Why are my periods so heavy and irregular at 45?

Question

Hello doctor,

I am 45 years old and have been experiencing very heavy periods on and off for more than two years. My bleeding usually lasts longer than seven days, and for about two to three days, it is so heavy that both a heavy-flow tampon and a sanitary pad become soaked within an hour.

My cycles are also irregular, and I sometimes miss my period for one or two months in between.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query.

At 45 years old, experiencing very heavy, prolonged, and irregular periods for the past two years is most commonly related to perimenopause. During this phase, hormonal fluctuations can cause skipped cycles at times and very heavy bleeding at other times.

However, bleeding that soaks through a heavy-flow tampon and pad within an hour is considered significantly heavy and should not be ignored. Such heavy bleeding can also be caused by conditions like

Uterine fibroids are non-cancerous growths of muscle tissue in the uterus that can increase menstrual flow and cause prolonged periods.
Endometrial polyps are small, soft overgrowths of the uterine lining that may lead to irregular or heavy bleeding.
Adenomyosis is a condition where the inner lining of the uterus grows into the muscular wall, often causing painful and heavy periods.
Thickening of the uterine lining, called endometrial hyperplasia (an overgrowth of the uterine lining usually due to hormonal imbalance, which can result in excessive bleeding and sometimes requires further evaluation to rule out precancerous changes).

Since this has been ongoing for quite some time, there is also a real risk of anemia (a condition where low red blood cells or iron levels cause tiredness, weakness, and dizziness, often due to heavy blood loss), especially with repeated heavy blood loss, even if you are already taking iron supplements like Dexorange(a combination of Ferric ammonium citrate, Folic acid, and Cyanocobalamin).

I strongly recommend that you consult a gynecologist for a proper evaluation. This should include a pelvic ultrasound to look at the uterus and lining, and given your age, an endometrial biopsy may be advised to rule out any precancerous (meaning not cancer yet, but it could become cancer if not treated) changes. It would also be important to check your hemoglobin and iron levels to assess whether the heavy bleeding has affected your blood count.

Treatment depends on the underlying cause and may include hormonal therapy such as Progesterone tablets or a hormonal IUD (intrauterine device), medications specifically to reduce bleeding, or, in some cases, surgical options if required.

In the meantime, continue taking your iron supplements regularly, include iron-rich foods in your diet, and watch for symptoms of severe anemia such as extreme fatigue, dizziness, palpitations, or shortness of breath. Please do not delay evaluation, as heavy bleeding for this long deserves proper medical attention.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern.

I have carefully reviewed your symptoms along with the lab reports you shared (attachments were removed to protect the patient's identity), and the findings are quite significant.

Your reports clearly confirm that you have developed iron deficiency anemia (a condition that happens when your body does not have enough iron to make healthy red blood cells), most likely as a result of your prolonged heavy menstrual bleeding. This is reflected in your low PCV (36.4 %), low mean corpuscular volume (75.4 fL), and low mean corpuscular hemoglobin (24.6 pg).

These values indicate that your red blood cells are smaller and contain less hemoglobin than normal, which is the typical pattern seen in anemia caused by iron loss. In simple terms, your body is struggling to produce enough healthy red blood cells to compensate for the ongoing blood loss during your periods.

It is also important to understand that while your anemia has been confirmed, these tests do not identify the root cause of your heavy bleeding. The reassuring part is that your thyroid levels (TSH or thyroid-stimulating hormone) and reproductive hormones (LH or luteinizing and FSH or follicle-stimulating hormone) are within the expected range for your age, which means they are unlikely to be the primary cause of your symptoms. This makes it even more important to evaluate the uterus itself for possible structural causes.

The next essential step would be to undergo a pelvic ultrasound to check for conditions such as fibroids (non-cancerous growths in the uterus), polyps (small growths in the uterine lining), or adenomyosis (when the uterine lining grows into the muscle wall), all of which can cause heavy menstrual bleeding.

Please continue taking your iron supplements (Dexorange, a combination of Ferric ammonium citrate, Folic acid, and Cyanocobalamin) as prescribed, as they are necessary to correct the anemia.

However, remember that iron treats the result (anemia) and not the source (heavy bleeding). The underlying cause of the bleeding must be addressed by a gynecologist to prevent the anemia from worsening and to rule out any serious concerns.

I hope this helps.

Please revert in case of further queries.

Thank you.