Understanding Heavy Bleeding Near Menopause

🩸 Understanding Heavy Bleeding Near Menopause: Beyond Hysterectomy

By Dr. Subha Rajan, BAMS

Founder, Dr. R.V. Pathy Ayurveda Clinic | Ayurvedic Physician & Mental Wellness Educator

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🌸 Introduction: A Whisper That Grows Louder

“Doctor, my periods are going on for 10 days now. Earlier it was just 4–5 days.”

“Every month the bleeding gets heavier. I feel drained.”

“My doctor said it’s normal — or to remove the uterus if it gets worse.”

These concerns are common — but deeply personal. Many women nearing menopause experience changes in their menstrual cycles, but very few feel safe enough to ask, explore, and understand what's happening inside their bodies.

Let’s walk through this together. This blog will help you understand:

Why bleeding increases near menopause

What’s normal and what’s not

The Ayurvedic perspective

Why hysterectomy isn’t always necessary

What happens to calcium and bones after surgery

How you can support your body — naturally and holistically

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🌙 What Is Perimenopause, and Why Is Bleeding Affected?

Perimenopause is the transitional phase before menopause, typically starting around the late 30s or early 40s. It can last 4–8 years, and the key reason for increased bleeding lies in one word: hormones.

🔄 Hormonal Chaos

Estrogen levels fluctuate, sometimes higher than usual

Progesterone drops due to missed ovulation (anovulatory cycles)

This leads to endometrial buildup and irregular shedding

Common Symptoms Include:

Longer periods (more than 7 days)

Heavier flow (sometimes with clots)

Shorter cycle intervals (e.g., 21 days instead of 28)

Intermittent spotting

Breast tenderness, mood changes, fatigue

These symptoms are biological, not pathological — but that doesn’t mean they should be ignored.

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🚨 When Is It Not Normal?

While some fluctuation is expected, you should consult a physician if you notice:

Periods lasting more than 10 days

Very heavy flow (changing pads every 1–2 hours)

Large clots

Intermenstrual bleeding (between periods)

Postmenopausal bleeding

Constant fatigue, dizziness, or paleness (may indicate anemia)

Pressure or fullness in the lower abdomen (possible fibroid)

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🧬 Possible Modern Diagnoses

Heavy or prolonged bleeding during perimenopause can be associated with:

Uterine fibroids (leiomyoma)

Endometrial hyperplasia

Endometrial polyps

Hormonal disorders (e.g., PCOS, thyroid issues)

Blood clotting disorders

Medications (e.g., blood thinners)

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🌿 Ayurvedic Understanding: Artava Dushti & Doshic Imbalance

In Ayurveda, the menstrual cycle is governed by Vata, Pitta, and Kapha, with Apana Vata specifically managing downward flow. Disturbances in this balance can manifest as excessive or irregular bleeding.

📚 Ayurvedic Terms Related to This Condition:

Asrigdara – excessive menstrual bleeding

Raktapitta – pitta-induced vitiation of blood

Artavavyapad – menstrual irregularities

Granthi / Arbuda – fibroid-like growths

🔥 Common Imbalances

Pitta vitiation causes excessive heat and blood flow

Vata aggravation disturbs the regulation and flow

Rakta dushti leads to impure, unregulated bleeding

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❌ Hysterectomy: A Common Suggestion — But Not the Only Way

Hysterectomy (removal of the uterus) is often recommended too early or too easily, especially if:

You’ve crossed 40

You’re not planning more children

you experience irregular bleeding

But here’s the reality:

Hysterectomy is not always necessary and should never be the first line of treatment without trying non-invasive, root-cause-based solutions.

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⚠️ What Happens If You Remove the Uterus?

If hysterectomy is done along with ovary removal (oophorectomy), it leads to surgical menopause — often much harsher than natural menopause.

☠️ Sudden Drop in Estrogen Can Cause:

Calcium imbalance

Bone demineralization (osteopenia / osteoporosis)

Joint and muscle pain

Tooth issues

Fatigue and mood swings

Early signs of aging

Ayurvedically, this is viewed as Majja dhatu and Asthi dhatu kshaya, along with aggravation of Vata dosha.

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🧘‍♀️ How Can You Prevent or Recover Holistically?

Whether you are:

Currently facing heavy bleeding

Nearing menopause

Have already undergone hysterectomy

…Ayurveda offers gentle, empowering support.

✅ Ayurvedic Management Plan:

1. Balance Vata-Pitta with herbs like:

Ashokarishta, Lodhra, Shatavari, Arjuna, Praval pishti

2. Rasayana Chikitsa:

Ashwagandha, Shatavari granules, Guduchi, Amalaki

3. Support Bone Health:

Mukta shukti bhasma, Laksha churna, Hadjod, sesame

4. Calcium-rich Natural Foods:

Ragi, sesame seeds, drumstick leaves, moringa, figs, dates, cow’s ghee

5. Lifestyle Care:

Abhyanga (medicated oil massage)

Gentle yoga

Breathing practices

Sun exposure for vitamin D

6. Mental Health Support:

Regular emotional check-ins

Aromatherapy

Journaling and counseling if needed

🩸 HORMONAL MILIEU DURING PERIMENOPAUSE

🔄 Hormonal Fluctuations

Perimenopause is marked by erratic ovarian activity, causing:

Hormone Typical Change Effect

Estrogen Unpredictably ↑ or ↓ May cause endometrial hyperplasia, fibroid growth

Progesterone Progressive ↓ Anovulatory cycles, unopposed estrogen

LH & FSH Overall ↑ (due to low feedback) Irregular follicle development

Androgens Mild ↓ or unchanged Still enough to cause PCOS features

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🧬 UTERINE FIBROIDS (LEIOMYOMAS)

📌 Definition:

Benign monoclonal tumors of smooth muscle origin in the myometrium.

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🧪 Pathogenesis:

1. Estrogen Dominance:

Estrogen stimulates fibroid growth by:

Increasing mitotic activity in myometrial cells

Promoting local growth factors like IGF-1, EGF, and TGF-β

2. Progesterone’s Paradoxical Role:

Promotes fibroid proliferation by:

Upregulating Bcl-2 (anti-apoptotic protein)

Stimulating ECM (extracellular matrix) production

Causing fibroid to grow while stabilizing uterine lining

3. ECM Accumulation:

Fibroids have more collagen, fibronectin, proteoglycans

Contributes to size, firmness, and resistance to regression

4. Angiogenesis:

↑ VEGF (Vascular Endothelial Growth Factor) → excessive vascular supply → heavy bleeding

5. Genetic Mutations:

MED12 mutation (in ~70% fibroids)

HMGA2, COL4A5/

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🧠 Perimenopausal Dynamics:

As estrogen becomes intermittently high, fibroids may temporarily grow

Decline in estrogen after menopause → reduced fibroid stimulation → natural shrinkage

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⚖️ Postmenopausal Behavior:

Fibroid Type Behavior Post-Menopause

Small Intramural Usually regress

Large Submucosal May persist or calcify

Symptomatic (bleeding, pressure) Require evaluation

> ⚠️ Postmenopausal bleeding warrants investigation (endometrial carcinoma rule-out).

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🪔 Ayurvedic View:

Granthi (kapha-pradhana + meda dushti) in the garbhashaya mamsa

Causative doshas: Kapha, Vata, Rakta

Ama accumulation, blocked Apana Vata, and strotorodha

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🌑 PCOS IN PERIMENOPAUSE

📌 Definition:

A chronic endocrine-metabolic disorder characterized by hyperandrogenism, anovulation, and polycystic ovaries

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🧪 Pathophysiology:

🔄 Hormonal Imbalance:l

Feature Change

↑ LH / ↓ FSH Stimulates theca cells → ↑ androgens

↑ Androgens Prevent normal follicular development

↑ Insulin Stimulates ovarian androgen production

↑ AMH Inhibits follicular sensitivity to FSHll

↓ Progesterone Due to chronic anovulation

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🧬 Metabolic Dysfunction:

Insulin resistance → ↑ androgens & ↓ SHBG → ↑ free testosterone

Obesity (esp. abdominal) worsens insulin sensitivity

Low-grade inflammatory state (↑ CRP, TNF-α, IL-6)

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🧠 Perimenopausal Impact

Ovulation further decreasesl

Progesterone continues to decline

Androgens may remain elevated or decline slowly

PCOS symptoms like irregular cycles, acne, facial hair may persist

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⚖️ Postmenopausal PCOS Behavior:

Symptom Likely Outcome

Ovarian cysts Reduce (ovarian atrophy)

Menstrual irregularity Resolves (menopause)

Hirsutism / acne May persist (if insulin resistance continues)

Cardiometabolic risk Remains ↑ (diabetes, hypertension, fatty liver)

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🪔 Ayurvedic View:

Beeja Dushti and Artava Kshaya

Dominant Kapha-Vata, Medo dhatu dushti, Srotas avarodha

Cysts = Kaphaja Granthi 

⚕️ CLINICAL DIFFERENTIATION

Feature Uterine Fibroid PCOS

Origin Myometrial tissue Ovarian follicles

Cause Estrogen excess LH/FSH imbalance, insulin

Symptoms Heavy bleeding, pressure, anemia Irregular cycles, acne, hirsutism

Menopause Effect Shrinks fibroid Resolves cysts, metabolic risk Remain

🌿 AYURVEDIC MANAGEMENT STRATEGY

✨ For Fibroids:

Kanchanara Guggulu, Ashoka bark, Lodhra, Triphala

Tikta-Virechana, Basti for Apana Vata regulation

Avoid Kapha-aggravating foods (dairy, sugar, wheat)

✨ For PCOS:

Varuna, Shatapushpa, Triphala, Vrikshamla

Lekhaniya basti, Udwarthana, Virechana

Lifestyle: Dinacharya with Kapha-pacifying diet + movement

🧠 ADDITIONAL PEARLS

🔹 Vata aggravation post-hysterectomy → dryness, bone loss

🔹 Estrogen drop = ↓ calcium absorption → osteoporosis risk

🔹 PCOS patients are at higher risk of postmenopausal metabolic syndrome

 TAKEAWAY FOR PRACTICE

Don’t rush to hysterectomy unless there's severe symptomatic fibroid

PCOS is not just about periods — it’s a lifelong metabolic pattern

Both can improve naturally post-menopause — but Ayurveda helps accelerate and stabilize the healing

Always investigate postmenopausal bleeding

Focus on Ahara, Vihara, Aushadha, and mental well-being

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💖 A Final Note from Me to You

 “Your uterus is not a problem to be removed — it’s a messenger asking you to pause, observe, and heal.”

We live in a world where symptoms are silenced and surgeries are fast-tracked. But Ayurveda reminds us — the body never lies, and healing happens when you honor your rhythms.

Don’t rush into removing the very organ that held your power, your cycles, your femininity.

Let’s first try to restore balance, not remove the root.

If you're going through these changes, I’m here to walk

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📞 To Book a Consultation

Dr. Subha Rajan, BAMS

💌 Personalized Ayurvedic care for hormonal balance and menopause