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[BrightLight]

Hello - I am super anxious today and looking for some reassurance.  I have read the page on heavy periods (Menorrhagia) and can see that this is part and parcel of the perimenopause and feel that this is what is going on for me right now.

Background : (Some of you know that I had an 'odd' period late December, it was heavy for me for a couple of days and then spotting on and off for a week or more, they decided to test hormone levels then and a high FSH came back.  Doctor advised I had been in perimenopause a while with these levels and might get a couple more periods and left it at that.  He said,  this probably explains the spotty period )

Anyway, the thing is, I feel like an adolescent and freaking out with the changes in my periods, that's what I went to the GP for and he seems sidetracked by my high FSH and still hasn't told me the parameters for 'normal' or abnormal bleeding and what is 'usual' to expect in perimenopause. After getting lots of help here, I have realised that things may continue to change, despite my GP's thoughts.  I have had strange symptoms for a year but he says these are not menopause related. 

The reason I ask is because low and behold I skipped a period in January but started one yesterday (a bit late I think but have lost track of timings).  No PMT, that is what happened last time, no particular pain, just a real sense of evacuation (sorry if TMI).

I would love reassurance that a period that is heavier than usual is expected due to low progesterone etc (not bleeding through pads and flooding, but it's not as thick as usual and seems to be fast and over in a couple of days)

I am getting health anxiety over this - first thinking I had low estrogen due to the GP and one of FSH and now thinking I have lots but no progesterone and no ovulating. This isn't a good thing long term I believe - am I ok to stop overthinking and worrying, I am SO reluctant to ask anymore questions of my GP, I want educating and he has labelled me as hypochondriac.

I have never had a heavy period in my life, so this is new to me.  I have a second FSH blood test tomorrow as per GP's plan to confirm 'menopause' - even though I need 12 months without a period to say this!

I feel quite tearful over all this, because I am not able to judge what is OK or not anymore.  I feel a bit pathetic really.  I am sure the answer might be, hormone levels will change and therefore periods.  What about ovulating, if I am not ovulating will I eventually stop having the periods when the estrogen falls low enough?  Making me ask that question again - do I need progesterone?

Thank you.

Edit:  I should add that I have only had one day of this quantity of bleeding and last time it happened, 2 days was the max, so I hope it will follow, it's the mechanism of all this that is concerning me

[BrightLight]

I just found this and totally agree

"Women need more descriptive information about the bleeding changes they can expect. We need clear guidance to help women understand what changes in bleeding patterns do and do not require medical attention."

http://www.ns.umich.edu/new/releases/22121-prolonged-and-heavy-bleeding-during-menopause-is-common

[honeybun]

Unfortunately it's part and parcel of peri.  Scant periods, missed periods and then flooding. You can expect the lot.
I went six months period free, then had a year of the bleeds from hell. Ended up needing an iron supplement and could barely leave the house for a week. Then nothing again for a few months and back to heavy bleeding. No other symptoms at this point......then eight months of no bleeding....at that point insomnia and flushes and sweats started.
Went on HRT at 49 and felt so much better.

It's best to expect the unexpected because no matter how much you research and read there is no real information of what happens to an indidual. We are all so different in what happens.

Try not to worry, you just have to take it as it comes.

I used to carry pads with me all the time for years because there was just no pattern to what was happening.


Honeybun
X

[Taz2]

It is a shock when our periods begin to change and we no longer seem to know how our bodies are going to behave BrightLight but what you are experiencing is perfectly normal and be reassured that as things go on you will become used to never being quite sure when a period is going to happen and how long it's going to last for. It can be difficult to know what constitutes bleeding which is heavy enough to demand medical attention. At my heaviest I was going through a super night-time towel plus super plus tampon every hour and a half to two hours. This would last for around a week and then tail off to normal flow over the next few days but sometimes weeks. It was embarrassing at times - ruining clothes, a friend's dining chair and a mattress at a B&B (worst feeling ever) but I did get used to it and it was not considered heavy enough to need intervention apart from a blood test to check for iron levels. My longest period lasted for over six weeks which was a nuisance and the longest time between them was nine months.

I can't help with the progesterone question as I just let things take their course and just assumed that it was hormones kicking in and out when they shouldn't which had led to the changes. Sorry that you are so anxious and I'm sure someone else will be along to give an explanation as to the mechanics of it all.

Please don't think of yourself pathetic.

Taz x 

[robotwars]

Same here, I came on in December for 8 days then no period till last Wednesday, then it arrived, really heavy and still bleeding.......
Hope this one doesn't last too long, you just never know when it's going to happen, I also carry pads in my handbag just in case................

[BrightLight]

Thank you ladies. You have helped enormously with my rising panic. It's quite dramatic flow and has thrown me a bit, bleeding is exactly what it feels like and scared me a bit. Off to the shops for supplies.

It's a real shock when all my life I've never had a single period problem, I am grateful for that

[honeybun]

I remember using two tampons at the same time plus two nighttime pads just to get out the house.
It does pass and the only good thing about it that I can think of is whilst your having bleeds you generally don't get hot flushes and sweats. At one point I would have welcomed my periods back because the sweats were worse.

Now there is a cheery thought 

As Taz says you do get sort of used to it andvitvdoes help to know you really are being very normal.

Honeybun
X

[BrightLight]

Thank you Honeybun - it really does help to here 'normal' stories from others.  I work for myself and have no mum or sister to ask these simple questions of, it makes a world of difference to share and just ask.

Taz and yourself have had some very heavy periods, I am only just starting this experience and it is certainly a case of changing my tactics, in order not to worry too much about going out - although I have not been out today! ha

Yes, a cheery thought on the night sweats   I am hoping to start my herbal supplements soon, so maybe they will help even things out a little bit, along with my mind reducing it's alarm reaction to these changes. 

[Hurdity]

Hi BrightLight

Just to add to what the others have said - and also to comment on what you said on the thread about stages of reproductive ageing - the answer re oestrogen and progesterone is in that magazine article on this website I have pointed you towards a couple of times - "The Perils of the Peri-menopause".
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

In particular these words:

Leading up to the menopause during the perimenopause, the follicles remaining are not only fewer in number but also of poorer quality and less able to respond to the stimulation by FSH. Occasionally, cycles occur where follicles have not developed fully and less estrogen is produced. Low levels of estrogen lead to menopausal symptoms, a rise in FSH, and a failure to trigger the LH surge leading to absence of egg release (ovulation). With no ovulation, progesterone production is also reduced, leading to irregular shedding of the lining of the womb and hence irregular periods. In the early stages, the ovaries fluctuate in how well they work, so that cycles may be normal some months and abnormal in others. Gradually the number of abnormal cycles increases so that eventually, no follicles develop, estrogen and progesterone production becomes very low, the lining of the womb is not stimulated at all, periods stop and FSH levels remain high. Finally, the menopause, the last period, occurs and is confirmed by having 12 months without periods.

In terms of oestrogen and progesterone then - when you missed a period, you did not ovulate that month but some stimulation of egg production must have occurred (through oestrogen and the other hormones). Because you did not ovulate you did not produce any extra progesterone and therefore did not bleed. The next cycle you obviously did produce an egg of sufficient quality which completed its development and you ovulated. You will have produced plenty of progesterone (from the corpus luteum), and the reduction in progesterone, following lack of fertilisation of this egg, caused the bleed you are now experiencing. This is heavier than normal because it is more than one month's worth of lining - but due to lower oestrogen levels - would probably not be equivalent to two of your normal months when fertile.

You mentioned that you used to get swollen ankles pre-menstrually - how long did this last for -  a week before the bleed? A couple of days before?  This will be due to the progesterone. The fact that you have also experienced the same swelling now indicates that this was a normal period for you - ie you did ovulate and produce progesterone.

Women are more prone than men to oedema. Female hormones (progesterone) tend to cause fluid retention so some women notice puffy ankles just before a period.
http://www.patient.co.uk/health/oedema-swelling

This also sounds like you are quite sensitive to progesterone or else have always produced quite a lot of it. You say you have never had a heavy period before (amazing!!) - and this supports this as well. You either did not have much oestrogen or produced a lot of progesterone or both.  You don't need extra progesterone unless bleeding becomes very heavy, although women who start HRT at this time will end up having a withdrawal bleed each month and the extra progestogen in the HRT will usually be sufficient to thin/shed the lining even in anovulatory cycles. That's my understanding anyway!

Feeling tearful is quite normal for this time in your life because of the surges and falls in these hormones - I cried buckets! I hope your symptoms don't get too bad!

Hurdity x

[BrightLight]

Thank you Hurdity - for the information and your patience - for all the explaining, my brain doesn't seem to retain the info for long   I appreciate your effort.

I think the progesterone issue came to mind as last year, when I did notice bleeding was shorter and brighter colour I read that this might be anovulatory bleeding - no follicle released and that this was due to low progesterone and sometimes if it goes on, women are given progesterone to stop the bleeding and to protect the uterus. I guess I presumed I had no follicles left (as per my Dr's assumption) and that any bleed I have will be annovulatory and really just the lining not being stable with only estrogen (?) .  I guess it doesn't really matter, I think I am just struggling that things are not working anymore plus the 'alarm' factor of heavy bleeding.

No, I have never had a heavy period, all my life they just ticked along, one day light, the next 3 normal flow, only regular tampon/pad and then tailed off - 5 days regularly, cycle has always been shorter than 28, usually 26 which shortened to 22/23 in the last year.

Today the heavy flow has stopped, now just very light bleeding, it's very different than it used to be, bright red and different quality.  This is the pattern of bleeding that took me to the Dr in January, a stop start flow, heavyish, then nothing, then starting again and then spotting.  The swollen ankles were literally for 24 hours and it was 2 days before the bleeding started.  I have always had a tendancy for a sense of water retention, generally in the stomach area, breasts, but not really the ankles. 

To be honest, I think I am still not accepting my hormones are not balanced - not accepting that things won't go back to my 'normal', I think that's the root of most of my 'problem'.  It's happening at a time of life where I am looking to turn a corner and for now, I seem to be wanting to 'fix' this problem before I continue.  Sounds a bit bonkers, but I am pretty sure that's the main problem and I am working on just accepting and moving ahead.

I feel a bit better the flow has slowed down, it was pretty heavy yesterday, just very tearful about feeling too young and unprepared for things to have 'broken' - rationally I know that this happens and it's natural, I just feel that way today.

I have been to have my second lot of blood tests this afternoon.  I have an appointment with the GP in two weeks to talk about the results and possibly HRT - he suggested this for the anxiety, I said this was my main concern - he did say he wasn't sure if it would help, but it might.

Thanks for the well wishes on symptoms - me too!   It's enough for me to accept the periods ending, I know lots of people would be celebrating  

[BrightLight]

Freaking out again   New worry

I now realise I have been having more frequent anovulatory bleeding - this is what I think is happening with the bright red/fast flow and then spotting, it is inconsistent, but not prolonged or happening regularly at this stage.  I have read this can lead to thickened lining over time (that can increase cancer risk) - I presume this is over a long time.  Can anyone explain?

I presume all women have a lot of anovulatory cycles and bleeds at this stage, so presume I need not worry? My GP hadn't explained or really listened to the type of bleeding I was complaining of in January that has just happened again - I am pretty sure this is to be expected and only concerning long term, but just checking




"In the perimenopausal years, decreased ovarian sensitivity to FSH and LH renders estrogen levels insufficient to produce the LH surge and ovulation. The corpus luteum cyst therefore does not form, so progesterone is not secreted. Progesterone not only stimulates ovulation, it blocks estrogen's ability to increase endometrial growth. In the absence of the LH surge, then, the follicles continue to produce estrogen, and the endometrium grows and thickens. Eventually the endometrium will outgrow its vascular support and shed, causing unpredictable medium-to-heavy bleeding.

Due to the lack of progesterone, there is no vasoconstriction of the spiral vessels within the endometrium and no orderly collapse to induce hemostasis as in normal menstrual bleeding. As a result, the bleeding can be spontaneous, heavy, and prolonged. Conversely, bleeding may be very light if estrogen release is too low to allow the endometrium to grow."

[honorsmum]

Have a look at Taz' s link on the other board - might answer your question?

[dahliagirl]

Sounds like mine.  I particularly disliked the ones with sudden bleeding and cramps on the afternoon of day 3

It has gradually improved over the last 10 months on elleste, then femoston 1/10.  I have predictable bleeds, that are reducing (I hope  )

Every time I went on a holiday, I bled.  Got good at looking for sanitary protection and ibuprofen in other languages.

[Briony]

I really feel for you as I know I would have reacted in exactly the same way, BrightLight. Have you got any further with changing GP? You deserve answers and support - not the dismissive arrogance you're currently subjected to.

I know you're undecided on HRT and I totally understand why. For me too, it was a last resort - though one I am now glad I accepted. My only problem was that being younger, and in peri menopause, the HRT wasn't powerful enough to control my hormones and I still had problems. I have now changed to Qlaira, designed specifically for women in our situation, and so far, I am pretty pleased with the results. (Biggest difference being increased positivity and reduced anxiety). This pill  is recommended especially for ladies with heavy or erratic periods, hence the reason I thought of mentioning it to you.

I have always been anti the pill, so it's ironic that I am now here singing its praises and find myself taking it at a time most people would consider 'old' for COPs, but my GP and the FPC both suggested it as the best option for a lady in her 30s or 40s who still needs higher levels of hormones. It has natural estrogen like HRT (the only pill which does ) and a synthetic progesterone. It's a new four phase pill with lower levels of hormones than any other, I believe. Could be worth investigating , assuming you haven't already.

Really hope you get some answers (and relief) soon.   B x

[BrightLight]

Thanks everyone - apart from the first day and a half of horrible fast flow, everything tailed off like it used to.  There is no pain or cramping with my periods, which is a plus.

Hi Briony
Thank you for your support.  I haven't changed GP yet, I really don't know why I have continued with the process with the current one.  I just thought I would follow through with his idea of 2nd FSH and then a chat about HRT. I have the forms to fill in for a new surgery, it takes a few weeks to switch, so I will do this after my final appointment with the current GP.

I think my main brain ache is what to treat?  I am sure from reading through the site that my symptoms are not nearly as severe as others.  For instance I am not sure how to tell if my bleeding would be defined as heavy, erractic or irregular - I'm not sure they are, compared to others.  I have only had one skipped period and this last bleed was sort of where it would have been in the calendar.  No bleeding at random points so far...

It is hard for me to decide what to treat because most of my life I do sort of adapt and put up with things unless they are really horrible and hanging around.  So far, most of my 'hormone' symptoms have shifted after a couple of days or even hours. Or maybe I am just learning to live with them - hmmm  I am a bit lost with it right now.  My anxiety rises when something 'new' happens and once I realise it is just more change, I seem to cope better.

Briony, I am glad that you are settled with your own care, I think I am nearly there with decisions for my own, but not quite.