Heavy bleeding: the perimenopause symptom no one mentions.
We talk about hot flushes and brain fog. We rarely talk about the bleeding.
Dr Alex Maughan, FRACGP MRCGP MBChB · 21 September 2026 · 3 min read
EXPLAINER
Heavy menstrual bleeding is one of the most dismissed symptoms of perimenopause. My patients have often seen several doctors about it before anyone suggests perimenopause could be the cause, and sometimes it's one of the only things that has changed.
Some are changing a pad every hour or two, passing clots or flooding overnight. By the time I see them, many are low in iron, tired and short of breath.
Why periods get heavier
During perimenopause, oestrogen levels often swing up and down rather than falling smoothly. As the supply of eggs shrinks, follicle stimulating hormone (FSH) rises to try to stimulate the follicles that are left. This can cause surges of oestrogen, leaving oestrogen high compared with progesterone.
That imbalance thickens the lining of the womb, which can mean heavier periods.
Heavy bleeding shouldn't be something women are told to push through.
It isn't always hormonal
There are other causes to rule out. Fibroids are the most common at this age: by 50, around 70% of white women and more than 80% of African American women will have at least one. Endometrial cancer is a rare but serious cause. That's why a pelvic ultrasound is important, to check for other possible diagnoses.
Why it matters
About 75% of women get symptoms during perimenopause and menopause, and they affect work, relationships and confidence. Heavy bleeding is part of that picture, and it deserves to be taken seriously.
- If your periods have become heavier in your 40s, it's worth asking why.
- Heavy bleeding can be a sign of perimenopause, even when nothing else has changed.
- Feeling tired or short of breath with heavy periods can be a sign of low iron. Mention it.
- A pelvic ultrasound helps check for other causes, such as fibroids.
Walk in prepared.
Five lifestyle tips for menopause, one evidence-backed tip for better sleep, and a printable worksheet to bring to your appointment.
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