Heavy and unpredictable menstruation is a sign of perimenopause – 06/21/2023 – Equilibrium

In 2016, Alisha Coleman, 52, an emergency call center worker in Georgia, was fired because she began experiencing a hallmark symptom of perimenopause: unpredictable, heavy periods. Once, her menses were so heavy that she bled on her clothes and onto an office chair. Another, she leaked onto the carpet. Such instances, as his employer put it, amounted to a failure to “practice high standards of personal hygiene” while on duty and were grounds for dismissal.

While Coleman’s case may be extreme, it points to a huge lack of information about perimenopause – the transition phase into menopause – and the daily challenge of dealing with a menstrual cycle so out of whack that it interferes with a woman’s quality of life. woman and her productivity, says Siobhan Harlow, professor of epidemiology at the University of Michigan School of Public Health.

(Coleman sued the company for sex discrimination, and the two sides eventually reached a settlement. Dozens of other lawsuits include allegations of sex discrimination in menstruation or menopause.)

One study that analyzed the menstrual cycles of 1,320 women transitioning into menopause found that 78% experienced periods that lasted more than ten days (the average is up to seven days). More than a third of the women in the study, which Harlow co-authored, had periods so heavy they had to change their toiletries every hour or two for more than three days. Most normal flow requires changing pads every four to eight hours.

“At this stage in life, it’s no longer true that women know when they’re going to bleed or how much they’re going to bleed,” says Harlow. Still, she adds, this symptom is rarely studied or discussed among women themselves.

Why does menstruation go crazy?

It all boils down to the irregular functioning of the ovaries, points out Malcolm Munro, professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles. In a regular cycle, the ovaries produce estrogen to nourish the egg and thicken the walls of the uterus awaiting its arrival, says Munro.

Once the egg is released, the ovary also emits progesterone, which prevents the lining from growing and changes its structure to make it a smooth landing place for a fertilized egg. If there is no fertilized egg, the ovary stops producing the hormone, which triggers menstrual bleeding. Progesterone is also responsible for stopping menstruation after a few days, he points out.

Think of the uterine lining “like the grass in your backyard,” Munro exemplifies. Estrogen acts like the water that helps the grass grow and progesterone is the equivalent of “mowing the lawn every four weeks” and keeping it tidy rather than letting it grow unchecked.

When a woman transitions into menopause, her ovaries produce less estrogen and have fewer eggs to release, which means there can be cycles where ovulation doesn’t occur, upsetting the delicate balance of hormones, says Munro.

“It’s not an intermittent circumstance,” he says, “it’s a spectrum.” In some women, it can lead to long gaps between each period because there is no progesterone. Lack of progesterone can also lead to lining buildup, which can “fall off randomly” and trigger unusually heavy periods, he says. Or, for others, there may be so little estrogen that the uterine lining doesn’t grow very much, leading to only a few splatters.

Harlow found in her study that smoking and a higher BMI (body mass index) were associated with heavier perimenopausal bleeding, although the reasons are unclear. Black women were more likely than white or Asian women to have heavier bleeding.

There are some risks associated with hormonal imbalances in women on their period. Chief among them is endometrial cancer, says Ekta Kapoor, assistant director of the Women’s Health Center at the Mayo Clinic. During the perimenopausal phase and even after a woman has had her last period, the lack of progesterone means the uterine lining can continue to grow and become abnormally thick – a condition called endometrial hyperplasia, which can turn cancerous, she says. One of the telltale signs of endometrial hyperplasia, says Kapoor, is heavy menstruation.

In cases where women have very heavy periods, Munro points out, they may also experience iron deficiency and anemia, which in turn may be linked to other common menopausal symptoms, including fatigue and brain fog.

What can you do to manage the cycle?

The first thing is to determine if your irregular period is caused by hormonal changes related to menopause or if there could be another culprit such as fibroids or endometrial hyperplasia. While there are no official guidelines on when to see a doctor, if multiple cycles are irregular and strong it’s a sign that you should seek help.

“This needs to be resolved with imaging tests or, in some cases, endometrial biopsy”, says Kapoor.

If the problem is purely hormonal, women may want to consider options for oral birth control or an IUD (hormonal intrauterine device), Kapoor says, both of which can help mitigate hormonal imbalances. Another option is to take progesterone pills. It may also be “reasonable and practical” to keep menstrual products on hand, she says.

Harlow points out that many women carry towels or a change of clothes in their purse.

If hormonal options don’t seem to work, women might consider talking to their doctors about an endometrial ablation – surgically removing the endometrial lining – to stop the heavy bleeding, or a hysterectomy. But these options are “a little drastic” and should be seen as a last resort, says Kapoor, since the transition to menopause, which can last from four to eight years, is a temporary phase of life and “often the end is at hand. View”.

Translated by Luiz Roberto M. Gonçalves