What's really happening
Your cycle is trying to keep up with fluctuating hormones—and it shows. Periods can become more painful, heavier, closer together, farther apart, or disappear entirely for months at a time… then suddenly return with a vengeance. It’s frustrating, confusing, and totally normal in perimenopause.
But why?
Ovulation becomes less regular, so estrogen and progesterone get out of sync—causing unpredictable and often heavier periods.
Scientific Breakdown
In perimenopause, the ovaries don’t ovulate every month. Without ovulation, progesterone levels drop, and estrogen can still spike. Estrogen builds up the uterine lining (endometrium), and with no progesterone to hold it in check, it can shed unpredictably—causing spotting, heavy flow, or extended periods. This hormone imbalance is also why cramps can feel more intense: estrogen stimulates uterine activity, and without progesterone’s calming effect, contractions (and discomfort) can increase.
• ↓ Progesterone = less regulation of bleeding = heavier or longer periods
• Estrogen spikes = thickened uterine lining = clots or sudden flow
• Missed ovulation = anovulatory cycles = skipped or erratic periods
Essentially…
Think of your period as a dance between estrogen and progesterone. In perimenopause, they’re out of sync—and your uterus responds to the chaos.
See a doctor if …
• Bleeding lasts longer than 10 days
• You’re soaking through a pad or tampon every hour for several hours
• You’re passing large clots regularly
• You experience new or extreme pain
• Fibroids
• Endometriosis
• Thyroid issues
• Endometrial hyperplasia or (rarely) cancer
Frequently Asked Questions (FAQs) about
Menstrual Cramps & Period Changes
Q: Is it normal to have really heavy periods in your 40s?
Yes—but that doesn’t mean it’s ideal or untreatable.
Q: Can HT help with cramps and irregular cycles?
Yes—especially progesterone-based therapies and hormonal IUDs.
Q: What if I don’t want hormones at all?
You still have great options—like NSAIDs, diet, and lifestyle shifts.
“I used to dread leaving the house during my period. I finally asked about a hormonal IUD, and now I barely bleed at all. I feel in control of my body again.”
— FLUXX community member, age 46
FLUXX Recommendations
1. Track your symptoms and cycle (even if it’s irregular)
2. Ask about progesterone or hormonal IUD to regulate bleeding
3. Support iron levels if flow is heavy or prolonged
Non-Hormonal Medications
• NSAIDs (e.g., ibuprofen or naproxen) to reduce pain and bleeding
• Tranexamic acid (by prescription) to slow heavy flow
• Magnesium, turmeric, or ginger to ease cramping and inflammation
• Evening primrose oil and omega-3s for hormonal support
• Acupuncture and seed cycling (limited evidence but widely used)
Lifestyle Suggestions
• Anti-inflammatory diet (whole foods, leafy greens, low sugar)
• Gentle movement or heat therapy for cramps
• Manage stress: cortisol can exacerbate hormonal imbalance
Myth-Busting
You don’t have to “wait it out” or just “let it run its course.” Heavy, painful, or erratic periods can and should be treated.
Modern Guidance
HT, birth control pills, or a hormonal IUD can help regulate cycles and reduce symptoms. Keep track of timing, flow, and changes. If anything feels extreme or worrisome, ask for an ultrasound or hormone panel.
Ask yourself
• “Are your periods heavier or just irregular?”
• “Do you want to preserve your cycle—or suppress it altogether?”
• “Are you open to hormonal options or looking for organic approaches first?”
Ask your doctor
• “Would progesterone or an IUD help with my bleeding?”
• “Do I need bloodwork or an ultrasound?”
• “What are my non-hormonal options if I’m not ready for HT?”
Most hormone therapies for cycle regulation are safe and effective for women in their 40s and 50s—especially if started early.
