Heavy Bleeding During Menopause: What’s Really Going On?

Menopause is a natural part of aging, but for many women, it comes with unexpected—and sometimes distressing—changes. One of the most confusing is heavy menstrual bleeding, especially during perimenopause (the years leading up to menopause).

If you're dealing with floods of bleeding, feeling unusually tired, or noticing changes in the color of your menstrual blood, you're not imagining things. There's a complex interplay between your hormones, iron levels, and even your immune system at work.

Why does this happen? —and what you can do about it using natural, herbal approaches.

What Counts as Heavy Bleeding?

Heavy bleeding (called menorrhagia) can mean:

• Soaking through pads or tampons every 1–2 hours

• Needing double protection

• Bleeding for more than 7 days

• Passing clots larger than a 50p coin

• Feeling tired, dizzy, or short of breath

This isn’t just a hassle—it's a medical issue that can seriously affect your health and well-being.

The Hormonal Imbalance Behind It

As you move through perimenopause, your body's production of the two main reproductive hormones—oestrogen and progesterone—becomes erratic.

Oestrogen: The Builder

Oestrogen encourages the growth of the uterine lining. During perimenopause, oestrogen levels may spike randomly, leading to an overly thickened lining—meaning there’s more to shed when your period comes.

Progesterone: The Balancer

Progesterone balances oestrogen. But if ovulation becomes irregular (common in your 40s and 50s), progesterone levels drop, leaving oestrogen unchecked. This leads to heavier, longer, and more erratic periods.

Iron: The Unsung Hero—and the Hidden Culprit

We often think of low iron as a result of heavy bleeding. And it definitely is. But what many people don’t realize is that low iron can also cause heavier bleeding—creating a vicious cycle.

How Low Iron Contributes to Heavy Bleeding:

Iron plays a vital role in:

• Regulating blood clotting

• Maintaining healthy blood vessels

• Supporting hormonal balance

When iron levels are too low:

• Platelet function is impaired, making it harder for your body to stop bleeding efficiently

• Blood vessels in the uterus may become more fragile and prone to rupture

• Hormonal regulation may be thrown further out of balance

So if you’re already low in iron, you may find your periods become even heavier, further depleting your stores. It’s a self-perpetuating cycle that’s very often missed.

What Menstrual Blood Can Tell You About Iron

A lesser-known sign of iron deficiency is a change in the color of your menstrual blood.

When iron levels are very low, your menstrual blood may appear:

• Paler or more watery

• Pinkish rather than deep red

• Less clotty, even if the volume is high

This is due to reduced hemoglobin—the iron-rich protein in red blood cells that gives blood its deep red color.

Iron Sequestration: When Your Body “Hides” Iron

Sometimes, your iron looks normal on blood tests—but you're still exhausted, foggy, and dealing with heavy bleeding. This might be due to iron sequestration, where your body locks iron away in storage and doesn't release it properly.

Why does this happen?

• Chronic inflammation (which increases with age)

• Hormonal disruption

• Stress or immune system imbalances

In these cases, your ferritin (iron storage) may be normal or high, but your serum iron or transferrin saturation (usable iron) is low.

Natural Support: A Holistic Approach to Heavy Bleeding

If you're looking for ways to reduce heavy bleeding and support your body without hormone replacement therapy, herbal and nutritional medicine can offer gentle but effective options.

Specific herbal remedies can be personalized and selected with professional guidance, these can be blended to help:

• Encourage hormonal balance

• Support healthy uterine function

• Promote normal clotting and blood flow

• Reduce inflammation that can contribute to bleeding

• Rebuild depleted iron stores naturally

Many women find that working with a \naturopath allows them to have a tailored natural approach to their unique needs—especially when cycles become unpredictable.

Supporting Iron Naturally

In addition to reducing blood loss, it’s critical to rebuild your iron stores:

Iron-Rich Foods:

• Red meat, liver (heme iron – most absorbable)

• Lentils, beans, dark leafy greens (non-heme iron)

• Blackstrap molasses (bonus: contains B vitamins too)

Boost Iron Absorption:

• Pair iron-rich foods with vitamin C (e.g. lemon juice, oranges, bell peppers)

• Avoid tea/coffee with meals—they reduce iron absorption

Supplements (if needed):

Supplementation of iron should only ever happen under the guidance of a qualified health care professional, as iron can become toxic if not needed, or not absorbed if supplemented incorrectly.

Final Thoughts

Heavy bleeding in perimenopause isn’t just "part of getting older"—it’s a sign of deeper shifts happening in your hormones and nutrient status. Oestrogen surges, low progesterone, and iron depletion can all fuel heavier periods. And low iron doesn't just result from bleeding—it can make the bleeding worse.

If you’re noticing paler menstrual blood, worsening fatigue, or periods that seem to be getting out of control, it’s time to seek help.

With the right herbal support, nutritional strategies, and gentle lifestyle changes, it is absolutely possible to rebalance your body naturally—and get back to feeling like yourself again.