Heavy periods are common in perimenopause, but common does not mean something you have to accept and endure — especially if bleeding is affecting your ability to leave the house.

Medically heavy bleeding is defined as soaking through a pad or tampon in under two hours, passing blood clots larger than a 10-rupee coin, or bleeding for more than seven days. If any of these apply to you, please see a gynaecologist.

The mechanism: perimenopause involves increasing numbers of anovulatory cycles — cycles where ovulation doesn’t occur. Without ovulation, progesterone is not produced in the second half of the cycle. Oestrogen continues to build up the uterine lining without progesterone’s balancing effect. The result is a thicker lining that sheds more heavily and sometimes irregularly.

The first step in evaluation is a pelvic ultrasound to check the uterine lining thickness and look for fibroids or polyps — both of which are common and treatable causes of heavy bleeding. A blood count will tell your doctor if you are anaemic from the blood loss (many women are without realising it).

Treatment options that actually work: prescription tablets taken during the heavy days to reduce blood loss (not a hormone), progesterone tablets (thin the lining over time), a hormonal intrauterine device (a small device fitted in the uterus by a gynaecologist that releases a low dose of progesterone and dramatically reduces bleeding for most women), and in some cases a minor procedure to thin the lining (endometrial ablation). Heavy periods with this level of impact on your life are a medical problem with very effective solutions.