In this article written for Ask4UFE, Dr. Jerilynn Prior weighs in to clear up some of the popular assumptions and misconceptions about uterine fibroids and their association with heavy menstrual flow during perimenopause.
Heavy and irregular periods are common among perimenopausal women. And uterine fibroids are often blamed as the
culprit. But as experts and literature suggest, the cause of abnormal bleeding could be something else entirely.
According to the Journal of Steroid Biochemistry and Molecular Biology, a woman could be considered
perimenopausal if, at a certain age—usually 45 years and older, she experiences menopausal-like symptoms such as
hot flushes, achy joints, difficulty sleeping, night sweats, and changes to her menstrual cycle. For some
perimenopausal women, periods can vary between 14 and 50 days. Along with being irregular, these periods can be
abnormally heavy.
Uterine fibroids also seem to be prevalent during this stage of life. But are they solely responsible for heavy bleeding as some may think?
“Perimenopausal heavy flow is so common that it could almost be called normal. But there’s a physical reason why
fibroids causing this bleeding doesn’t make sense,” says Dr. Jerilynn C. Prior Professor of Medicine and Endocrinology
at the University of British Columbia and the Founder of the Center for Menstrual Cycle and Ovulation Research.
“Fibroids grow within the muscle of the uterine wall and most of the time they’re far from the lining of the uterus—or
the endometrium—which is what bleeds.”
A landmark study published in the Journal of American Medical Women’s Association found similar and supportive
data. Seltzer and colleagues looked at the medical charts of 500 perimenopausal women. Of those, 91 were found to
have heavy, prolonged, and irregular periods. But a closer look found that only six of the 91 women actually had
uterine fibroids.
“Fibroids and heavy bleeding can co-occur at this time because of the hormonal changes of perimenopause,” explains
Dr. Prior. “Namely higher estrogen and lower progesterone cause both heavy bleeding and fibroids to grow. During
perimenopause, estrogen is on average 30% higher and progesterone is 50% lower. This amount of progesterone is not
adequate for the amount of estrogen.”
Estrogen runs high during perimenopause because the body wants to rid itself of all potential ovarian follicles in
preparation for menopause. And every follicle makes estrogen. With each cycle, more follicles are recruited, dissolved,
and the result is higher estrogen. “Estrogen is what makes tissues grow,” continues Dr. Prior. “It makes the muscle cells
of fibroids grow and it makes the lining of the uterus thicken. But you need prog
Knowing this, what’s the first step a perimenopausal woman can take to tame her period?
Before tackling any hormonal imbalance, Dr. Prior offers an even simpler solution that can be used at any age for
heavy periods: Ordinary over the counter ibuprofen.
“There’s a balance of prostaglandins—a fatty hormone—in the uterus,” says Dr. Prior. “And if these two prostaglandins
are out of balance, that is part of causing heavy flow.” Ibuprofen is a drug that can alter this imbalance. “Taking 200-
400 milligrams of ibuprofen with each meal—breakfast, lunch, and dinner—on every heavy flow day decreases flow by
a quarter to a half. Every woman everywhere should know that.”
If a woman is still bleeding heavily and chooses hormone therapy, Dr. Prior prescribes progesterone, which shouldn’t
be confused with progestin—a synthetic form of progesterone that has been linked to breast cancer. Length of time
taking progesterone along with prescribed amounts will vary amongst women, but this regimen does show promise.
Along with alleviating heavy bleeding, “progesterone usually improves sleep and decreases anxiety and stress
responses,” adds Dr. Prior. But, she admits, progesterone can be expensive.
Reference List
- Hale GE, Hitchcock CL, Williams LA, Vigna YM, Prior JC. Cyclicity of breast tenderness and night-time vasomotor symptoms in mid-life women: information collected using the Daily Perimenopause Diary. Climacteric 2003; 6(2):128-139.
- Prior JC. Perimenopause: The complex endocrinology of the menopausal transition. Endocr Rev 1998; 19:397-428.
- Rafique S, Sterling EW, Nelson LM. A new approach to primary ovarian insufficiency. Obstet Gynecol Clin North Am 2012; 39(4):567-586.
- Burger HG. Diagnostic role of follicle-stimulating hormone (FSH) measurements during the menopausal transition–an analysis of FSH, oestradiol and inhibin. European Journal of Endocrinology 1994; 130:38-42.
- Prior JC. Clearing confusion about perimenopause. BC Med J 2005; 47(10):534-538.
