A woman raises her arms in victory as the sun rises in front of her.
Be free of the symptoms of perimenopause. (For Spectrum Health Beat)

Any of this sound familiar?

Your periods are so heavy and irregular, you are left exhausted and weak. You never know when your period is going to appear, and during it, you can barely stay ahead of the mess. The cramps are not too bad, but once the bleeding starts, you know you are in for several bad days followed by a week of spotting. When the bleeding stops, the aftermath means being tired with less motivation to run or lift weights, let alone go for a brisk walk.

What is your diagnosis? Probably perimenopause.

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Fast facts

Causes of heavy irregular periods:
•Hypo-or hyper-thyroid
•High prolactin levels
•Polycystic ovarian syndrome
•Uterine polyps or fibroids

Options to improve heavy irregular periods:
•Maintain healthy weight
•Normal blood sugars
•Birth control pill
•Oral progesterone
•Progesterone-containing IUD

Probably is an important word as just because someone might fit the story for perimenopause, it is necessary to make sure the irregular periods are not caused by anything else.

Perimenopause is the normal life phase when periods start to change as your ovaries run out of follicles, or immature eggs. Hormone levels change and fluctuate.

The result? Irregular periods, often close together or spaced out and sometimes heavy and sometimes light. These changes can also be caused by an over- or under-active thyroid, changes in weight such as rapid loss or gain, high prolactin levels, polycystic ovary, and conditions which affect the uterus such as polyps or fibroids.

Especially in women who are overweight, with diabetes or high blood pressure, it is crucial to make sure the uterine lining is not too thick, which could be caused by pre-cancer or uterine cancer.

A patient I’ll call Molly came to see me to figure out why she felt so tired all the time.

At 48, she could hardly keep up with life, including her high school kids’ schedules, spending time with her husband beyond comparing schedules, and her full-time job.

Her work was hosting a biggest loser contest, and she felt too tired and lacked motivation to start an exercise plan or make any real attempt at eating healthy in order to lose 15 pounds. Her periods interfered with work in that she had to leave a planning meeting because she felt her period start and feared she would make a mess.

What made matters worse, she was planning for a dream trip with several families and worried about bleeding while on the trip.

Her recent blood work revealed that her hemoglobin blood count was 10 and her iron (ferritin) was 15, which prompted her primary care doctor to find her a gynecologist. She had lost enough blood on a regular basis and couldn’t take enough iron to make up what her body needed.

Her doctor ruled out thyroid or prolactin problems. She had an ultrasound and came to see me, hoping for some options to get her irregular and heavy periods to stop.

She appeared otherwise healthy except for being slightly overweight. Her cholesterol and blood sugar levels were borderline high and thyroid and prolactin normal. Her ultrasound—done after a period—showed a normal lining thickness and no fibroids or any other abnormality.

We talked about the phase of life she’s in and her options.

Because her periods were so heavy, it would be a good idea to first sample her uterine lining with an endometrial biopsy. Because she did not smoke and had no family or personal history of blood clots, she was still a candidate for the low-dose birth control pills, which could be used to help her not have her period while on a trip.

Another option: bioidentical FDA-approved progesterone to take from day 10 of her cycle for 15 days, which could make the periods more regular and light, but would not provide birth control. An IUD with progesterone could also work for her as it would give her birth control as well as control heavy bleeding.

After a good discussion about the pros and cons of each option, she chose an IUD as she also needed birth control, and we placed the IUD in time to ensure her periods would at least be better, if not gone.

In terms of the other symptoms of perimenopause, she chose to focus on a healthy lifestyle now that the periods would no longer be the issue.

She chose a schedule of short daily workouts to fit in between other obligations, having been reminded she needed to care for herself in order to care for others.

This included all of the SEEDS and supporting her system with consistent sleep, water, multivitamin, Vitamin D, iron-rich foods, calcium in her diet, exercise—a bit every day—and a short time of quiet and gratitude every day.