerals known to support hormonal balance may offer supplementary relief.
If you are in search of comprehensive symptom relief, hormone replacement therapy (HRT) is a sound option to discuss with your GP, who can advise the best course of treatment. Alternatively, speaking with a menopause specialist can help.