Having to manage menorrhagia — heavy menstrual periods that disrupt daily life — is a common issue. Heavy periods are more likely to affect women in their 40s due to perimenopause (the menopause transition). About one-third of women ages 40 to 45 experience heavy periods.

In a survey conducted by ThisIsMenopause, many women described having heavy menstrual periods as a symptom of perimenopause.

Their responses included:

“I’m on a blood thinner, so I had a lot of bleeding and clots. I got through them, but now I get frustrated because I feel overly emotional and know I should be having a period but nothing happens.”

“Hot flashes, anxiety, and heavy periods are the things affecting me.”

“[I wish others understood] how heavy periods would be.”

Here’s what you need to know about heavy periods with clots after 40, including when to talk to your healthcare provider.

Perimenopause and Heavy Periods With Clots

Several factors can cause heavy periods. For many women, irregular periods are the first sign of perimenopause, which usually begins during a woman’s 40s. Heavy periods with clots during this time are often caused by natural hormonal changes.

The hormones estrogen and progesterone work together to control the menstrual cycle. They tell your body when it’s time to start your period.

During perimenopause, estrogen declines, creating an imbalance between the two hormone levels. This imbalance can lead to menstrual cycle changes, such as heavier bleeding. It can also cause other symptoms, like hot flashes and mood swings.

Ovulation — the release of an egg from the ovaries — may also happen irregularly during perimenopause. This can cause the lining of the uterus, which is shed during your period, to build up. If you have more uterine lining to shed, it can result in heavy perimenopausal bleeding with clots.

Can Heavy Periods With Clots Be Normal?

People with heavy periods may deal with bleeding that lasts longer than one week, heavy blood flow during short spans of time, and blood clots. These menstrual cycle changes are common during perimenopause.

It’s not unusual to notice small, gel-like clumps of blood during your period. This is because menstrual bleeding is naturally regulated by clotting. Most of the clots your body makes break apart before they leave the uterus.

Clots may not have enough time to break apart if your flow is stronger. When that happens, you can end up passing clots that look like pieces of jelly, which is often a normal part of menstruation and not a sign of a problem.

It’s normal for blood clots to look bright red, dark red, or maroon during times of heavy flow. The blood looks lighter because it’s passing through your body too quickly to oxidize and darken.

When To See Your Doctor

Check in with your doctor if your menstrual bleeding is becoming heavier with each period, you’re starting to pass larger blood clots, or you see clots more often. These changes may be signs of other medical conditions, especially when combined with shortness of breath or dizziness. Your doctor may run tests to rule out other potential causes of heavy bleeding with clots, such as uterine fibroids (noncancerous growths).

Some cases of heavy menstrual bleeding require urgent medical care.

Managing Heavy Periods With Clots

Heavier periods are common during perimenopause, but bleeding shouldn’t be so heavy that it interferes with your daily activities and your well-being. The good news is that there are several treatment options available to help manage heavy menstrual bleeding.

Medications like hormonal birth control pills or nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce bleeding. If medications aren’t helpful, your doctor may suggest a surgical procedure like a hysterectomy (removal of the uterus) or uterine ablation to improve your quality of life.