Very heavy bleeding

[JJkate]

Hi, I've always had heavy painful periods, lost between 100 to 150mls a month in my mooncup over 4 days, most of it in the middle two days. I am late 40's. I started perimenopause age 42 and it hit me like a ton of bricks age 44.

I took HRT for 2.5 years but due to progesterone intolerance making me feel suicidal I came off it gradually and stopped in December.

Since then my periods have gradually returned to being heavier again but the last three months even worse. Every three weeks and super heavy. The last one was 200mls fluid loss mostly over two days. I've always had very heavy loss over a day or two but this is worse and I'm also passing clots about two inches long.

I'm diagnosed with adenomyosis and am waiting to see a consultant but this could take 44 weeks. I react very badly to most meds and don't want to take hormones due to mental health side effects. I'm also very wary of hysterectomy as know that comes with it's own issues and often it's doesn't cure everything. I've been offered TA but loathe to take it as most meds I take affect me so badly.

Is this normal? Has anyone else had this? I don't feel like I have many options left. Is it just menopause and will stop soon? Thanks for any advice on advance :)

I had a Mirena coil when my heavy, flooding periods caused anaemia. And of course anaemia causes heavy periods as well.

It won’t stop anytime soon without treatment. If you aren’t on any sort of progesterone your endometrium may be thickened as well as the Adenomyosis. It should be a thin sheet you shed every month. You are probably getting rid of a winter weight duvet. Have you had a coil? You might not want one but it’s honestly the most effective way getting progesterone locallly delivered. And that’s what you need to stabilise bleeding.

And no it’s not normal but an awful lot of women have it. Have you got any maternity pads? V good for gushing whilst you wait to get sorted.

Hi OP,

I’m older than you and still have bleeding. I am also progesterone intolerant so I am having a hysterectomy. I wish I had done it years ago.
My best friend’s sister is an OB/gyn and they have both had hysterectomies- the Ob/Gyn said she thinks every woman should have them as she treats so many problems (cancer) in the ovaries/cervix and wombs of older women that don’t happen if it’s not there. So please consider a hysterectomy again.

If you take any oestrogen, reducing it reduces the bleeding. If not, I’m sorry I have no advice. I don’t know if there is a way to reduce the effects of your normal oestrogen.

Thanks all. I have tried progesterone in different forms but it makes me suicidal so not an option unfortunately. I am toying with the idea of mirena but think that is likely to have the same bad side effects but maybe it's worth a try if this continues.

You might do better with hrt with mirena, that covers progesterone so you’d just be needing the oestrogen. Might be a better balance. Progesterone is needed to safeguard and stabilise the endometrium, you’ll struggle with the bleeding without it unfortunately I think. The other thing to ask about is endometrial ablation as an alternative to hysterectomy. I don’t know if that’s indicated given your other condition but it has the benefit of helping the bleeding whilst leaving your womb etc in situ.

I am progesterone intolerant too but there are so many progestin options that is is very rare for someone to not be able to find a single agent that suits.

Slynd (drospirenone) is one that it can be argued is not a progestogen at all - it is derived from spironolactone. It is available alone as a mini pill.

The mirena IUS as others have mentioned can be a really good option.

If none of these are for you, there's the option of an endometrial ablation too, although this is only for bleeding, it doesn't permit the use of unopposed estrogen.

The hormones from the mirena stay local to the uterus apparently and don’t travel round the whole body in the way that they would from an injection or oral form. I have one for flooding and it’s miraculous. Easy enough to remove if you don’t want to keep it.

Maybe worth trying a mirena, although if you have any fibroids, it may not stay in (which is what happened when I tried it). I ended up having hysterectomy, after which they told me I had adenomyosis, this hadn't been picked up despite many scans and hysteroscopies beforehand.

I don't know how the heavy bleeding could have been stopped without the hysterectomy - I was taking hrt with progesterone for 2 or 3 years and it certainly didn't make me bleed less. Coming up for 2 years since my surgery and life is so much better, have not had any adverse effects such as prolapse or loss of sensation (also kept my ovaries but had tubes removed). My ferritin levels (I think they were 15 before surgery?! Hospital was totally unbothered, which was annoying) are back up. I hadn't realised how exhausted I was due to blood loss, no matter how much iron I took, it just got lost again.

Anyway, I hope that makes you feel a bit more positive about the possibility of hysterectomy. I was wary but it turned out to be the best thing I could have done.

Ps TA also did nothing at all to reduce bleeding for me, I don't think it helps if the heavy bleeding is due to adenomyosis. You mentioned progesterone making you feel suicidal, I thought I was fine with it but thinking back, I did several times feel really down and almost suicidal just before bleeding started in the year before my hysterectomy - I thought it was pmdd, maybe it was connected to taking progesterone? I take list the oestrogen part of hrt now and don't feel like this anymore.