Every few months, a post goes around the perimenopause subreddits that stops the scroll. Usually it's a woman describing what her period has become (a "crime scene," a "murder scene," bleeding through everything in an hour) and asking, quietly, is this normal? The comments flood in. Half the replies are "same, girl, same." The other half are women saying the one word that changes everything: fibroids.
We are not here to tell you what's normal. We're here to give you the receipts (the actual clinical thresholds), so the next time you're bleeding through a pad every hour, you know whether you're describing a Tuesday or a data point that deserves a workup. The difference matters, because the treatment paths are completely different.
Heavy vs. flooding: the clinical line
"Flooding" is a community word, but it maps to something specific: bleeding that overwhelms your period products. The NHS is more useful than we are here, because they give numbers. You may have heavy periods if you Established: NHS:
- Need to change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than recommended
- Need to use two types of period product together (a pad and a tampon) to catch the flow
- Have periods lasting more than 7 days
- Pass blood clots larger than about 2.5cm (about the size of a 10p coin, or a grape if you're not British)
- Bleed through to your clothes or bedding
- Avoid daily activities, like exercise, or take time off work because of your periods
- Feel tired or short of breath a lot
Read that list again, slowly. Every single line is a threshold, not a vibe. "Bleeding through to your clothes" isn't a personality trait; it's on the NHS's official checklist. If you hit any of these, you are not being dramatic. You're describing a condition with a name.
The perimenopause twist
Here's the part that makes this whole conversation confusing: heavy periods can be normal approaching menopause Established: NHS. Your hormone levels are swinging wildly as ovulation becomes unreliable, and the lining of your uterus gets thicker before it sheds. That genuinely can mean heavier, longer, weirder periods for a stretch.
So "heavy is normal in perimenopause" is a true sentence, and "heavy periods can be a sign of something real" is also a true sentence. Both can be true, which is exactly why the thresholds matter. Normal-perimenopause-heavy tends to stay within the NHS checklist at the mild end. Flooding (soaking a pad every hour, hour after hour, passing clots that make you wince) trends toward the "worth investigating" end. Especially when it's a change from your baseline.
The fibroids question
If you read the comments on any flooding post, you'll see the same word over and over: fibroids. That's not a coincidence. Fibroids are non-cancerous growths in or around the womb, and their single most common symptom is heavy or painful periods Established: NHS. They mainly affect women who have not been through menopause, which, if you're in perimenopause, is exactly where you are.
Fibroids don't always cause symptoms, so plenty of women have them and never know. But the symptom list overlaps with the flooding conversation in a way you should know: heavy periods, painful periods, stomach pain, lower back pain, peeing more often or suddenly, bloating or trouble pooing, and pain during sex Established: NHS.
Here's the part women repeat in every thread, and it's worth hearing: fibroids are diagnosed with an ultrasound, but only if somebody orders one. Your GP can't see fibroids from a conversation. The NHS pathway is: you describe the symptoms, your GP does a physical and pelvic exam, and if they think fibroids are possible, they refer you to a specialist for an ultrasound scan Established: NHS. That referral is the whole ballgame. Nothing happens until someone asks for the scan.
When to push
You don't need to be in crisis to book the conversation. The NHS says to see a GP if Established: NHS:
- Heavy periods are affecting your life
- You've had heavy periods for some time
- You have severe pain during your periods
- You bleed between periods or after sex
- You have heavy periods and other symptoms, like pain when peeing, pooing, or having sex
Bleeding between periods, bleeding after sex, and postmenopausal bleeding of any kind are the ones that should never wait. If you are fully postmenopausal and bleeding at all, that's a same-week call, not a someday call.
And if you're showing signs of iron loss (tired all the time, short of breath, pale), say so. Heavy bleeding is the most common cause of iron deficiency anaemia in women with fibroids Established: NHS. "I'm exhausted" is a symptom, not a confession.
What happens next, if you go
If you do get the workup, the options are more boring, and more effective, than you'd think. For heavy bleeding alone, treatments start with things like tranexamic acid (which reduces bleeding), prescription anti-inflammatories, the combined pill, or a hormonal IUS Established: NHS. If a condition like fibroids is found, treatment depends on size, number, and location, from medication to shrink symptoms to procedures like endometrial ablation, myomectomy (removing the fibroids), or in the most severe cases, hysterectomy Established: NHS.
None of that is a decision you make today. It's a decision you make after you have information. The information starts with a phone call.
The bottom line
Heavy periods approaching menopause can be normal. But "can be normal" is doing a lot of work in that sentence; it doesn't mean your pattern is automatically fine, and it doesn't mean the fibroids word in the comments is just noise.
The line we want you to remember: if you're changing protection every 1–2 hours, bleeding through to clothes or bedding, or passing clots bigger than a 10p coin, that's flooding, and flooding is a doctor conversation. Write it down. Bring it to the appointment. Ask for the ultrasound if the conversation goes nowhere. The worst case is you find out everything's fine. The best case is you find out the thing that's been wrecking your week has a name, and a treatment.
This article is for information, not diagnosis. If you're bleeding through protection every hour for more than a couple of hours, bleeding heavily with dizziness or shortness of breath, or bleeding after menopause, contact a healthcare professional promptly.
