Perimenopause: Should you be worried about blood clots during your period?

As if the hot flushes and mood swings weren’t bad enough, perimenopause can also cause drastic changes to your menstrual cycle.

Everyone has heard of menopause: that time for women, usually when they’re in their 40s or 50s, when their period finally stops altogether.

But have you heard of perimenopause?

This is the transition time before menopause and usually lasts a few years.

Navigating the physical and emotional changes of perimenopause can be difficult, painful and sometimes confronting – particularly if your period suddenly becomes heavy and clotty.

While blood clots are often a normal part of the process, health experts warn they can signal an underlying problem.

Here’s how to tell if you should be concerned or if nature is just taking its course.

What is perimenopause?

Menopause, or the end of your menstrual cycle, occurs when you haven’t had a period in 12 months, which happens on average at around the age of 51.

The years leading up to this are known as perimenopause.

Dr Elissa Heneike, from No. 1 Women’s Health, says fluctuating hormone levels during perimenopause can cause a range of symptoms.

“This can include irregular periods, changes to bleeding, hot flushes, insomnia, fatigue, weight gain, vaginal dryness, mood changes, breast tenderness and reduced concentration,” she says.

Perimenopause usually lasts about four years, however some women experience symptoms for five to 10 years before their final period.

What are normal menstrual changes?

During perimenopause, menstrual cycles may become longer or shorter, you may skip a period or the flow may become lighter or heavier.

Women’s Health Melbourne specialist gynaecologist Dr Tzippora Ben-Harim says these changes are a result of diminishing ovarian function.

“Almost all systems and organs in our body are sensitive to oestrogen, so each woman is unique in her transition,” she says.

Gynaecologist Dr Raelia Lew says normal blood loss is less than 80ml.

“More than this is considered excessive and over time can lead to iron deficiency and anaemia,” she says.

Dr Heneike says bleeding or spotting between periods or with sex, and bleeding if it has been more than 12 months since your last period, can be early signs of medical problems and you should see your GP.

What causes blood clots?

Dr Ben-Harim says menstrual clots, which are made up of blood and protein, are usually a normal part of menstruation.

When a woman menstruates, her uterine lining sheds and the body releases anticoagulants to help break it down.

But if the blood flow is faster than the body’s ability to produce these anticoagulants, blood clots are released.

They vary in colour from bright to dark red.

Normal versus abnormal clotting

Unlike blood clots in veins, menstrual clots by themselves aren’t dangerous, but Dr Heneike says they are often associated with excessive bleeding.

“Small clots can be common and are nothing to worry about, but if larger than a 50 cent coin they may indicate excessively heavy bleeding,” she says.

Signs of an abnormally heavy flow include large clots, needing to change your pad or tampon more than every two hours, gushing blood and bleeding longer than a week.

Dr Lew says irregular and heavy menstrual bleeding should be taken seriously, as it could be a sign of:

“A full investigation is a must, including blood work and a detailed pelvic ultrasound study,” she says.

Managing the symptoms of perimenopause

Dr Ben-Harim says hormone replacement therapy can help manage the symptoms of perimenopause, but risks include a slight increase in heart disease, stroke and breast cancer.

Dr Heneike says a healthy lifestyle, maintaining a healthy weight, a nutritious diet and limiting caffeine and alcohol can also lessen some of the effects.

“There are natural supplements and prescription medications that can help alleviate the symptoms of menopause,” she says.

Written by Dimity Barber.