Why do periods get worse before menopause?

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by Anne Henderson, ⊕ medically reviewed by Dr Rebecca Tomlinson on 5th September, 2022

Many women hope their periods will slow down, lighten and then stop at menopause… but unfortunately, this isn’t always the case. Though they can space out, periods in menopause can very often become more frequent and heavy for many women.

In this short video, our Consultant Gynaecologist Anne Henderson explains why periods can get heavier and during perimenopause, periods get closer together, and what options are available to help you manage troublesome periods.

Did you know? If you want to help to reduce troublesome periods, you might want to try organic sanitary protection. Anne also suggests keeping within the healthy BMI range, as fat actually produces oestrogen, which can make periods heavier.

Prefer to read? Here’s the text version of Anne’s video

My periods are changing – what’s going on?

Changes to menstrual flow is one of the most common symptoms that women experience from 40s onwards, but particularly as they reach the late perimenopause. Changes included:

  • Increased flow
  • Periods getting closer together
  • Increased frequency in periods 
  • Reduced frequency of periods

So in simple terms the periods can either get much closer together or can start to space out.

Women can also experience inter-menstrual bleeding – which is the technical term for spotting in between periods. And finally, they may also find that their periods become not only heavier but more painful.

Why do periods change in perimenopause?

The key trigger to the changes is changes in ovulation. This results in what we call ‘disordered hormonal flux’ during the cycle.

Instead of having a regular cyclical swing of oestrogen and progesterone each month, which most women have if they have a 28 day cycle, the hormone release can become very disordered, almost random. And that then leads to effectively random shedding of the lining without any predictable pattern.

Many women are under the misapprehension that as the lead up to the menopause their periods will actually get much lighter and they’ll have less to worry about, but sadly the reverse is true. And in fact their periods generally get heavier closer together and much more troublesome.

Getting help with periods during perimenopause and menopause

Management of heavy periods caused by menopause and perimenopause is a complex area. It’s multifactorial and it will depend on the woman’s own individual circumstances:

  • Her age
  • Her contraceptive needs
  • Her fertility
  • Her family history
  • Whether or not you suspect there is any other underlying pathology

Most problems are undoubtedly due to hormonal changes, but some women may have an underlying problem. For example with fibroids, polyps or perhaps an inflammation or infection in the womb lining. So it’s important that that group of women have appropriate investigations to exclude problems that need separate treatment.

Here are products for period support.

Practical ways to manage heavy periods

Management of heavy menstrual periods around the time of the menopause divides into three separate categories:

  1. Non-hormonal
  2. Hormonal methods
  3. Surgical techniques

Non-hormonal treatments for difficult periods

Non-hormonal treatments are those which women may have already been given by their GP or their Practice Nurse before seeing a specialist like myself. These would include drugs such as:

  • Non steroidal anti inflammatory drugs (NSAIDs) – such as ibuprofen – which can help with blood loss and pain during a period.
  • There are other drugs within this category including Tranexamic acid which is a non hormonal drug which minimises clotting and can help with heavy, difficult periods.

Hormonal methods of treatment a slightly more complex and they include:

  • The Pill – both combined and mini pill.
  • The Mirena IUS – a progesterone-containing coil – which many women may have used for contraception previously but has a separate license for heavy periods.
  • HRT (Hormone Replacement Therapy).

Many patients are surprised that HRT can be used to control heavy periods, but it can actually be one of the most effective means of treating peri-menopausal and menopausal women, particularly if they have other symptoms as well as troublesome periods.

Surgical treatments for problem periods

Surgical options are available for women who have not responded to the first two categories of treatment. They’re not for everybody, but some women do have very troublesome periods that are impacting quality of life and they need additional treatment.

The simplest form of surgical management is a procedure called an endometrial ablation. That means that the lining – or endometrium – of the womb is stripped or ‘ablated’, usually by some form of heat.

That can be enormously effective and 90% of women who have this sort of procedure may find that they either have no periods or the periods are much lighter and more manageable. So it’s certainly one of the first line treatments to consider in this category. Finally, for those women who do not respond to the other forms of treatment, we may consider a hysterectomy.

The number of women who undergo hysterectomy (in connection with difficult periods) is far lower than it was 10 or 20 years ago. It is used more in cases of cancer or precancerous lesions. But for those women who have a genuine problem, it’s still a very effective form of treatment.

Is there a natural way to manage difficult periods during menopause?

There are things that patients can do to help themselves. The first thing that I would advise patients to do is to look at the sort of sanitary protection that they’re using and consider using an organic brand rather than one of the standard brands available.

Organic products are generally made from bleach-free organic cotton which doesn’t use dioxins and other chemicals in the processing. There is quite interesting anecdotal evidence – including from my own patients – that this does help heavy painful periods.

Here are expert tips on preventing and managing period leakage

We don’t fully understand why that should be, and I would be the first to say that we do need more scientific research and more randomized work looking into it, but it’s certainly a fascinating area of interest.

The other area that women should consider is weight control, general fitness levels and general health. It’s recognised that women who have a higher BMI are more likely to have heavier periods because of the additional oestrogen production in the fat cells in the adipose (fat) tissue.

So if women do struggle with periods in the perimenopause it’s vital that they keep their weight within the ‘normal’ BMI range.

Here are some of the best over the counter period change and painful period management supplements and products.

How to get more help period changes

Your GP is your first port of call – most GPs are knowledgeable in this area. They can also make referrals for further investigations needed, and connect you with a specialist like myself who’s a gynaecologist who specifically trained in further management.

The menopause doctor you see may ask you to describe your last period, so they can understand your symptoms and determine what stage of menopause you are at.

Here is how to talk to your GP about intimate symptoms

Here are even more expert tips and advice on period changes during perimenopause.

About Anne Henderson

Our fantastic Consultant Gynaecologist Anne Henderson has worked within the NHS and private sectors for 15 years. From running large-scale menopause clinics where she helped hundreds of women access then-pioneering body identical hormones through to working with complementary practitioners to provide truly holistic care, Anne leads the way when it comes to caring, innovative, whole-woman focused practice.


Anne Henderson

Anne Henderson

Consultant Gynaecologist

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