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Dr. Jerilynn C. Prior, Scientific Director, Centre for Menstrual Cycle and Ovulation Research

Ask Jerilynn |

Heavier Flow in Perimenopause

I am 49 and have had a regular light period all my life. I have 3 children and do not use oral contraception. Recently I have been experiencing large clots and heavier flow. It is the clots that concern me because I have never seen this before. Should I seek the help of a gynocologist?


Thank you for your question. It is quite common for women in perimenopause, which you probably are, to have heavier flow and with that go clots. Often menstrual cramps also increase.

The only worrisome problem about clots and heavier flow is if it means that you are at risk for a low blood count (anemia) because of loss of iron. An indicator of that is use of 16 or more soaked normal-sized pads or tampons in one full period. Often the reason for heavy flow in perimenopause is that estrogen levels are high and progesterone levels are low or the time of progesterone in the cycle (luteal phase) is too short. These hormonal changes also cause the increased cramps.

I'd look at “Very Heavy Menstrual Flow” for some suggestions. If it persists you should tell your doctor, get a blood count and probably start cyclic progesterone therapy.

The good news is that periods and all of the changes of perimenopause will eventually go away and you will graduate into menopause.

Hope this is helpful to you.

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