Taming the Crimson Tide: What Every Woman Needs to Know About Heavy Periods in Perimenopause
She was terrified.
She stopped me in the hall when she heard I was a doctor who helps women in perimenopause.
She ran out of her progesterone tablets and was terrified that she might have another hemorrhagic event. Her vaginal bleeding was so severe that she went to the emergency room for evaluation.
She checked out fine and was given a prescription for medroxyprogesterone. She was given a prescription that would last for 10 days and she was told to follow up with her primary care doctor.
She ran out of medication and was not able to reach her primary care doctor for a refill.
As she approaches me, she is terrified she will bleed to death without the medication.
She wants to know what will happen if she does not get the medication renewed. She believes there is something terribly wrong with her.
No one told her about the “super soaker” events that can occur during perimenopause. We talked about how these crimson tide events can be an awful but common symptom of perimenopause.
We talked about how she would be a wonderful candidate for a progesterone IUD.
After having her join the practice and completing the intake forms, I renewed her prescription for medroxyprogesterone.
I could see how much she was suffering and how worried she was that this could happen again.
We are also getting her set up with iron infusions as she was identified as having iron deficiency anemia.
Perimenopause is a transitional phase leading up to menopause, characterized by hormonal fluctuations that can cause changes in menstrual cycles.
One of the significant and often distressing symptoms experienced during this time is menorrhagia or heavy menstrual bleeding.
This condition can have profound effects on a woman’s health and quality of life, leading to iron deficiency, anemia, and severe fatigue.
The Impact of Menorrhagia
Menorrhagia during perimenopause can be severe enough to cause iron deficiency anemia, a condition where the body lacks adequate healthy red blood cells due to insufficient iron.
This deficiency can result in symptoms such as extreme fatigue, dizziness, headaches, and a rapid heart rate. Less severe cases can lead to bleeding through pads and tampons and getting on clothes or even office chairs at work. These episodes can be extremely embarrassing for women.
In some extreme cases, the bleeding is so intense that women may feel as if they are bleeding to death, prompting emergency room visits out of fear and concern [1].
Causes of Heavy Bleeding
During a normal menstrual cycle, levels of follicle-stimulating hormone (FSH) rise, causing eggs in the ovaries to mature. These egg follicles produce more estrogen, which stimulates the endometrium, the lining of the uterus, to thicken in preparation for a fertilized egg.
When you ovulate or release a mature egg, more progesterone is created, which stops the lining growth. If the egg isn’t fertilized, the drop in progesterone signals your body to shed the endometrium, leading to your period.
During perimenopause, as ovulation becomes irregular and sometimes absent, estrogen levels fluctuate wildly and can promote overgrowth of the endometrium. Progesterone is the hormone that prevents overgrowth of the endometrium, but during anovulatory cycles, there is no progesterone to stop the overgrowth.
This hormonal imbalance can lead to the thickening of the uterine lining, which may cause heavy and prolonged bleeding. Other potential causes include uterine polyps, fibroids, or even more serious conditions like endometrial hyperplasia or cancer [2,3].
Epidemiology and Prevalence
Heavy menstrual bleeding is a common complaint among women in their 40s and 50s, with studies indicating that nearly 25% of women in this age group experience menorrhagia. The prevalence of iron deficiency anemia remains high among menstruating women, affecting up to 65% of this population due to menstrual blood loss [4].
Managing Menorrhagia and Iron Deficiency
1. Medical Evaluation:
It is crucial for women experiencing heavy bleeding to consult with a healthcare provider to rule out underlying conditions such as polyps, fibroids, or cancer. Diagnostic evaluations may include ultrasounds or endometrial biopsies.
2. Iron Supplementation:
Due to the significant blood loss, dietary iron may not suffice to replenish iron stores. Oral iron supplements are often recommended, and in severe cases, intravenous iron infusions or blood transfusions may be necessary.
3. Lifestyle Adjustments:
Maintaining a balanced diet rich in iron, such as leafy greens, red meat, and fortified cereals, can help manage iron levels. Additionally, vitamin C can enhance iron absorption. Hydration is also key during this time to prevent dehydration.
4. Weight management
Fat tissue produces estrogen which can worsen metorrhagia. Focusing on gaining muscle and losing fat, especially around the midsection will help prevent severe metorrhagia.
5. Hormonal Treatments:
Hormonal therapies, including oral contraceptives or progesterone treatments, can help regulate menstrual cycles and reduce bleeding. In many cases, a progesterone-containing IUD may be beneficial.
6. Surgical Options:
For those who do not respond to medical treatments, surgical interventions such as endometrial ablation or hysterectomy may be considered to control bleeding.
Conclusion
Menorrhagia during perimenopause is a significant health issue that can lead to debilitating symptoms and affect a woman’s quality of life. Awareness and understanding of this condition can empower women to seek appropriate medical care and make informed decisions about their health. Regular monitoring of iron levels and proactive management strategies are essential to prevent complications such as severe anemia and to maintain overall well-being.
REFERENCES
[1] In the ER … Again! Heavy Menstrual Bleeding — Hormones Matter https://www.hormonesmatter.com/in-the-er-again-heavy-bleeding/
[2] Perimenopausal Bleeding and Bleeding After Menopause — ACOG https://www.acog.org/womens-health/faqs/perimenopausal-bleeding-and-bleeding-after-menopause
[3] Get help for abnormal perimenopausal bleeding — Main Line Health https://www.mainlinehealth.org/blog/abnormal-perimenopausal-bleeding
[4] Critical iron deficiency anemia with record low hemoglobin — NCBI https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439022/
