Editor's note: This article was sponsored by Overlake Medical Center and Clinics.
Debilitating periods were a monthly ritual for Gemma*, a 53-year-old mother of two from Sammamish. For most of her adult life, her period brought on cramps, heavy bleeding and migraine headaches so severe that she couldn’t get out of bed; it caused her to miss work regularly.
Gemma welcomed the break from her “monthly monster” during both of her pregnancies, and hoped her symptoms would mellow over time. Instead, her periods became heavier and more painful. By her late 30s, the experience was unbearable, she says.
Like Gemma, many busy women hope they’ll leave painful periods behind in midlife, only to find that their cycles become heavier, more painful and more erratic. These changes can occur long before people notice other physiological changes typically associated with the onset of menopause, such as hot flashes or night sweats.
“In the late 30s and into the 40s, there are hormone fluctuations that cause changes with periods. Typically, we’ll see periods becoming longer, heavier and more intense,” says Katie Van Kessel, M.D., an OB-GYN with Overlake Obstetricians & Gynecologists in Bellevue.
Beginning in a woman’s mid-30s, the menstrual cycle can lengthen by anywhere from a week to as long as 90 days or more. Some women experience shorter cycles with more days of bleeding per cycle, says Van Kessel. “Some patients say they feel like they barely get a break from bleeding between cycles.”
Midlife period changes often include heavier bleeding; one study found that menstruating women at age 50 lost as much as 50 percent more blood than those between the ages of 30 and 45. Midlife hormonal fluctuations can also intensify conditions such as premenstrual dysphoric disorder (PMDD), premenstrual syndrome (PMS), bloating and migraine headaches, says Van Kessel.
The fact that these changes occur when women are in their 30s, 40s and 50s — when parenting, work and family responsibilities pile up — makes them particularly unwelcome. That’s when many women, like Gemma, decide to seek help. “Around age 38, I finally went to my doctor and asked what I could do,” says Gemma. “The pain was so bad, but now I had two kids to take care of. I couldn’t just be immobilized each month with a toddler and a preschooler running around.”
“People know what’s normal for them, but it can be hard to know what’s considered ‘heavier than normal’ or ‘too painful,’” says Van Kessel. In general, changing a pad or tampon every 30 minutes to an hour for more than 24 hours means bleeding is heavier than normal. Pain that’s not relieved by nonsteroidal anti-inflammatory pain relievers, such as ibuprofen, or is intense enough to result in missed work or school should also warrant a visit to your health-care provider, she notes.
“Anything that’s outside of your ‘normal,’ or that makes you feel like your period is changing for the worse, is a reason to come in,” she says.
A physician visit may include an ultrasound, along with a blood test to check iron levels, since anemia (low stored iron) is more common in women with heavy menstrual periods. Your doctor may also check for certain cancers; according to the American College of Obstetricians and Gynecologists, heavy bleeding can be a symptom of endometrial cancer.
Depending on a patient’s age and health history, hormonal birth control can be a safe and effective treatment for painful periods, says Van Kessel. (Patients with high blood pressure or diabetes may not be candidates for hormonal treatments, however.) Hormonal birth control, such as birth control pills or the Mirena IUD, often result in periods that are lighter and less painful. Antidepressants may be used to treat PMDD, although these medications won’t reduce physical period symptoms such as bleeding or cramping.
There are surgical options for people who don’t plan to have more biological children or who don’t want to take hormonal birth control. Endometrial ablation, an outpatient surgery that destroys the uterine lining, can stop or reduce periods. If fibroids are the source of pain, uterine artery embolization (UAE) can block the blood vessels to the uterus to prevent the fibroids from growing.
Patients who use hormonal birth control or endometrial ablation to treat painful periods may stop having periods altogether, says Van Kessel. “Once people realize that it’s really okay not to have a period every month, there’s this sense of relief. People get their lives back. I hear ‘Oh my goodness, this is great!’ all the time.”
When Gemma finally pursued treatment for her painful periods, she was interested in nonsurgical options; she’d already had two rounds of laparoscopic surgery to treat endometriosis. She opted for an IUD and was happy to find that her heavy periods, debilitating pain and migraine headaches nearly vanished. She didn’t experience any downsides, she says. The IUD lasts five years; she can forget about it until it’s time for a new one.
Her only regret? Suffering so long before getting help, she says. “I’d [choose an IUD] again in a heartbeat. I just wish I’d done it sooner.”
*Not her real name.