Perimenopausal Bleeding and Heavy Periods: When Should You Consider Surgery?

Perimenopause, the transitional phase leading up to menopause, is a time of significant hormonal changes. For women, this period is accompanied by irregular and sometimes heavy menstrual bleeding. While these symptoms can often be managed with lifestyle changes and medications, there are cases where surgery might become a necessary option.

Menopause vs Perimenopause

Menopause marks the end of a woman’s reproductive years and is diagnosed after 12 consecutive months without a menstrual period. It typically occurs between the ages of 45 and 55, though some women may experience it earlier or later. Menopause is caused by a natural decline in reproductive hormones, particularly oestrogen and progesterone, as the ovaries reduce their hormone production.

Perimenopause is the transitional period leading up to menopause, lasting an average of four to eight years. During this time, hormone levels fluctuate unpredictably, often causing irregular menstrual cycles and other symptoms, such as:

• Hot flashes
• Mood swings
• Sleep difficulties
• Fatigue
• Vaginal dryness

For many women, the most noticeable change during perimenopause is in their menstrual cycles, which can become more erratic in timing, duration, and flow.

Understanding Perimenopausal Bleeding

During perimenopause, fluctuating levels of oestrogen and progesterone affect the menstrual cycle. Common symptoms of perimenopausal bleeding include irregular periods, spotting between periods, abnormal uterine bleeding, and heavy menstrual bleeding.

Abnormal Uterine Bleeding During Perimenopause

Abnormal uterine bleeding (AUB) refers to bleeding from the uterus that is irregular in volume, frequency, or duration, outside the normal range of menstrual bleeding. Many women experience AUB during perimenopause, however, AUB can also be a sign of a gynaecological condition. It’s always a good idea to visit your GP if you’re experiencing any abnormal vaginal bleeding, whether you are going through perimenopause or not.

During perimenopause, AUB is typically caused by hormonal imbalances from irregular oestrogen and progesterone levels, causing the uterine lining to build up excessively and leading to unpredictable or heavy bleeding. AUB can also be caused by the following gynaecological conditions:

• Uterine Fibroids: Noncancerous growths in the uterus can result in prolonged or heavy bleeding.
• Endometrial Polyps: Overgrowths of the uterine lining can cause spotting or irregular bleeding.
• Endometrial Hyperplasia: A thickened uterine lining due to prolonged oestrogen exposure, which increases the risk of uterine cancer.
• Thyroid Disorders: Conditions like hypothyroidism or hyperthyroidism can impact menstrual irregularity.
• Cancer or Precancerous Conditions: Although rare, uterine or cervical cancer can present with abnormal bleeding.

Heavy Period Bleeding During Perimenopause

Heavy periods are a common symptom during perimenopause that can sometimes disrupt daily life. While heavy bleeding may be common with perimenopause, just like AUB, it can also be a sign of a medical condition. Heavy periods during perimenopause can result from hormonal imbalances, uterine fibroids, endometriosis, endometrial polyps, and endometrial hyperplasia. Adenomyosis can also cause heavy bleeding and is a condition where the uterine lining grows into the uterine wall, causing painful and heavy periods.

When You Might Need Surgery for Perimenopausal Bleeding

While many cases of perimenopausal bleeding can be managed with medication or hormonal treatments, surgery may be recommended for certain conditions or persistent symptoms, such as persistent heavy bleeding, fibroids or polyps, endometrial hyperplasia or cancer, or if non-surgical treatments have failed.

Surgical Options

• Endometrial Ablation: A minimally invasive procedure that removes the uterine lining to reduce or stop bleeding, usually best for women who do not wish to have more children.
• Hysteroscopy: A camera-assisted procedure to remove polyps or fibroids causing heavy bleeding.
• Myomectomy: Surgery to remove fibroids while preserving the uterus, ideal for women desiring future pregnancies.
• Hysterectomy: The complete removal of the uterus is often a last resort and is only recommended for severe cases of fibroids, adenomyosis, or recurrent heavy bleeding.
• Uterine Artery Embolisation (UAE): A non-surgical option that shrinks fibroids by cutting off their blood supply.

When to Visit Dr Kelly Hankins for Perimenopausal Bleeding

Dr Kelly Hankins is a highly experienced gynaecologist offering compassionate and personalised treatment options for people experiencing perimenopausal bleeding. You should visit Dr Hankins if you’re experiencing heavy or prolonged periods disrupting daily life, bleeding between periods or after intercourse, or symptoms of anaemia (e.g., fatigue, dizziness, or shortness of breath).

No matter the cause of your abnormal uterine bleeding, Dr Hankins offers multiple surgical and non-surgical treatment options and always takes your needs and concerns into consideration, selecting the best options to suit your needs and comfort.

 

Perimenopausal bleeding and abnormal bleeding are common yet complex aspects of the transition to menopause. While some changes are normal, persistent or heavy bleeding may indicate underlying conditions that require medical attention.

By understanding the potential causes and treatment options, you can take control of your health during this transitional phase. If you’re concerned about perimenopausal or abnormal uterine bleeding, don’t hesitate to consult Dr Kelly Hankins for expert guidance and care. Early intervention can ensure a smoother transition and better overall health.