If you're a woman in your 40s or early 50s feeling exhausted all the time, you might wonder what is causing this everyday tiredness despite eating healthy. A new study suggests that heavy or prolonged menstrual bleeding during perimenopause can significantly contribute to fatigue, adding to an already overwhelming mix of symptoms.

Perimenopause is the transitional phase before menopause when a woman's body begins to produce less estrogen, leading to irregular periods and hormonal fluctuations. This stage can last several years, and often brings symptoms like hot flashes, mood swings, sleep disturbances, and changes in menstrual flow. Most women transitioning through perimenopause experience irregular periods (including changes in the amount and duration of menstrual flow). 

Heavy Menstrual Bleeding (HMB) – Excessive bleeding during periods

Prolonged Menstrual Bleeding (PMB) – Bleeding that lasts longer than usual

Despite being so common, AUB has received little attention in both medical research and public discussions. This study published in the journal Menopause is one of the first to explore the link between abnormal bleeding during perimenopause and extreme fatigue.

Heavy Bleeding Affects Energy Levels:

One key reason heavy bleeding leads to fatigue is iron deficiency anaemia. When women lose excessive blood during perimenopause, iron levels drop, making it harder for the body to produce enough healthy red blood cells. This results in:

Feeling worn out all the time

Low energy levels

Difficulty staying alert

Persistent exhaustion, even after rest

To investigate this connection, researchers analyzed daily menstrual cycle data from over 2,300 midlife women. They found that women who experienced HMB or PMB during the six months before a follow-up visit were significantly more likely to report extreme fatigue, even after adjusting for other causes.

Doctors Call for Greater Awareness:

Currently, perimenopausal bleeding issues don’t get nearly as much attention as symptoms like hot flashes or mood swings. Many women don’t seek help because they assume irregular bleeding is “just part of getting older.” But ignoring these changes can lead to undiagnosed anemia and long-term fatigue.

“This study highlights the need for greater clinical awareness of abnormal uterine bleeding during perimenopause, particularly given how common it is and its link to low energy or fatigue,” says Dr. Stephanie Faubion, medical director for The Menopause Society. “Educating women about prolonged or heavy menstrual bleeding during perimenopause and the potential health consequences is also needed.”

What Women Can Do:

Monitor your cycles– If you experience excessively heavy or prolonged periods, track them and discuss patterns with your doctor.

Get tested for anaemia– A simple blood test can determine if your iron levels are low.

Consider treatment options– If bleeding is severe, medical treatments like iron supplements, hormonal therapy, or minimally invasive procedures may help.

Don’t ignore extreme fatigue– If you feel persistently exhausted, don’t just assume it’s normal. Fatigue that disrupts daily life deserves medical attention.

Fatigue during perimenopause is not just in your head, it has real physiological causes. Heavy and prolonged bleeding can drain your energy, yet it’s often overlooked in menopause discussions. This new research sheds light on the importance of identifying and addressing abnormal uterine bleeding so that women can manage fatigue more effectively and improve their overall quality of life.

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