I'm so mad right now that we've been told our entire lives that anaemia is a normal part of being female, take iron tablets, you'll be fine! 🙄 I've been taking iron tablets for 30 YEARS, and still rarely have ferritin levels over 30. Just last week I learned I have adenomyosis - a condition that can cause heavy bleeding. It's taken 30 years to find a doctor who is even remotely interested in finding the cause of my chronic anaemia. So yeah, I'm tired 🫠
I wish I could say your experience is uncommon, but I can't. It's unacceptable and I am so sorry this happened to you. But yeah, being tired can also be multifactorial!
This is so validating and an interesting read. I have not been one to complain about my heavy periods but my ferritin is below 10 for the second time in a year. I have been so exhausted for so long I just assumed this was my new normal.
Do you have an opinion about iron infusions vs oral iron?
When I have people who have taken iron and their ferritin is < 10 I try to get them set up for infusions. That way the iron level can be corrected quickly and you can see how much of the fatigue is iron related. Also, important to investigate/treat heavy periods.
Thank you so much for this- I wasn’t sure about safety of infusions. I was finally able to see a gyn who has made recommendations but not sure about investigation.
Had to comment that I just took my trusty iron supplement while hearing the "Menopause Manifesto" referenced on This American Life. It was a full Vajenda moment!
I was just coming here to mention This American Life! I loved how that imprisoned nurse was trying to combat misinformation in her prison and that she mentioned Menopause Manifesto explicitly!
Thanks as always. This ring sounds interesting, but also possibly annoying or tricky to place? How is it inserted and removed? My ob-gyn gave me an IUD for heavy bleeding at 46 and my period disappeared completely except for some minor symptoms and a tiny bit of light spotting once a month before my cycles became irregular. Grateful she talked me into it & wish I hadn't spent my life filling diva cups multiple times a day. (Super awkward when you work in an outdoors job with men and you routinely have to go to the bathroom behind a bush. My period also loved showing up on special vacations, no matter how much I tried to plan around it to avoid it. The exotic places I have leaked blood all over the place...One bonus of diva cup is you can actually quantify how many mLs of blood you're losing each month.)
My IUD is now my progesterone source that counters my estradiol patch, but I'll need a new one this year as it's now 5 years old. One day I'd like a different progesterone option as my ob-gyn will likely retire and she was thoughtful enough to insert it at the hospital, with proper pain management. I'm afraid of getting a new doctor who will insist on jamming it in during an office visit so knowing a different option is on the horizon for the future is reassuring.
Heavy periods are also a sign of low thyroid levels (scant hyperthyroid). I wonder how many OB/GYN's test patients for this. Low iron is also from hypothyroidism. I assume women who have no uterus would not benefit from the ring you have mentioned.
Unfortunately some women (like myself) require dose adjustments of synthroid in order to use any form of estrogen even vagifem or that ring. The ring would be convenient though. Thanks for responding.
I have two questions. My OB performed a uterine ablation for my heavy perimenopausal bleeding. It worked— Normalized my life at that tumultuous time, I wonder if it’s advisable? Second question, I would love to be part of the trial for the ring. Is that a possibility? Thank you for your work!
So true about iron deficiency. I had to have iron transfusions at 44 and I also thought my period was heavy "but not that bad". I think I would have bled out to death if not for ablation. A lot of doctors also don't understand the testing. My iron was in the low "normal" range while my ferritin was super low but not everyone checks for that.
As a woman with a bleeding disorder my periods have been a subject of investigation since age 14! So has my iron level. I had a bout of anemia about 18 months ago, between my haematologist and GP we found an iron supplement that dragged my levels up to « fine » but that took a year of trial & error.
I am 78 years old and for the the third time in 5 years, I have just had heavy bleeding for two weeks. I have a good GP and a good colposcopy doctor and when all the test results are in, they can't find anything wrong. My GP suspects that I just have a lot of estrogen in my body that adds up and produces these periods. I do have an odd history in that I started menstruating when I was ten, was on birth control pills from age 19-39, and finished menstruating in my mid-forties. Until now. I also had an abortion in my early twenties. No kids. Have you ever heard of this before?
This kind of bleeding needs to be investigated to make sure it isn't a precancer. A colposcopy can't answer the question. The recommended tests here would be an ultrasound and then either a hysteroscopy to look inside the uterus and do sampling or an endometrial biopsy. The decision to proceed with one or the other would depend on a few variables. But this should be looked into if it hasn't been already.
I have a question about this statement: "The progesterone levels were 1.19 ng/ml and a level > 1 ng/ml is associated with ovulation". I was always taught that progesterone >3 ng/mL is associated with ovulation, and this is consistent with ASRM statement on diagnosis and treatment of luteal phase deficiency. Is there other data on progesterone that I'm missing? Would love to check it out if so. Alternative hypothesis: is the vaginal ring study looking at average progesterone levels over the whole cycle or over the luteal phase? Maybe there's a difference between 1 ng/mL averaged over a 14-day luteal phase vs. peak progesterone level at Day 21-23
I clarified, thanks for pointing out. Also, I've read somewhere else that 1 ng/ml is considered the minimum for endometrium protection, so now I need to dig that up.
49, perimenopausal - bleed for +5 months straight (I'm not kidding when I say over the 5 months, I only had 2 days twice with no bleeding) with clots daily (though overall volume would ebb and flow) and endometrial thickness of 15.3. After trying 10mg norethindrone for a month (that did nothing), finally had 80mg/day of megace stop the bleeding and had a hysteroscopy with D&C. Biopsy came back as normal (no evidence even of hyperplasia). So I now have an IUD and will taper off the megace in 2 more weeks (2 weeks post-procedure currently). So I won't know for a bit if the Mirena on its own will be able to stop the bleeding consistently. 🤷♀️
But it is really common to bleed that long and have everything turn out normal, not even typical hyperplasia? My periods my whole life may have been heavy at times, but very consistent and always 5-6 days.
Bloodwork before the procedure: hemoglobin was 12, ferritin was 11.5, iron was 36, iron sat was 8%. So I'm just taking a iron supplement now and hoping that will bounce back.
So we're treating the symptoms I guess, but will I really never know the cause? Or could it really just be perimenopause? Ultrasound found a single 3.1cm peduculated, subserosal fundal fibroid that hasn't grown in 18 months, so my doctor didn't think that was the cause of the bleeding.
So I just thought I'd ask to see if there are any other tests I should be asking about? It's not that I want to find there to be something wrong with me, but without knowing the cause, I'm nervous we're missing something.
If you have a life long history of heavy bleeding, then being screened for a bleeding disorder is likely worthwhile (blood test). Also, have you tried tranexamic acid?
I have not tried tranexamic acid. I think they've been heavier at times as I've gotten older and my weight increased, but the heavier bleeding didn't have clots until recently. Have a follow-up this week so I'll ask my doctor about further blood tests, and if tranexamic acid is an option if the Mirena doesn't control the bleeding once I'm off the megace. Thanks!
Ah, this is great. When I was on FemRing & Prometrium I thought it would be great to have a ring w/ both drugs. I'm off HT now, but I'm glad for those 'coming up the pike.'
My doctor has recommended an iud for progesterone as I can’t tolerate oral progesterone, and my insurance won’t pay for the patches. I’m a little leery of this. What are your thoughts? When I tried going without estrogen, my hot flashes were unbearable.
"We need to study things that feel intuitive because “vibes” isn’t science." 👏 👏 👏 As always, thank you for your thoughtful analysis!
I'm so mad right now that we've been told our entire lives that anaemia is a normal part of being female, take iron tablets, you'll be fine! 🙄 I've been taking iron tablets for 30 YEARS, and still rarely have ferritin levels over 30. Just last week I learned I have adenomyosis - a condition that can cause heavy bleeding. It's taken 30 years to find a doctor who is even remotely interested in finding the cause of my chronic anaemia. So yeah, I'm tired 🫠
I wish I could say your experience is uncommon, but I can't. It's unacceptable and I am so sorry this happened to you. But yeah, being tired can also be multifactorial!
This is so validating and an interesting read. I have not been one to complain about my heavy periods but my ferritin is below 10 for the second time in a year. I have been so exhausted for so long I just assumed this was my new normal.
Do you have an opinion about iron infusions vs oral iron?
When I have people who have taken iron and their ferritin is < 10 I try to get them set up for infusions. That way the iron level can be corrected quickly and you can see how much of the fatigue is iron related. Also, important to investigate/treat heavy periods.
Thank you so much for this- I wasn’t sure about safety of infusions. I was finally able to see a gyn who has made recommendations but not sure about investigation.
You are so helpful - thank you 🙏
I had years of prolonged periods, low iron and fatigue only to be dismissed as anxiety and mental health issues. I am still bitter
Had to comment that I just took my trusty iron supplement while hearing the "Menopause Manifesto" referenced on This American Life. It was a full Vajenda moment!
I didn't know my book got a shout out on This American Life!
Such a powerful story. https://www.thisamericanlife.org/856/youve-come-to-the-right-person/act-two-1
For anyone who may be deaf or hard-of-hearing, the transcript is here: https://www.thisamericanlife.org/856/transcript.
I was just coming here to mention This American Life! I loved how that imprisoned nurse was trying to combat misinformation in her prison and that she mentioned Menopause Manifesto explicitly!
Thanks as always. This ring sounds interesting, but also possibly annoying or tricky to place? How is it inserted and removed? My ob-gyn gave me an IUD for heavy bleeding at 46 and my period disappeared completely except for some minor symptoms and a tiny bit of light spotting once a month before my cycles became irregular. Grateful she talked me into it & wish I hadn't spent my life filling diva cups multiple times a day. (Super awkward when you work in an outdoors job with men and you routinely have to go to the bathroom behind a bush. My period also loved showing up on special vacations, no matter how much I tried to plan around it to avoid it. The exotic places I have leaked blood all over the place...One bonus of diva cup is you can actually quantify how many mLs of blood you're losing each month.)
My IUD is now my progesterone source that counters my estradiol patch, but I'll need a new one this year as it's now 5 years old. One day I'd like a different progesterone option as my ob-gyn will likely retire and she was thoughtful enough to insert it at the hospital, with proper pain management. I'm afraid of getting a new doctor who will insist on jamming it in during an office visit so knowing a different option is on the horizon for the future is reassuring.
As I haven't seen the ring, i can't say for sure, but I suspect it's similar to other vaginal rings which are very easy to insert and remove.
Heavy periods are also a sign of low thyroid levels (scant hyperthyroid). I wonder how many OB/GYN's test patients for this. Low iron is also from hypothyroidism. I assume women who have no uterus would not benefit from the ring you have mentioned.
No, but there's already a ring with just estrogen -- FemRing; it's been around for years.
Unfortunately some women (like myself) require dose adjustments of synthroid in order to use any form of estrogen even vagifem or that ring. The ring would be convenient though. Thanks for responding.
I have two questions. My OB performed a uterine ablation for my heavy perimenopausal bleeding. It worked— Normalized my life at that tumultuous time, I wonder if it’s advisable? Second question, I would love to be part of the trial for the ring. Is that a possibility? Thank you for your work!
I don't see an active trial recruiting yet.
So true about iron deficiency. I had to have iron transfusions at 44 and I also thought my period was heavy "but not that bad". I think I would have bled out to death if not for ablation. A lot of doctors also don't understand the testing. My iron was in the low "normal" range while my ferritin was super low but not everyone checks for that.
As a woman with a bleeding disorder my periods have been a subject of investigation since age 14! So has my iron level. I had a bout of anemia about 18 months ago, between my haematologist and GP we found an iron supplement that dragged my levels up to « fine » but that took a year of trial & error.
It’s not even as simple as « take iron » 😂
I am 78 years old and for the the third time in 5 years, I have just had heavy bleeding for two weeks. I have a good GP and a good colposcopy doctor and when all the test results are in, they can't find anything wrong. My GP suspects that I just have a lot of estrogen in my body that adds up and produces these periods. I do have an odd history in that I started menstruating when I was ten, was on birth control pills from age 19-39, and finished menstruating in my mid-forties. Until now. I also had an abortion in my early twenties. No kids. Have you ever heard of this before?
This kind of bleeding needs to be investigated to make sure it isn't a precancer. A colposcopy can't answer the question. The recommended tests here would be an ultrasound and then either a hysteroscopy to look inside the uterus and do sampling or an endometrial biopsy. The decision to proceed with one or the other would depend on a few variables. But this should be looked into if it hasn't been already.
Thank you so much. I’ve has the ultrasounds so on to the next step.
I have a question about this statement: "The progesterone levels were 1.19 ng/ml and a level > 1 ng/ml is associated with ovulation". I was always taught that progesterone >3 ng/mL is associated with ovulation, and this is consistent with ASRM statement on diagnosis and treatment of luteal phase deficiency. Is there other data on progesterone that I'm missing? Would love to check it out if so. Alternative hypothesis: is the vaginal ring study looking at average progesterone levels over the whole cycle or over the luteal phase? Maybe there's a difference between 1 ng/mL averaged over a 14-day luteal phase vs. peak progesterone level at Day 21-23
I clarified, thanks for pointing out. Also, I've read somewhere else that 1 ng/ml is considered the minimum for endometrium protection, so now I need to dig that up.
The 1 ng/ml was from the research study and I am sure they meant over the entire luteal phase. So the average daily.
Thank you so much! Appreciate the clarification.
49, perimenopausal - bleed for +5 months straight (I'm not kidding when I say over the 5 months, I only had 2 days twice with no bleeding) with clots daily (though overall volume would ebb and flow) and endometrial thickness of 15.3. After trying 10mg norethindrone for a month (that did nothing), finally had 80mg/day of megace stop the bleeding and had a hysteroscopy with D&C. Biopsy came back as normal (no evidence even of hyperplasia). So I now have an IUD and will taper off the megace in 2 more weeks (2 weeks post-procedure currently). So I won't know for a bit if the Mirena on its own will be able to stop the bleeding consistently. 🤷♀️
But it is really common to bleed that long and have everything turn out normal, not even typical hyperplasia? My periods my whole life may have been heavy at times, but very consistent and always 5-6 days.
Bloodwork before the procedure: hemoglobin was 12, ferritin was 11.5, iron was 36, iron sat was 8%. So I'm just taking a iron supplement now and hoping that will bounce back.
So we're treating the symptoms I guess, but will I really never know the cause? Or could it really just be perimenopause? Ultrasound found a single 3.1cm peduculated, subserosal fundal fibroid that hasn't grown in 18 months, so my doctor didn't think that was the cause of the bleeding.
So I just thought I'd ask to see if there are any other tests I should be asking about? It's not that I want to find there to be something wrong with me, but without knowing the cause, I'm nervous we're missing something.
If you have a life long history of heavy bleeding, then being screened for a bleeding disorder is likely worthwhile (blood test). Also, have you tried tranexamic acid?
I have not tried tranexamic acid. I think they've been heavier at times as I've gotten older and my weight increased, but the heavier bleeding didn't have clots until recently. Have a follow-up this week so I'll ask my doctor about further blood tests, and if tranexamic acid is an option if the Mirena doesn't control the bleeding once I'm off the megace. Thanks!
Ah, this is great. When I was on FemRing & Prometrium I thought it would be great to have a ring w/ both drugs. I'm off HT now, but I'm glad for those 'coming up the pike.'
My doctor has recommended an iud for progesterone as I can’t tolerate oral progesterone, and my insurance won’t pay for the patches. I’m a little leery of this. What are your thoughts? When I tried going without estrogen, my hot flashes were unbearable.