If you have periods that last for longer than 7 days or you are losing more than 80ml of blood over the days of your cycle then your periods may be described as 'heavy'. The technical term for this: menorrhagia. Menorrhagia can be due to the hormone changes that accompany perimenopause. Diet and lifestyle can be hugely helpful for anyone with heavy periods by possibly reducing heavy bleeding and by helping to maintain iron levels.
What are heavy periods?
What does this mean practically? It's not exactly dinnertime conversation! Consensus is that a 'normal' period should be around 80ml of blood loss. A regular soaked regular pad or tampon holds 5ml or about one teaspoon; heavy holds 10ml. So 80ml across the days of your period is somewhere between 8 and 16 soaked pads/tampons. Having to change a pad or tampon more than every 2 hours means heavy and you shouldn't have to change a pad at night. Other signs of too heavy periods are doubling up with pads/tampons, clots larger than a 20c piece and/or restricting activities due to your period.
What's the problem with heavy periods?
The obvious issue with heavy periods is iron loss. Your blood holds iron which is crucial for your body to do all the things it needs to do. Signs of iron deficiency are fatigue, breathlessness, hair loss and easy bruising. It is easily tested in a blood test which your GP can order for you (test: serum ferritin).
The second reason is that it is a fairly good indicator that something isn't quite right. For example, adenomyosis, fibroids, uterine polyps or anovulatory cycles. Therefore it's definitely worth visiting your GP if you have heavy periods.
Is there something special about heavy periods in your 40s?
The answer is yes! If you are a woman in your 40s and you have heavy (or painful) periods then the most likely explanation for your heavier periods is perimenopause.
Perimenopause is the 2-12 years before you stop menstruating (known as menopause). It is a period of hormonal transition between releasing an egg 'guaranteed' every month (i.e. the 'reproductive years') to not releasing any eggs, ever (i.e. 'menopause'). The average age for women to reach menopause is 51 years in Australia. This means perimenopause typically starts around the time a woman turns 40 - but can be slightly earlier or slightly later.
During this period of hormone transition there will be some months where you do not release an egg. (fyi, Whether you get your period or not is irrelevant). Eggs come in a special packaging called the corpeus luteum. The breakdown of this packaging after the egg is released signals your body to release a hormone called progesterone.
Not releasing an egg means no progesterone and no progesterone means heavier periods.
Why? Progesterone is known as the 'period lightening hormone'. Progesterone helps to keep our periods lighter and shorter.
So as eggs stop being released and the corpeus luteum stops being broken down, then progesterone stops being made.
This is why during our 40s when we are in perimenopause our progesterone slowly declines and our periods may become heavier!
What can I do if I have heavy periods?
A common option is the hormonal IUD which can reduce flow by up to 90%! This is a reasonably good option as it may still permit some natural cycling (which without going into detail is a good thing as your body will continue to get some real progesterone). The IUD itself has a non-natural progesterone (progestin) and this may cause hair loss and mood problems. However, for many people, this is a great solution.
Managing iron levels is essential because it can lead to anemia, thyroid issues, hair loss, fatigue etc. Your GP can easily test your iron levels with a blood test. Most people know that food sources of iron are from red meat (beef, lamb) and to a lesser extent other meats (chicken, eggs, fish). Non-animal sources of iron are good too, but they are much harder to get into your body so are unlikely to do the job of replacing iron that is lost with heavy periods. I often recommend chicken liver to people trying to increase their iron levels. Liver should be the prized part of any animal, but our Western eating culture tends to avoid it. This can make eating chicken liver tricky business. But it is powerful stuff in the world of iron: one bite of liver has the same iron as an entire steak! The alternative option is to take iron supplements on alternate days to maximise absorption. There are a few nuances with type and dose of iron which are too long to mention here, but you should definitely take your iron supplements away from tea, coffee and calcium supplements and with vitamin C (e.g. capsicum, asparagus - it doesn't have to be a glass of orange juice.... in fact, please don't!) The other alternative is an iron infusion which you should discuss with your GP.
A final idea is to cut out dairy, specifically the A1 dairy protein. Does it work? I'm not yet sure, but some practitioners swear by it. The logic is that dairy stimulates prostaglandins that increase bleeding. With the increase in A2 dairy products on the supermarket shelf this is certainly something that is relatively easy to try and could do no harm.
Conclusion
I hope this gives you a little insight into diet and lifestyle options for managing heavy periods in your 40s. Perhaps try cutting out dairy A1 protein or using the hormonal IUD to reduce flow. If flow is high, but not unmanageable then make sure you keep a close eye on your iron levels. And please remember that the first port of call should always be your GP. There are lots of possible reasons for heavier periods and it is worth ruling out anything more sinister than the changing hormones of perimenopause.
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