For many women, progesterone replacement therapy is the best treatment for perimenopausal bleeding irregularities.

Why Progesterone Therapy Could Be the Best Treatment for Perimenopausal Bleeding Irregularities

by Charlotte

Most women are used to experiencing hormonal fluctuations. Since puberty, our bodies become accustomed to the ebb and flow of estrogen and progesterone that guide the reproductive cycle. The changes are routine and familiar. We come to know what to expect. But perimenopause can change that, as it introduces new and foreign hormonal states.

Perimenopause is the time leading up to menopause, when the hormonal transformation that eventually leads to the latter starts. This can begin as many as 10 years before menopause, when a woman is in her late 30s or early 40s, although the average age is 47. While the transition is relatively uneventful for some, for others it can bring significant physical and emotional challenges that often go unaddressed. 

Some of the most common symptoms of perimenopause that may require treatment are excessively heavy, prolonged, or frequent menstrual bleeding as well as spotting. While these symptoms are prevalent, they are not necessarily benign; perimenopausal bleeding patterns can be uncomfortable, painful, and may even carry potential health risks. As such, getting the best treatment for perimenopausal bleeding irregularities can be crucial to your well-being. For many women, that treatment is progesterone therapy.

Recognizing Common Perimenopausal Bleeding Patterns 

Each woman has a unique journey toward menopause. For some, perimenopause is marked by severe hot flashes and mood swings. Others lose interest in sex, can’t sleep, or develop severe PMS. And there are still others who seem to escape nearly all the symptoms perimenopause can bring. But irregular periods are a virtually universal experience. In fact, many in the medical community consider irregular periods to be the single defining feature of perimenopause. 

The irregularities associated with perimenopause typically include longer or shorter cycles, longer or shorter periods, and lighter or heavier bleeding, most of which are not cause for concern or distress. However, most women will at some point—and, sometimes, for prolonged periods of time—experience a marked and potentially disruptive increase in the number, duration, and severity of bleeding episodes. According to a groundbreaking 2014 study by researchers at the University of Michigan:

[O]f the more than 1,300 women ages 42-52 in the study, 91 percent recorded 1-3 occurrences in a three-year period of bleeding that lasted 10 or more days, nearly 88 percent reported six or more days of spotting, and close to 78 percent recorded three or more days of heavy flow. More than a quarter of the women had as many as three episodes of the 10+ days of bleeding in a six-month period.

While the ubiquity of such perimenopausal bleeding patterns can be comforting to those who worry their symptoms automatically point to a serious medical issue separate from perimenopause, it doesn’t suggest that the patterns are inconsequential. Rather, it demonstrates that even “normal” experiences of perimenopause commonly include disruptive bleeding, and many women may potentially benefit from intervention. 

Other Health Conditions Linked to Abnormal Bleeding 

It is important to note that not all changes in bleeding patterns during perimenopause should be assumed to be the result of “normal” hormonal transition. Although many types of menstrual irregularities can be attributed to perimenopause alone, these same irregularities can sometimes point to health problems, including conditions that are triggered or aggravated by fluctuating levels of estrogen and progesterone. Some of the most common conditions that can cause changes in your bleeding patterns include:

  • Polyps: non-cancerous growths on the uterine lining or wall
  • Endometrial atrophy: thinning of the uterine lining caused by low estrogen
  • Endometrial hyperplasia: thickening of the uterine lining caused by disproportionately high estrogen

Unfortunately, women often do not immediately realize that they are experiencing symptoms of these conditions precisely because they can mimic the symptoms of perimenopause. As a result, diagnosis and treatment may be delayed, leading to unnecessary suffering and, sometimes, the development of even more serious health problems. 

Regardless of whether you think you have one of these conditions, it is always a good idea to consult your health care practitioner about any new or unusual changes in your bleeding patterns. In particular, be sure to report:

  • Excessive menstrual bleeding (also referred to as flooding)
  • Bleeding more than every three weeks
  • Bleeding between periods
  • Bleeding after sex
  • Bleeding that lasts longer than usual

Of course, staying aware of your body and maintaining an open dialogue with your practitioner are good practices at any point in life, but can become even more so in a time of significant physiological transformation.  

Finding the Best Treatment for Perimenopausal Bleeding Irregularities

Talking to a health care practitioner about changes in your bleeding patterns during perimenopause isn’t just about identifying potentially dangerous health conditions. It is important to address any distressing or unusual bleeding pattern, even if it can be explained by perimenopause alone. Long, heavy, or frequent periods and spotting are often endured and thought to simply be an inevitable part of life, but they can seriously interfere with your functionality, emotional health, and overall well-being. Without medical attention, they may also lead to other health problems, such as anemia. 

Because perimenopausal changes in bleeding are caused by fluctuating hormone levels, re-establishing hormonal balance is typically the only way to correct disruptive bleeding patterns. Supporting that balance via a healthy diet, reduced stress, and regular exercise is a good first step. However, for many women, the best treatment for perimenopausal bleeding irregularities is hormone therapy. Which form that therapy takes depends on your symptoms, health status, and preferences; while some women are prescribed hormonal contraceptives to address menstrual irregularities during perimenopause, progesterone replacement therapy may be a more appropriate choice. 

Perimenopause symptoms are often misattributed to falling estrogen levels, but many perimenopausal bleeding patterns—including heavy bleeding, short cycles, and continual spotting—point to disproportionately high estrogen vs. progesterone. Introducing exogenous progesterone can restore hormonal balance to resolve disruptive perimenopausal bleeding while also potentially addressing a number of other perimenopause symptoms. In fact, some experts believe that progesterone therapy is the safest, most appropriate, and most effective form of intervention for virtually all symptomatic perimenopause.

To ensure that you receive the best care for irregular perimenopausal bleeding, consider seeking out a practitioner who specializes in hormone health. These practitioners have a deep understanding of the hormone changes you are experiencing and can help you determine if intervention is right for you. If you decide to pursue hormone therapy, they will develop a treatment plan that can be customized to your needs and designed to produce the best outcomes. With their guidance, you can take the first steps toward regulating your bleeding patterns and regaining your sense of well-being.

If you are concerned about your perimenopausal bleeding, BodyLogicMD can help you find answers. The BodyLogicMD network is comprised of top medical professionals specializing in hormone health and integrative medicine. BodyLogicMD-affiliated practitioners are dedicated to helping women address perimenopause symptoms through personalized treatment plans that enhance quality of life. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz today. 

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.