Menorrhagia—or heavy bleeding—is the grand finale for many women. It is the “Super Nova” event. It can turn a normal workday into a crisis scene.
Why Now?
You might think, “If my hormones are dropping, shouldn’t my periods get lighter?” Eventually, yes. But in the transition, the opposite happens. This is due to Unopposed Estrogen. Estrogen’s job is to thicken the uterine lining (like grass growing on a lawn). Progesterone‘s job is to mow the lawn. In perimenopause, you often have high estrogen spikes but no ovulation (so no progesterone mower). The grass grows wild. It gets thick, unstable, and vascular. When it finally sheds, it isn’t a trickle; it’s a landslide.
Defining “Too Heavy”
You need to know when this becomes a medical emergency.
- The Rule of 1: Soaking through one heavy-duty pad or tampon in one hour.
- The Clot Rule: Passing clots larger than a quarter (or a grape).
- The Duration Rule: Bleeding heavily for more than 7 days.
If you are changing your protection every 45 minutes, you cannot leave the house. This is quality-of-life interfering and health-threatening.
The Fixes
You do not have to “tough this out.”
- Tranexamic Acid: A non-hormonal pill you take only on heavy days. It helps your blood clot faster, reducing flow by up to 50%.
- Mirena IUD: This releases a tiny amount of progestin directly into the uterus, keeping the lining thin so there is nothing to shed. It often stops periods entirely.
- Ablation: A minor procedure that burns off the lining of the uterus.
Do not accept “it’s just menopause” as an answer for flooding. You are losing vital blood volume.