Full Transcript Heavy Bleeding in Perimenopause: When to Pay Attention 0:01 If a pad or 0:01 If a pad or tampon soaks in 0:01 tampon soaks in 0:02 tampon soaks in less than an hour 0:02 less than an hour 0:02 less than an hour or comes out in lumps 0:04 or comes out in lumps 0:04 or comes out in lumps the size of a coin, you 0:05 the size of a coin, you 0:05 the size of a coin, you know what we're talking about. 0:06 know what we're talking about. 0:06 know what we're talking about. Stop scrolling through the 0:07 Stop scrolling through the 0:07 Stop scrolling through the feed. You don't 0:08 feed. You don't 0:08 feed. You don't have to put up with this. 0:09 have to put up with this. 0:10 have to put up with this. And it's not just 0:10 And it's not just 0:10 And it's not just perimenopause. But 0:12 perimenopause. But 0:12 perimenopause. But before you panic, 0:13 before you panic, 0:13 before you panic, I want you to take a deep 0:14 I want you to take a deep 0:14 I want you to take a deep breath. I want to 0:15 breath. I want to 0:15 breath. I want to talk about heavy 0:17 talk about heavy 0:17 talk about heavy periods, 0:17 periods, 0:17 periods, perimenopause, and 0:19 perimenopause, and 0:19 perimenopause, and how 0:20 how 0:20 how common it is. I 0:21 common it is. I 0:21 common it is. I see this in my 0:22 see this in my 0:22 see this in my practice every week. 0:23 practice every week. 0:23 practice every week. Women are told that it's 0:24 Women are told that it's 0:24 Women are told that it's completely normal to 0:25 completely normal to have heavy and 0:26 have heavy and 0:26 have heavy and irregular cycles. It's 0:28 irregular cycles. It's 0:28 irregular cycles. It's part of 0:28 part of 0:28 part of perimenopause, and they 0:29 perimenopause, and they 0:29 perimenopause, and they feel 0:30 feel 0:30 feel embarrassed because it's 0:31 embarrassed because it's 0:31 embarrassed because it's uncomfortable. This is very
Why Heavy Periods Happen in Perimenopause 0:33 uncomfortable. This is very 0:33 uncomfortable. This is very tiring. When you 0:34 tiring. When you 0:34 tiring. When you leak at work, 0:35 leak at work, 0:35 leak at work, you know, you have to 0:36 you know, you have to 0:36 you know, you have to carry spares with you everywhere 0:38 carry spares with you everywhere 0:38 carry spares with you everywhere . This is 0:39 . This is 0:39 . This is too much. So 0:41 too much. So 0:41 too much. So today I'll tell you
The Role of Estrogen & Progesterone 0:43 today I'll tell you 0:43 today I'll tell you why this happens, how 0:44 why this happens, how 0:44 why this happens, how to understand whether it's 0:45 to understand whether it's 0:45 to understand whether it's normal or an 0:46 normal or an 0:46 normal or an alarm signal, and what 0:47 alarm signal, and what 0:47 alarm signal, and what real 0:48 real 0:48 real control options you have. Because you 0:51 control options you have. Because you 0:51 control options you have. Because you shouldn't suffer and you shouldn't have to 0:52 shouldn't suffer and you shouldn't have to 0:52 shouldn't suffer and you shouldn't have to endure it 0:53 endure it . There is a way out. I'm Dr. 0:55 . There is a way out. I'm Dr. 0:55 . There is a way out. I'm Dr. Jennifer Rollins, an 0:56 Jennifer Rollins, an 0:58 integrative 0:58 integrative medicine obstetrician-gynecologist, and I 0:59 medicine obstetrician-gynecologist, and I 0:59 medicine obstetrician-gynecologist, and I help 1:00 help 1:00 help middle-aged women every day. So let's 1:01 middle-aged women every day. So let's 1:01 middle-aged women every day. So let's begin. To 1:03 begin. To 1:03 begin. To understand why 1:04 understand why 1:04 understand why bleeding becomes 1:05 bleeding becomes 1:05 bleeding becomes heavier, you need 1:06 heavier, you need 1:06 heavier, you need to know what 1:07 to know what 1:07 to know what happens at the 1:08 happens at the 1:10 hormonal level during perimenopause, 1:10 hormonal level during perimenopause, because this is almost 1:11 because this is almost 1:11 because this is almost never explained to women. 1:13 never explained to women. 1:15 When you understand this , everything will become logical. 1:17 , everything will become logical. 1:18 , everything will become logical. Your menstrual 1:19 Your menstrual 1:19 Your menstrual cycle depends on the 1:20 cycle depends on the 1:20 cycle depends on the interaction of two 1:21 interaction of two 1:21 interaction of two hormones: estrogen 1:22 hormones: estrogen 1:22 hormones: estrogen and progesterone. 1:23 and progesterone. 1:24 and progesterone. Estrogen builds up 1:25 Estrogen builds up 1:25 Estrogen builds up the lining of the 1:26 the lining of the 1:26 the lining of the uterus in the first 1:27 uterus in the first 1:27 uterus in the first half of the cycle. Then 1:29 half of the cycle. Then , during ovulation— 1:31 , during ovulation— if it 1:31 if it 1:31 if it occurs— 1:32 occurs— the remnant of the follicle in 1:33 the remnant of the follicle in 1:33 the remnant of the follicle in the ovary,
What Happens When You Donu2019t Ovulate 1:34 the ovary, 1:34 the ovary, called the corpus 1:35 called the corpus 1:35 called the corpus luteum, produces 1:36 luteum, produces 1:36 luteum, produces progesterone. 1:37 progesterone. 1:39 Progesterone 1:39 Progesterone stabilizes and 1:40 stabilizes and 1:40 stabilizes and matures this mucous 1:41 matures this mucous 1:41 matures this mucous membrane. Therefore, when both 1:43 membrane. Therefore, when both 1:43 membrane. Therefore, when both estrogen and 1:44 estrogen and 1:44 estrogen and progesterone drop 1:45 progesterone drop 1:45 progesterone drop at the end of the cycle, 1:46 at the end of the cycle, 1:46 at the end of the cycle, around day 20-24, 1:48 around day 20-24, 1:48 around day 20-24, you get a 1:48 you get a 1:49 you get a controlled and 1:50 controlled and 1:50 controlled and orderly 1:51 orderly 1:51 orderly menstruation. But this is what 1:52 menstruation. But this is what 1:52 menstruation. But this is what happens during 1:53 happens during 1:53 happens during perimenopause. You 1:55 perimenopause. You 1:55 perimenopause. You start having cycles 1:56 start having cycles 1:56 start having cycles because you haven't 1:57 because you haven't 1:57 because you haven't ovulated. That is, 1:59 ovulated. That is, 1:59 ovulated. That is, cycles where you don't 2:00 cycles where you don't 2:00 cycles where you don't ovulate consistently 2:01 ovulate consistently 2:01 ovulate consistently on time or don't ovulate at all 2:02 on time or don't ovulate at all 2:02 on time or don't ovulate at all . And
Why Periods Become Heavy & Unpredictable 2:04 . And 2:04 . And the absence of ovulation 2:06 the absence of ovulation 2:06 the absence of ovulation means the absence of a corpus 2:07 means the absence of a corpus 2:07 means the absence of a corpus luteum. 2:08 luteum. 2:08 luteum. The absence of a corpus luteum 2:09 The absence of a corpus luteum 2:09 The absence of a corpus luteum means 2:10 means 2:10 means the absence of 2:10 the absence of 2:10 the absence of 2:12 progesterone production. And without 2:12 progesterone production. And without progesterone 2:13 progesterone 2:13 progesterone regulating the lining, 2:14 regulating the lining, 2:14 regulating the lining, estrogen continues 2:15 estrogen continues 2:15 estrogen continues to build it up, and it 2:17 to build it up, and it 2:17 to build it up, and it becomes thicker and 2:18 becomes thicker and 2:18 becomes thicker and thicker inside the 2:19 thicker inside the 2:19 thicker inside the uterus. And there is no 2:20 uterus. And there is no 2:20 uterus. And there is no stabilizing 2:21 stabilizing 2:21 stabilizing counterweight. When 2:22 counterweight. When 2:22 counterweight. When the shell finally 2:23 the shell finally 2:23 the shell finally sheds, it 2:24 sheds, it 2:24 sheds, it happens very 2:25 happens very 2:25 happens very intensely. It is very 2:26 intensely. It is very 2:26 intensely. It is very copious, often with 2:27 copious, often with 2:27 copious, often with clots, and 2:28 clots, and 2:28 clots, and feels quite 2:29 feels quite 2:29 feels quite dramatic. In 2:30 dramatic. In 2:30 dramatic. In Western medicine, we 2:31 Western medicine, we 2:31 Western medicine, we don't have a 2:32 don't have a 2:32 don't have a specific term 2:33 specific term 2:33 specific term for this, but we often 2:34 for this, but we often 2:34 for this, but we often describe it as 2:35 describe it as 2:35 describe it as estrogen 2:36 estrogen 2:36 estrogen dominance 2:36 dominance 2:36 dominance because your 2:37 because your 2:37 because your estrogen is not 2:38 estrogen is not 2:38 estrogen is not being supported by 2:39 being supported by 2:39 being supported by progesterone levels. So, 2:40 progesterone levels. So, 2:40 progesterone levels. So, you have high levels of 2:41 you have high levels of 2:41 you have high levels of estrogen relative to
Whatu2019s Normal During Perimenopause 2:43 estrogen relative to 2:43 estrogen relative to progesterone. This is 2:44 progesterone. This is 2:44 progesterone. This is why menstruation and 2:45 why menstruation and 2:45 why menstruation and cycles become very 2:46 cycles become very 2:47 cycles become very unpredictable. 2:48 unpredictable. 2:50 You may miss a 2:50 You may miss a month altogether because you didn't 2:51 month altogether because you didn't 2:51 month altogether because you didn't ovulate, and therefore did 2:53 ovulate, and therefore did 2:53 ovulate, and therefore did n't have a period 2:54 n't have a period , and the next month 2:55 , and the next month 2:55 , and the next month the bleeding will be 2:56 the bleeding will be 2:56 the bleeding will be heavier when the 2:57 heavier when the 2:57 heavier when the endometrium finally 2:58 endometrium finally 2:58 endometrium finally comes out. The schedule 3:01 comes out. The schedule 3:01 comes out. The schedule you've relied on for 3:02 you've relied on for 3:02 you've relied on for a long time becomes 3:03 a long time becomes 3:03 a long time becomes unreliable almost 3:04 unreliable almost 3:04 unreliable almost instantly. So, you 3:05 instantly. So, you 3:05 instantly. So, you may have shorter 3:06 may have shorter 3:06 may have shorter periods or cycles, 3:08 periods or cycles, 3:08 periods or cycles, or they may start to 3:09 or they may start to 3:09 or they may start to stretch out over time. 3:10 stretch out over time. 3:10 stretch out over time. Here's something that many 3:11 Here's something that many 3:11 Here's something that many women don't 3:12 women don't 3:12 women don't realize. You 3:13 realize. You 3:13 realize. You can still occasionally 3:14 can still occasionally 3:15 can still occasionally ovulate even 3:16 ovulate even 3:16 ovulate even during perimenopause. 3:17 during perimenopause. 3:17 during perimenopause. Therefore, you should
When Heavy Bleeding Becomes a Warning Sign 3:18 Therefore, you should 3:18 Therefore, you should use 3:19 use 3:19 use contraception if you are 3:20 contraception if you are 3:20 contraception if you are not planning a 3:20 not planning a 3:20 not planning a pregnancy. So, 3:22 pregnancy. So, 3:22 pregnancy. So, during perimenopause, you 3:24 during perimenopause, you 3:24 during perimenopause, you may have alternating 3:25 may have alternating 3:25 may have alternating normal cycles with 3:26 normal cycles with 3:26 normal cycles with anovulatory ones, which 3:27 anovulatory ones, which 3:27 anovulatory ones, which makes everything chaotic. 3:28 makes everything chaotic. 3:29 makes everything chaotic. And perimenopause 3:30 And perimenopause 3:30 And perimenopause always 3:31 always 3:31 always feels like chaos. 3:32 feels like chaos. 3:33 feels like chaos. But when it comes to 3:34 But when it comes to 3:34 But when it comes to menstruation, it's because 3:35 menstruation, it's because
When You Should See a Doctor 3:36 they become 3:36 they become heavier and more 3:37 heavier and more 3:37 heavier and more unpredictable. 3:38 unpredictable. 3:39 unpredictable. Okay, this is exactly the 3:39 Okay, this is exactly the 3:39 Okay, this is exactly the section 3:41 section 3:41 section you probably 3:41 you probably 3:41 you probably came here for. Let 3:43 came here for. Let 3:43 came here for. Let me clarify. What is the 3:44 me clarify. What is the 3:44 me clarify. What is the normal range for 3:45 normal range for 3:45 normal range for perimenopause? This 3:47 perimenopause? This 3:47 perimenopause? This may be heavier 3:48 may be heavier 3:48 may be heavier bleeding than you are 3:49 bleeding than you are 3:49 bleeding than you are used to. Maybe 3:50 used to. Maybe 3:50 used to. Maybe your 3:51 your 3:51 your period used to last 4 3:52 period used to last 4 3:52 period used to last 4 or 5 days, but now it lasts 7 3:54 or 5 days, but now it lasts 7 3:54 or 5 days, but now it lasts 7 or 8. You may 3:55 or 8. You may 3:55 or 8. You may have clots, but 3:56 have clots, but 3:56 have clots, but they should be 3:56 they should be 3:56 they should be smaller 3:57 smaller 3:57 smaller than a quarter.
Other Causes of Heavy Bleeding 3:59 than a quarter. 3:59 than a quarter. Cycles can become 4:00 Cycles can become 4:00 Cycles can become shorter or 4:01 shorter or 4:01 shorter or longer. You may 4:02 longer. You may 4:02 longer. You may miss 4:02 miss 4:03 miss your period and then 4:04 your period and then 4:04 your period and then have heavy bleeding. 4:05 have heavy bleeding. 4:06 have heavy bleeding. All of this corresponds to 4:07 All of this corresponds to 4:07 All of this corresponds to hormonal 4:08 hormonal 4:08 hormonal fluctuations during 4:09 fluctuations during 4:09 fluctuations during perimenopause. Although 4:11 perimenopause. Although 4:11 perimenopause. Although this is quite annoying, 4:13 this is quite annoying, 4:13 this is quite annoying, disrupts the usual rhythm, 4:14 disrupts the usual rhythm, 4:14 disrupts the usual rhythm, and causes 4:15 and causes 4:15 and causes discomfort, it is often 4:16 discomfort, it is often 4:16 discomfort, it is often typical and in 4:17 typical and in 4:17 typical and in itself does not pose a 4:18 itself does not pose a 4:18 itself does not pose a danger. Let's 4:20 danger. Let's 4:20 danger. Let's talk about the 4:20 talk about the 4:20 talk about the reasons why I want 4:21 reasons why I want 4:21 reasons why I want you to see a 4:22 you to see a 4:22 you to see a doctor. This is when I 4:23 doctor. This is when I 4:23 doctor. This is when I want you to 4:24 want you to 4:24 want you to see a doctor. 4:25 see a doctor. 4:25 see a doctor. Let's talk 4:26 Let's talk 4:26 Let's talk about this. So, if 4:27 about this. So, if 4:27 about this. So, if a pad or tampon 4:29 a pad or tampon 4:29 a pad or tampon gets wet every hour 4:30 gets wet every hour 4:30 gets wet every hour for 1-2 hours—that's 4:31 for 1-2 hours—that's 4:31 for 1-2 hours—that's too much. Passing out 4:33 too much. Passing out 4:33 too much. Passing out clots larger than a 4:34 clots larger than a 4:34 clots larger than a quarter.
Fibroids, Polyps & Adenomyosis 4:35 quarter. 4:35 quarter. Bleeding that lasts 4:37 Bleeding that lasts 4:37 Bleeding that lasts longer than 10 days. 4:38 longer than 10 days. 4:38 longer than 10 days. Bleeding between 4:39 Bleeding between 4:39 Bleeding between menstruation. So, 4:40 menstruation. So, 4:40 menstruation. So, if you had a 4:41 if you had a 4:41 if you had a stable cycle and 4:42 stable cycle and 4:42 stable cycle and suddenly have 4:43 suddenly have 4:43 suddenly have spotting or 4:44 spotting or 4:44 spotting or bleeding in the middle of 4:45 bleeding in the middle of 4:45 bleeding in the middle of it, you should 4:45 it, you should 4:45 it, you should see a doctor. 4:46 see a doctor. 4:47 see a doctor. Dizziness, 4:47 Dizziness, 4:47 Dizziness, feeling light- 4:49 feeling light- 4:49 feeling light- headed, or fatigue 4:50 headed, or fatigue 4:50 headed, or fatigue during menstruation 4:51 during menstruation 4:51 during menstruation may be signs of
Thyroid Issues & Heavy Periods 4:52 may be signs of 4:52 may be signs of significant blood loss. 4:53 significant blood loss. 4:54 significant blood loss. Any bleeding. 4:55 Any bleeding. 4:55 Any bleeding. If you haven't had a 4:56 If you haven't had a 4:56 If you haven't had a period for 4:57 period for 4:57 period for 12 months, so you're 4:58 12 months, so you're 4:58 12 months, so you're officially in menopause, 4:59 officially in menopause, 4:59 officially in menopause, and now you're 5:00 and now you're 5:00 and now you're bleeding—you 5:01 bleeding—you 5:01 bleeding—you need to get it 5:02 need to get it 5:02 need to get it checked out right away. 5:03 checked out right away. 5:03 checked out right away. Postmenopausal 5:04 Postmenopausal 5:04 Postmenopausal bleeding 5:04 bleeding 5:04 bleeding definitely requires 5:06 definitely requires 5:06 definitely requires examination. I want to 5:07 examination. I want to 5:07 examination. I want to be honest with you 5:08 be honest with you 5:08 be honest with you about something. When 5:09 about something. When 5:09 about something. When women come to 5:10 women come to 5:10 women come to me with very heavy 5:11 me with very heavy 5:11 me with very heavy perimenopausal 5:12 perimenopausal 5:12 perimenopausal bleeding, we don't 5:13 bleeding, we don't 5:13 bleeding, we don't say, "It's just 5:14 say, "It's just 5:14 say, "It's just perimenopause" and 5:15 perimenopause" and 5:15 perimenopause" and send them 5:16 send them 5:16 send them home. We rule out 5:18 home. We rule out 5:18 home. We rule out certain conditions because 5:19 certain conditions because , while it could be 5:20 , while it could be 5:21 , while it could be perimenopause, there are
Ruling Out Uterine Cancer & Precancerous Changes 5:22 perimenopause, there are 5:22 perimenopause, there are many things that 5:23 many things that 5:23 many things that mimic it, and it's important 5:24 mimic it, and it's important 5:24 mimic it, and it's important not to miss anything. 5:25 not to miss anything. 5:25 not to miss anything. So, let's look at other 5:26 So, let's look at other 5:27 So, let's look at other causes of heavy 5:27 causes of heavy 5:27 causes of heavy bleeding that are not 5:28 bleeding that are not 5:28 bleeding that are not related to 5:29 related to 5:29 related to perimenopause. 5:30 perimenopause. 5:30 perimenopause. Let's talk 5:31 Let's talk 5:31 Let's talk about them. First, 5:32 about them. First, 5:32 about them. First, uterine fibroids or 5:33 uterine fibroids or 5:33 uterine fibroids or structural abnormalities 5:35 structural abnormalities . Fibroids are 5:36 . Fibroids are 5:36 . Fibroids are benign muscle 5:37 benign muscle 5:37 benign muscle tumors in the wall of the 5:38 tumors in the wall of the 5:38 tumors in the wall of the uterus. They can
Why Iron & Ferritin Matter 5:39 uterus. They can 5:39 uterus. They can be located 5:40 be located 5:40 be located inside the uterus. They 5:41 inside the uterus. They 5:41 inside the uterus. They may be on 5:41 may be on 5:41 may be on the surface of the uterus. 5:42 the surface of the uterus. 5:42 the surface of the uterus. In fact, they are 5:43 In fact, they are 5:43 In fact, they are quite common in 5:44 quite common in 5:44 quite common in women after the age of 40. 5:45 women after the age of 40. 5:45 women after the age of 40. Some even say that 5:46 Some even say that 5:46 Some even say that up to 70% of women will have
Treatment Options for Heavy Bleeding 5:48 up to 70% of women will have 5:48 up to 70% of women will have them by the age of 50. Many 5:49 them by the age of 50. Many 5:49 them by the age of 50. Many fibroids do not 5:50 fibroids do not 5:50 fibroids do not cause any 5:51 cause any 5:51 cause any symptoms at all. But some 5:52 symptoms at all. But some 5:52 symptoms at all. But some of them press on the 5:53 of them press on the 5:53 of them press on the endometrium inside the 5:54 endometrium inside the 5:54 endometrium inside the cavity, 5:55 cavity, 5:55 cavity, causing significant 5:56 causing significant 5:56 causing significant bleeding. And when 5:57 bleeding. And when 5:57 bleeding. And when combined with 5:58 combined with 5:58 combined with hormonal 5:58 hormonal 5:58 hormonal changes, this bleeding 6:00 changes, this bleeding 6:00 changes, this bleeding becomes even stronger. 6:01 becomes even stronger. 6:01 becomes even stronger. Uterine polyps are 6:02 Uterine polyps are 6:02 Uterine polyps are simply small, 6:02 simply small, 6:02 simply small, benign 6:03 benign 6:03 benign growths of the lining of the 6:04 growths of the lining of the 6:04 growths of the lining of the uterus. They are 6:05 uterus. They are 6:05 uterus. They are very similar to fibroids 6:06 very similar to fibroids 6:06 very similar to fibroids in that they are also a 6:07 in that they are also a 6:07 in that they are also a structural 6:07 structural 6:07 structural problem. They 6:08 problem. They 6:08 problem. They can also cause 6:09 can also cause 6:09 can also cause heavy bleeding and 6:10 heavy bleeding and 6:10 heavy bleeding and spotting 6:11 spotting 6:11 spotting between 6:11 between 6:11 between periods. 6:12 periods. Secondly, adenomyosis. This is a 6:14 Secondly, adenomyosis. This is a 6:14 Secondly, adenomyosis. This is a condition in which the 6:15 condition in which the 6:15 condition in which the lining of the uterus 6:16 lining of the uterus 6:16 lining of the uterus grows into the muscle of 6:17 grows into the muscle of 6:17 grows into the muscle of the uterus. It causes
Progesterone & Hormonal Treatment Options 6:18 the uterus. It causes 6:18 the uterus. It causes heavy and painful 6:19 heavy and painful 6:19 heavy and painful menstruation. Even 6:20 menstruation. Even 6:20 menstruation. Even women in their 30s 6:22 women in their 30s 6:22 women in their 30s can notice this. 6:23 can notice this. 6:23 can notice this. But when they 6:24 But when they 6:24 But when they start going 6:25 start going 6:25 start going through perimenopause, 6:26 through perimenopause, 6:26 through perimenopause, the condition worsens 6:27 the condition worsens 6:27 the condition worsens due to hormonal 6:28 due to hormonal 6:28 due to hormonal fluctuations. On ultrasound, this 6:29 fluctuations. On ultrasound, this 6:29 fluctuations. On ultrasound, this may look like an 6:30 may look like an 6:30 may look like an enlarged, "soft" 6:31 enlarged, "soft" 6:32 enlarged, "soft" uterus. Third, the 6:33 uterus. Third, the 6:33 uterus. Third, the thyroid gland. 6:34 thyroid gland. 6:34 thyroid gland. Hypothyroidism is 6:35 Hypothyroidism is 6:35 Hypothyroidism is very 6:36 very 6:36 very common. In fact, " 6:37 common. In fact, " thyropause"—I even 6:39 thyropause"—I even 6:39 thyropause"—I even made a separate video about it 6:40 made a separate video about it 6:40 made a separate video about it —is an often 6:40 —is an often 6:40 —is an often undiagnosed 6:41 undiagnosed 6:41 undiagnosed cause of heavy 6:42 cause of heavy 6:42 cause of heavy periods in women 6:43 periods in women 6:43 periods in women after 40. It's worth 6:44 after 40. It's worth 6:44 after 40. It's worth checking out. And 6:46 checking out. And 6:46 checking out. And honestly, everyone over 6:47 honestly, everyone over 6:47 honestly, everyone over 40 should 6:48 40 should 6:48 40 should get a full set of 6:49 get a full set of 6:49 get a full set of tests every year, including 6:50 tests every year, including 6:50 tests every year, including thyroid hormones 6:51 thyroid hormones 6:51 thyroid hormones . And lastly, 6:53 . And lastly, uterine cancer or 6:53 uterine cancer or 6:53 uterine cancer or precancerous conditions. I 6:55 precancerous conditions. I 6:55 precancerous conditions. I don't want to scare you, 6:56 don't want to scare you, 6:56 don't want to scare you, but since this can 6:58 but since this can 6:58 but since this can cause heavy 6:59 cause heavy 6:59 cause heavy bleeding, it's important to 7:00 bleeding, it's important to 7:00 bleeding, it's important to get tested 7:01 get tested 7:01 get tested for this as well. Women in 7:03 for this as well. Women in 7:03 for this as well. Women in perimenopause 7:04 perimenopause 7:04 perimenopause are at an age
Hormonal IUDs & Birth Control 7:05 are at an age 7:05 are at an age when the risk of uterine cancer 7:06 when the risk of uterine cancer 7:06 when the risk of uterine cancer may increase. If 7:08 may increase. If 7:08 may increase. If you have other factors 7:09 you have other factors 7:09 you have other factors such as obesity, 7:10 such as obesity, 7:10 such as obesity, diabetes, lack of 7:11 diabetes, lack of 7:11 diabetes, lack of pregnancies, or a 7:12 pregnancies, or a 7:12 pregnancies, or a family history of 7:13 family history of 7:13 family history of uterine or 7:14 uterine or 7:14 uterine or colon cancer, these 7:15 colon cancer, these 7:15 colon cancer, these also need to 7:16 also need to 7:16 also need to be considered. If 7:18 be considered. If 7:18 be considered. If your doctor suspects a 7:19 your doctor suspects a 7:19 your doctor suspects a structural problem, 7:20 structural problem, 7:20 structural problem, such as a polyp, fibroid, or 7:22 such as a polyp, fibroid, or 7:22 such as a polyp, fibroid, or adenomyosis, they 7:23 adenomyosis, they 7:23 adenomyosis, they will order an ultrasound and 7:24 will order an ultrasound and 7:24 will order an ultrasound and possibly an 7:25 possibly an 7:25 possibly an endometrial biopsy, which is an 7:26 endometrial biopsy, which is an 7:26 endometrial biopsy, which is an office procedure. 7:28 office procedure. 7:28 office procedure. This is how you can 7:29 This is how you can 7:29 This is how you can assess the condition of the 7:30 assess the condition of the 7:32 uterine mucosa. So don't be afraid of 7:32 uterine mucosa. So don't be afraid of these tests. I know 7:34 these tests. I know 7:34 these tests. I know they can be 7:35 they can be 7:35 they can be unpleasant, but there are 7:35 unpleasant, but there are 7:35 unpleasant, but there are many 7:36 many 7:36 many good 7:37 good 7:37 good pain relief methods available now. It is important that 7:38 pain relief methods available now. It is important that 7:38 pain relief methods available now. It is important that you get 7:39 you get 7:39 you get tested now and do not 7:40 tested now and do not 7:40 tested now and do not ignore these 7:41 ignore these 7:41 ignore these symptoms. The last 7:42 symptoms. The last 7:42 symptoms. The last test I 7:43 test I 7:43 test I want to mention is 7:44 want to mention is 7:44 want to mention is iron. Therefore, heavy
Non-Hormonal Treatment Options 7:45 iron. Therefore, heavy 7:45 iron. Therefore, heavy menstruation can 7:46 menstruation can 7:46 menstruation can cause 7:46 cause 7:46 cause blood loss. 7:47 blood loss. 7:47 blood loss. Blood loss depletes 7:48 Blood loss depletes 7:48 Blood loss depletes iron stores. And 7:49 iron stores. And 7:49 iron stores. And many women with 7:50 many women with 7:50 many women with heavy 7:50 heavy 7:50 heavy perimenopausal 7:51 perimenopausal 7:51 perimenopausal bleeding have 7:52 bleeding have 7:52 bleeding have iron deficiency, sometimes 7:53 iron deficiency, sometimes 7:53 iron deficiency, sometimes serious. And they do 7:53 serious. And they do 7:53 serious. And they do n't even 7:54 n't even 7:54 n't even realize it. 7:55 realize it. 7:55 realize it. They just consider 7:56 They just consider 7:56 They just consider it normal because they have 7:58 it normal because they have 7:58 it normal because they have problems: shortness of breath on the 7:59 problems: shortness of breath on the 7:59 problems: shortness of breath on the stairs, 7:59 stairs, 7:59 stairs, dizziness, foggy 8:01 dizziness, foggy 8:01 dizziness, foggy head, exhaustion, 8:02 head, exhaustion, 8:02 head, exhaustion, and children running 8:03 and children running 8:03 and children running around. Parents 8:04 around. Parents 8:04 around. Parents need care. 8:05 need care. 8:06 need care. But low ferritin, the 8:07 But low ferritin, the 8:07 But low ferritin, the iron store, drops 8:08 iron store, drops 8:08 iron store, drops first. Therefore, a 8:09 first. Therefore, a 8:09 first. Therefore, a standard 8:10 standard 8:10 standard complete 8:11 complete 8:11 complete blood count may 8:11 blood count may 8:11 blood count may miss it when your 8:12 miss it when your 8:12 miss it when your ferritin is critically 8:13 ferritin is critically 8:13 ferritin is critically low. I always 8:14 low. I always 8:14 low. I always check ferritin in 8:15 check ferritin in 8:15 check ferritin in every woman after 40 8:16 every woman after 40 8:16 every woman after 40 . By the way, I 8:18 . By the way, I 8:18 . By the way, I made a whole video about 8:19 made a whole video about 8:19 made a whole video about important tests, it's 8:20 important tests, it's 8:20 important tests, it's here. Tests that are 8:22 here. Tests that are 8:22 here. Tests that are important for women 8:23 important for women 8:23 important for women after 40. So 8:24 after 40. So 8:24 after 40. So check it out too
Treating Fibroids, Polyps & Adenomyosis 8:25 check it out too 8:25 check it out too . If your 8:26 . If your 8:26 . If your ferritin is low, 8:27 ferritin is low, 8:27 ferritin is low, iron intake is 8:27 iron intake is 8:27 iron intake is important and you may 8:29 important and you may 8:29 important and you may need a 8:30 need a 8:30 need a higher than standard 8:31 higher than standard 8:31 higher than standard pharmacy dose. I usually 8:32 pharmacy dose. I usually 8:32 pharmacy dose. I usually recommend 8:33 recommend 8:33 recommend iron bisglycinate; 8:34 iron bisglycinate; 8:34 iron bisglycinate; It needs to be 8:35 It needs to be 8:35 It needs to be combined with 8:36 combined with 8:36 combined with vitamin C for 8:37 vitamin C for 8:37 vitamin C for better absorption, 8:38 better absorption, 8:38 better absorption, but it is milder than 8:39 but it is milder than 8:39 but it is milder than ferrous sulfate. But 8:41 ferrous sulfate. But 8:41 ferrous sulfate. But we also want to 8:42 we also want to 8:42 we also want to address the cause of 8:43 address the cause of 8:43 address the cause of the blood loss. So you 8:44 the blood loss. So you 8:44 the blood loss. So you check your 8:45 check your 8:45 check your iron levels. Even if 8:46 iron levels. Even if 8:46 iron levels. Even if you have iron deficiency 8:47 you have iron deficiency 8:47 you have iron deficiency anemia, what are we going to 8:48 anemia, what are we going to 8:48 anemia, what are we going to do about heavy 8:49 do about heavy 8:49 do about heavy menstruation? And that's exactly what 8:50 menstruation? And that's exactly what 8:50 menstruation? And that's exactly what I'll talk about 8:51 I'll talk about 8:51 I'll talk about next. So stay 8:52 next. So stay 8:52 next. So stay with us. You have 8:53 with us. You have 8:53 with us. You have real options, and I 8:54 real options, and I 8:54 real options, and I want you to know about 8:55 want you to know about 8:56 want you to know about all of them. So, 8:56 all of them. So, 8:56 all of them. So, first the hormonal 8:58 first the hormonal 8:58 first the hormonal options. Since 8:59 options. Since 8:59 options. Since the problem is usually 9:00 the problem is usually 9:00 the problem is usually low 9:01 low 9:01 low progesterone 9:01 progesterone 9:01 progesterone compared to 9:02 compared to 9:02 compared to estrogen, 9:03 estrogen, 9:06 progesterone helps most women. Taking 9:06 progesterone helps most women. Taking oral 9:07 oral 9:07 oral micronized 9:08 micronized 9:08 micronized progesterone ( 9:09 progesterone (
Supporting Progesterone Naturally 9:10 progesterone ( brand name Prometrium or 9:11 brand name Prometrium or 9:11 brand name Prometrium or prescription version) is 9:12 prescription version) is 9:12 prescription version) is great for 9:13 great for 9:13 great for women with heavy 9:14 women with heavy 9:14 women with heavy periods. You 9:16 periods. You 9:16 periods. You can take it 9:18 can take it 9:18 can take it cyclically, from day 14 to 28 9:19 cyclically, from day 14 to 28 9:19 cyclically, from day 14 to 28 , or continuously 9:21 , or continuously . It depends on 9:22 . It depends on what stage of 9:23 what stage of 9:23 what stage of perimenopause you 9:24 perimenopause you 9:24 perimenopause you are in, 9:25 are in, 9:25 are in, right? It also 9:25 right? It also 9:25 right? It also helps with sleep, which is 9:27 helps with sleep, which is 9:27 helps with sleep, which is also just great. 9:28 also just great. 9:28 also just great. It can reduce 9:29 It can reduce 9:29 It can reduce blood loss in 9:29 blood loss in 9:29 blood loss in many women, and 9:30 many women, and 9:30 many women, and many of them will say, 9:31 many of them will say, 9:31 many of them will say, "Oh, my cycles 9:32 "Oh, my cycles 9:32 "Oh, my cycles are back to normal 9:33 are back to normal ." You may also want 9:34 ." You may also want 9:34 ." You may also want to consider a 9:34 to consider a 9:34 to consider a hormonal 9:35 hormonal 9:35 hormonal intrauterine 9:36 intrauterine 9:36 intrauterine device. For example, 9:37 device. For example, 9:37 device. For example, Mirena, Liletta, there are many 9:38 Mirena, Liletta, there are many 9:38 Mirena, Liletta, there are many companies. It 9:39 companies. It 9:39 companies. It delivers 9:40 delivers 9:40 delivers progesterone 9:40 progesterone 9:40 progesterone directly to 9:41 directly to 9:41 directly to the lining of 9:42 the lining of 9:42 the lining of the uterus. This is one of the 9:43 the uterus. This is one of the 9:43 the uterus. This is one of the most effective 9:44 most effective 9:44 most effective treatments for 9:45 treatments for 9:45 treatments for heavy menstruation, 9:46 heavy menstruation, 9:46 heavy menstruation, even in 9:47 even in 9:47 even in perimenopausal women. And 9:48 perimenopausal women. And 9:48 perimenopausal women. And the bonus is that it's a 9:49 the bonus is that it's a 9:49 the bonus is that it's a great
Magnesium & Hormonal Health 9:50 great 9:50 great contraceptive option if 9:51 contraceptive option if 9:51 contraceptive option if you need it. 9:52 you need it. 9:52 you need it. It is now valid for up to 8 9:54 It is now valid for up to 8 9:54 It is now valid for up to 8 years. So you can 9:55 years. So you can 9:55 years. So you can actually go through your 9:56 actually go through your 9:56 actually go through your period before menopause and 9:57 period before menopause and 9:57 period before menopause and not need 9:58 not need 9:58 not need anything else for 9:59 anything else for 9:59 anything else for contraception, which is very 10:00 contraception, which is very 10:00 contraception, which is very convenient. You 10:01 convenient. You 10:01 convenient. You can also take 10:02 can also take 10:02 can also take oral 10:02 oral 10:02 oral progesterone 10:03 progesterone 10:03 progesterone in addition if you 10:04 in addition if you 10:04 in addition if you start having trouble 10:05 start having trouble 10:05 start having trouble sleeping. It's important to know 10:06 sleeping. It's important to know 10:06 sleeping. It's important to know that during 10:06 that during 10:06 that during perimenopause, 10:07 perimenopause, 10:07 perimenopause, ovulation can still 10:08 ovulation can still 10:08 ovulation can still occur even 10:09 occur even 10:09 occur even if your cycles 10:09 if your cycles 10:09 if your cycles become irregular 10:10 become irregular . So if you 10:11 . So if you 10:11 . So if you need 10:12 need 10:12 need contraception, 10:12 contraception, 10:12 contraception, be sure 10:13 be sure 10:13 be sure to discuss this 10:14 to discuss this 10:14 to discuss this issue. 10:14 issue. 10:14 issue. Low-dose 10:15 Low-dose 10:15 Low-dose hormonal 10:15 hormonal 10:15 hormonal contraceptives, such 10:16 contraceptives, such 10:16 contraceptives, such as pills, patches, 10:17 as pills, patches, 10:17 as pills, patches, or rings, 10:18 or rings, 10:18 or rings, can also regulate your 10:19 can also regulate your 10:19 can also regulate your cycle, reduce 10:19 cycle, reduce 10:19 cycle, reduce bleeding, and 10:20 bleeding, and 10:20 bleeding, and provide protection 10:21 provide protection 10:21 provide protection against unwanted 10:21 against unwanted 10:21 against unwanted pregnancy. So 10:22 pregnancy. So 10:22 pregnancy. So they 10:23 they 10:23 they also suit some women. If 10:24 also suit some women. If 10:24 also suit some women. If you have a contraindication 10:25 you have a contraindication 10:25 you have a contraindication to estrogen 10:26 to estrogen 10:26 to estrogen and cannot 10:27 and cannot 10:27 and cannot take it, another 10:28 take it, another 10:28 take it, another option is 10:29 option is
Anti-Inflammatory Diet & Foods to Limit 10:30 progesterone-only pills. 10:31 progesterone-only pills. Non-hormonal 10:32 Non-hormonal 10:32 Non-hormonal treatments may 10:33 treatments may 10:33 treatments may include 10:33 include 10:33 include medications such as 10:34 medications such as 10:34 medications such as ibuprofen or 10:35 ibuprofen or 10:35 ibuprofen or tranexamic acid 10:36 tranexamic acid . They both 10:37 . They both 10:37 . They both reduce 10:37 reduce 10:37 reduce blood loss, sometimes by up to 10:39 blood loss, sometimes by up to 10:39 blood loss, sometimes by up to 40% on the days of heaviest 10:40 40% on the days of heaviest 10:40 40% on the days of heaviest bleeding. You 10:41 bleeding. You 10:41 bleeding. You start taking them 10:42 start taking them 10:42 start taking them 10:43 just before your 10:43 just before your expected 10:44 expected 10:44 expected period or at the 10:45 period or at the 10:45 period or at the very beginning of it; 10:45 very beginning of it; 10:45 very beginning of it; They help 10:46 They help 10:46 They help reduce the pain of 10:47 reduce the pain of 10:47 reduce the pain of cramps, as well as the 10:48 cramps, as well as the 10:48 cramps, as well as the bleeding itself. This is a good 10:49 bleeding itself. This is a good 10:49 bleeding itself. This is a good short-term 10:50 short-term 10:50 short-term option, but if 10:51 option, but if 10:51 option, but if you have heavy 10:52 you have heavy 10:52 you have heavy periods for the 10:53 periods for the 10:53 periods for the next 4–6 years, 10:54 next 4–6 years, 10:55 next 4–6 years, you probably 10:55 you probably 10:55 you probably need a different 10:56 need a different 10:56 need a different approach. So, let's 10:57 approach. So, let's 10:57 approach. So, let's talk about the 10:58 talk about the 10:58 talk about the structural causes 10:59 structural causes 11:00 structural causes that I mentioned 11:00 that I mentioned 11:00 that I mentioned earlier: fibroids, polyps, 11:02 earlier: fibroids, polyps, 11:02 earlier: fibroids, polyps, adenomyosis. There are specific treatments for each 11:03 adenomyosis. There are specific treatments for each 11:03 adenomyosis. There are specific treatments for each of these structural 11:04 of these structural 11:04 of these structural problems 11:05 problems 11:06 . 11:06 . Hysteroscopic 11:07 Hysteroscopic 11:07 Hysteroscopic removal, or 11:08 removal, or 11:08 removal, or hysteroscopy, can 11:09 hysteroscopy, can 11:09 hysteroscopy, can help remove 11:11 help remove 11:11 help remove polyps. Sometimes 11:12 polyps. Sometimes 11:12 polyps. Sometimes 11:14 a hysterectomy is needed to 11:14 a hysterectomy is needed to remove large
What to Do If Heavy Bleeding Continues 11:15 remove large 11:15 remove large fibroids that are difficult 11:16 fibroids that are difficult 11:16 fibroids that are difficult to control and that 11:17 to control and that 11:17 to control and that are located outside the 11:18 are located outside the 11:18 are located outside the uterus. But this is a 11:19 uterus. But this is a 11:19 uterus. But this is a question that should be 11:20 question that should be 11:20 question that should be discussed with your 11:21 discussed with your 11:21 discussed with your gynecologist, 11:21 gynecologist, 11:21 gynecologist, as there are both 11:23 as there are both 11:23 as there are both hormonal and 11:24 hormonal and 11:24 hormonal and surgical 11:25 surgical 11:25 surgical treatment options. In addition to 11:26 treatment options. In addition to 11:26 treatment options. In addition to drug 11:27 drug 11:27 drug treatment, I advise 11:28 treatment, I advise 11:28 treatment, I advise patients 11:28 patients 11:28 patients to maintain progesterone levels 11:29 to maintain progesterone levels 11:29 to maintain progesterone levels 11:31 naturally 11:31 naturally with magnesium 11:32 with magnesium 11:32 with magnesium glycinate; in fact, 11:33 glycinate; in fact, 11:33 glycinate; in fact, magnesium is involved in 11:34 magnesium is involved in 11:34 magnesium is involved in over 300 reactions in the 11:35 over 300 reactions in the 11:35 over 300 reactions in the body. It 11:36 body. It 11:36 body. It supports 11:36 supports 11:36 supports hormonal 11:37 hormonal 11:37 hormonal signaling pathways 11:38 signaling pathways 11:38 signaling pathways involved in 11:39 involved in 11:39 involved in progesterone production. In 11:40 progesterone production. In 11:40 progesterone production. In addition, it is great for 11:41 addition, it is great for 11:41 addition, it is great for improving 11:42 improving 11:42 improving sleep. It also 11:43 sleep. It also 11:43 sleep. It also reduces inflammation. 11:45 reduces inflammation. 11:45 reduces inflammation. You should also 11:46 You should also 11:46 You should also combine this with an 11:47 combine this with an 11:47 combine this with an anti-inflammatory 11:48 anti-inflammatory 11:48 anti-inflammatory diet. It is worth 11:49 diet. It is worth 11:49 diet. It is worth limiting the consumption of
Your Options for Managing Perimenopause Bleeding 11:50 limiting the consumption of 11:50 limiting the consumption of sugar, refined 11:51 sugar, refined 11:51 sugar, refined carbohydrates, and 11:52 carbohydrates, and 11:52 carbohydrates, and alcohol, as 11:53 alcohol, as 11:53 alcohol, as they can significantly 11:54 they can significantly 11:54 they can significantly increase 11:55 increase 11:55 increase hormonal 11:55 hormonal 11:55 hormonal imbalances, 11:56 imbalances, 11:56 imbalances, cause heavy 11:57 cause heavy 11:57 cause heavy bleeding, and 11:58 bleeding, and 11:58 bleeding, and worsen 11:59 worsen 11:59 worsen 12:01 thyroid diseases. 12:01 thyroid diseases. Therefore, following an 12:02 Therefore, following an 12:02 Therefore, following an anti-inflammatory diet 12:03 anti-inflammatory diet 12:03 anti-inflammatory diet is equally important. 12:04 is equally important. 12:04 is equally important. If your bleeding is 12:05 If your bleeding is 12:05 If your bleeding is caused by low 12:06 caused by low 12:06 caused by low progesterone levels 12:07 progesterone levels 12:07 progesterone levels and you are interested in other 12:08 and you are interested in other 12:08 and you are interested in other bioidentical 12:09 bioidentical 12:09 bioidentical hormone therapies, 12:10 hormone therapies, 12:10 hormone therapies, watch my 12:11 watch my 12:11 watch my next video—“A 12:12 next video—“A 12:12 next video—“A Doctor’s Guide to 12:12 Doctor’s Guide to 12:12 Doctor’s Guide to Hormone Replacement 12:13 Hormone Replacement 12:13 Hormone Replacement Therapy.” It 12:14 Therapy.” It 12:14 Therapy.” It considers all 12:14 considers all 12:14 considers all options for 12:15 options for 12:15 options for using both 12:15 using both 12:16 using both estrogen and 12:16 estrogen and 12:16 estrogen and progesterone. If 12:17 progesterone. If 12:17 progesterone. If you like this 12:18 you like this 12:18 you like this content, please like 12:18 content, please like 12:19 content, please like , 12:19 , 12:19 , subscribe, and
Final Takeaway & Next Steps 12:20 subscribe, and 12:20 subscribe, and comment on what you 12:20 comment on what you 12:20 comment on what you would like to learn 12:21 would like to learn 12:21 would like to learn more about. I love 12:22 more about. I love 12:22 more about. I love speaking on various 12:23 speaking on various 12:23 speaking on various topics related to perimenopause 12:24 topics related to perimenopause 12:24 topics related to perimenopause and menopause, and I would be 12:25 and menopause, and I would be 12:25 and menopause, and I would be happy to create 12:26 happy to create 12:26 happy to create content that you 12:27 content that you 12:27 content that you really need.
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