If you are in your 40s and noticing changes in your periods, such as cycles coming closer together, months without a period, or heavier bleeding, you may be wondering what is happening. These may be symptoms of perimenopause or fibroids, or a combination of both.
Could perimenopause and fibroids be causing your periods to change? Yes. Both perimenopause and uterine fibroids can make your menstrual cycle irregular or cause bleeding that is heavier or lasts longer.
This article explains what changes you might expect, what may be normal, and when you should seek medical attention.
What Is Perimenopause?
Perimenopause is the time that gradually leads up to menopause, when hormone levels begin to change and can cause a range of symptoms.
Some menstrual cycle changes may be considered normal, but heavy or ongoing bleeding should not be ignored. The American College of Obstetricians and Gynecologists reports that any change from your normal pattern is considered abnormal uterine bleeding and should be evaluated.
What Are Uterine Fibroids?
Fibroids are noncancerous growths that develop in or on the uterus. They are made from the same type of tissue as the muscular layer of the uterus and can be very small or exceptionally large.
Fibroids can go undetected and cause no symptoms, or they can negatively affect a woman’s quality of life, depending on their size and location. No one knows exactly what triggers their growth, but fibroids can grow larger when exposed to excess estrogen.
What Is “Normal” vs. Not Normal for Bleeding During Perimenopause?
According to the Cleveland Clinic, hormone levels during perimenopause can rise and fall unpredictably. This can change the timing of your period and the symptoms you experience. Some changes may be normal, while others should be evaluated.
Perimenopause Symptoms Usually Considered Normal
- Periods that change timing and come closer together or farther apart.
- Skipping a month and then having a heavier period the next month.
- Blood flow that changes from light to heavy from one cycle to the next.
- Spotting between periods.
- Unpredictable cycles that do not disrupt your life.
Perimenopause Symptoms That Are Not Considered Normal
- Bleeding that is very heavy or hard to contain with your usual pads or tampons.
- Periods that last much longer than usual for you.
- Continuously passing large clots.
- Bleeding that disrupts your routine at home or work or interferes with sleep.
- Frequent spotting or bleeding between your normal periods.
- Any bleeding after you have gone 12 months without a period.
Fibroids Can Cause Heavier Bleeding During Perimenopause
If fibroids are already making your periods heavier, symptoms may become worse during perimenopause. Hormone changes can alter your normal period, while fibroids can interfere with how the uterus works and cause heavier or longer bleeding.
Other common fibroid symptoms include:
- Heavy bleeding that soaks through feminine products more quickly than normal.
- Periods that last longer than seven days.
- Passing large clots.
- Lower abdominal pain or pressure.
- Frequent urination or constipation.
- Back or leg pain.
- Pain during sex.
The hormone changes of perimenopause can already make your cycle unpredictable, and fibroids may exacerbate these changes. You may notice shorter or longer cycles, a missed period followed by very heavy flow, spotting between periods, or bleeding that differs every month.
The key is to watch for changes from your personal baseline. If your period suddenly feels very different from what you are used to, talk with your doctor.
How Do I Know If My Symptoms Are From Perimenopause or Fibroids?
Fibroids and perimenopause share some symptoms, so it can be difficult to tell which is causing heavy bleeding or other changes. Certain patterns may offer clues.
Symptoms More Likely Related to Perimenopause
- Sporadic period timing, including skipped cycles.
- Bleeding that varies from light to heavy each cycle.
- Changes that come and go rather than remaining constant.
Symptoms More Likely Related to Fibroids
- Heavy bleeding during every cycle.
- Large clots or sudden “gushing” flow.
- Pelvic pressure, pain, or bloating.
- Needing to urinate often.
- Bleeding that disrupts your schedule or sleep.
When Bleeding Needs Medical Attention
Some symptoms should not be ignored because they can lead to more serious problems. Seek medical attention if:
- Bleeding is unusually heavy and lasts a long time.
- You feel lightheaded or short of breath, or your heartbeat is unusually fast.
- You bleed between periods or after sex.
- You have any vaginal bleeding after menopause.
How Doctors Normally Evaluate Bleeding in Perimenopause
Your doctor can evaluate your symptoms to help determine the underlying cause. The evaluation may include:
- A detailed review of your menstrual cycle history and symptoms.
- A pelvic exam.
- An ultrasound to check for fibroids or other conditions.
- Blood tests to check for anemia when heavy bleeding is present.
In some cases, additional testing may be needed.
What Are Treatment Options for Fibroids During Perimenopause?
Treatment depends on how severe your symptoms are and how much they affect your life. Options may include:
- Monitoring symptoms when they are mild.
- Using medications to help control bleeding.
- Procedures to stop heavy bleeding.
- Surgical options such as myomectomy or hysterectomy.
- Minimally invasive treatment such as uterine fibroid embolization, which cuts off the fibroids’ blood supply so they shrink.
Where Can I Learn More About Fibroid Treatment During Perimenopause?
The Atlanta Fibroid Center is a center of excellence for fibroid treatment, and women come from across the region to seek relief from their symptoms.
Dr. John Lipman and Dr. Sima Banerjee are board-certified interventional radiologists who specialize in uterine fibroid embolization. This minimally invasive procedure is highly effective at shrinking fibroids and relieving painful symptoms.
Dr. Lipman has spent his career raising awareness of this nonsurgical treatment option to help women avoid hysterectomy and preserve their uterus.
Set up a consultation today to learn more about UFE and whether it may be a good option for your needs and circumstances.
FAQs
What Happens with Fibroids During Perimenopause?
Fibroids may grow or remain the same size during perimenopause depending on hormone changes. Some may begin to shrink as you get closer to menopause.
Can Bleeding Caused by Perimenopause and Fibroids Get Worse Before It Gets Better?
Yes. Hormone changes during perimenopause can make bleeding less predictable. If you also have fibroids, periods may become even more irregular, heavier, or longer.
How Do I Know if My Period Bleeding Is Caused by Perimenopause or Fibroids?
The best way to identify the cause is to make an appointment with your OB/GYN. A pelvic exam or ultrasound may help find the source of your symptoms. Perimenopause often makes periods irregular, while fibroids are more likely to cause consistently heavy bleeding and painful symptoms.
Do Fibroids Shrink After Menopause?
Most fibroids shrink after menopause because estrogen levels fall, but this does not always happen right away. Some women continue to have symptoms that require treatment.
