Heavy Clotty Periods in Perimenopause

Hi Mia,

Hope you are well! I don’t know if you remember me, but I met you at T M’s house back in October. I was the person with the history of fibroids who had just had surgery. I bought your book and have been reading it and implementing what you suggested. I truly love everything I am learning from it. It has truly been great to understand more about the connection between gut-hormone-seretonin connection. And I have seen some differences, my breasts are no longer soar, my periods are back to 28 days apart and I am not as emotional during my period. (Unlike many of your clients I get depressed and anxious during my period, but not before nor after)

Unfortunately, despite my surgery and following your book suggestions for 3 months my period flow is drastically heavy with many clots. I have been using a progestorone cream for 3 months but so far no major changes in flow. Also my period lasts for two weeks out of the month. With the heavy cycle lasting for 3 days. I just got my hemoglobin count done and it was at a 6.7. I am quite worried and my Drs have been mentioning the “H” word unless I get a UTI (the internal birth control device). I am of course working to get it up through iron. I was temporarily put on estradiol and aygestin for this week to stop the bleeding. However, from your book I
know that this is not a good solution. And that this type of hormone treatment can make things worse. I chose to take it to stop my bleeding immediately and buy me time for a better course of action.

In addition, when I asked my doctor for bio-identical hormones-he just laughed and said they dont work. (Im changing doctors anyway!). I have spoken to two other doctors and no one seems interested in prescribing bio identical hormones or figuring out what is wrong. Its either option 1) Birth control or option 2) hysterectomy.

I am not sure if you have a discussion board on your website but I wanted to email and see if you could help in some way. I feel that I may need a prescription for bio identical progesterone. I know you cannot prescribe medication or hormones without being in person so I am wondering if you know anyone in the Bay Area. As my own health practitioners are not willing to help in this way. And I am feeling quite sad and alone. Any help would be greatly appreciated.

Thank you,

Warmest Wishes,


Dear A.S.,
I don’t know how many times I have heard this from patients over the years. It is really sad that most doctors don’t put two and two together here.
In perimenopause your estrogen is high and erratic. Estrogen makes the lining in your uterus grow thick. At the same time progesterone , the hormone that will stop the growth and prepare the lining for a normal once-a-month shedding, is too low. In turn, you end up with a really thick “fresh” lining, and once you menstruate you bleed heavily often passing big clots.
Why does it not make sense to most doctors to simply replace the progesterone with bio-identical progesterone, the hormone the ovaries are not producing enough of anymore?
Prometrium is a commercially made bioidentical progesterone available at most pharmacies. A dose of 100mg twice daily, day 16-28 of the menstrual cycle (day one is the first day of bleeding) will normalize the menstrual bleeding for most women and prevent surgeries like ablations and hysterectomies.
However, a hemoglobin of 6.7 is a very serious problem. You definitely need to be under medical supervision and might even need a blood transfusion! Please find a doctor that you can work with as soon as possible!

Mia Lundin R.N.C.N.P.