Heavy Periods During Perimenopause? Understanding Fibroids, Endometriosis & Your Treatment Options
Heavy periods, painful menstruation, and pelvic discomfort can affect your quality of life. Learn about medical treatment options, including MYFEMBREE, and how to support your pelvic health through perimenopause and menopause.
Changes in your menstrual cycle are common during perimenopause. Your periods may become heavier, more unpredictable, or increasingly uncomfortable. But how do you know what's a normal hormonal change and what might require medical attention?
For some women, heavy menstrual bleeding and pelvic pain may be associated with conditions such as uterine fibroids or endometriosis.
Treatment options are available, including prescription medications, medical management, and supportive pelvic health therapies.
At MAUD Medical Clinic in Calgary, our medical doctors provide assessments and care for women's health concerns, including heavy menstrual bleeding, uterine fibroids, endometriosis, perimenopause, and menopause.
Why Do Periods Get Heavier During Perimenopause?
Perimenopause is the transitional stage leading up to menopause, when estrogen and progesterone levels begin to fluctuate.
These hormonal changes can affect your menstrual cycle, sometimes causing heavier bleeding, irregular periods, or increased menstrual discomfort.
However, not all heavy bleeding is caused by perimenopause.
Other possible causes include:
Uterine fibroids: Non-cancerous growths in or around the uterus that can contribute to heavy menstrual bleeding, pelvic pressure, and discomfort.
Endometriosis: A condition in which tissue similar to the uterine lining grows outside the uterus, potentially causing significant menstrual pain and chronic pelvic discomfort.
Adenomyosis: A condition involving endometrial-like tissue within the muscular wall of the uterus, which can cause heavy or painful periods.
Uterine polyps: Growths in the uterine lining that may contribute to abnormal bleeding.
Heavy menstrual bleeding can sometimes lead to iron deficiency or anemia, causing symptoms such as fatigue, weakness, shortness of breath, or dizziness. A healthcare professional may recommend blood tests or additional investigations, such as a pelvic ultrasound, to identify the underlying cause.
If your periods are becoming increasingly heavy, painful, or unpredictable, a medical assessment can help determine appropriate next steps.
What Medical Treatments Are Available for Heavy Periods, Fibroids & Endometriosis?
Treatment depends on the underlying condition, the severity of symptoms, your medical history, and your personal preferences.
Medical management may include:
Hormonal medications: Certain hormonal treatments can help manage heavy menstrual bleeding or endometriosis-related pain.
Hormonal intrauterine devices (IUDs): These may help reduce menstrual bleeding and pain for some patients.
Non-hormonal medications: Certain medications can reduce menstrual blood loss or help manage pain.
Specialized prescription therapies: Medications such as MYFEMBREE may be considered for eligible patients with specific conditions.
Procedures or surgery: Depending on the diagnosis, symptoms, and treatment goals, procedural or surgical options may also be discussed.
Not every treatment is suitable for every patient. A physician can help explain the available options, potential benefits, risks, and alternatives.
What Is MYFEMBREE?
MYFEMBREE is a prescription medication approved in Canada for premenopausal women experiencing:
Heavy menstrual bleeding associated with uterine fibroids.
Moderate-to-severe pain associated with endometriosis.
It contains three medications: relugolix, estradiol, and norethindrone acetate.
Relugolix reduces the activity of certain reproductive hormones, while estradiol and norethindrone acetate are included to help reduce some effects associated with lowered estrogen levels.
MYFEMBREE is not a general treatment for perimenopause, menopause, or vaginal dryness.
It is not suitable for everyone and has important safety considerations, including blood clot risks and potential bone mineral density loss. Other contraindications, precautions, and treatment-duration considerations may apply.
Your physician can discuss whether this or another treatment is appropriate for your individual circumstances.
Is MYFEMBREE Covered in Alberta?
Yes. MYFEMBREE was added to the Alberta Drug Benefit List effective April 1, 2026, under Special Authorization.
According to the published Alberta coverage criteria, eligible patients must meet specific requirements.
Alberta MYFEMBREE Coverage Requirements
Age: 18 years or older.
Menopausal status: Premenopausal.
Eligible condition: Confirmed heavy menstrual bleeding associated with uterine fibroids.
Prescriber: A clinician with expertise in diagnosing and managing uterine fibroids.
Initial authorization: Up to six months.
Renewal: Eligible for automatic renewal, subject to applicable requirements.
The published criteria also state that treatment should be discontinued following successful surgery or a procedure, when pregnancy is planned, upon reaching menopause, or following a meaningful decline in bone mineral density.
MYFEMBREE should not be combined with another gonadotropin-releasing hormone (GnRH) agonist or antagonist.
Important: Although MYFEMBREE is approved in Canada for both fibroid-related heavy menstrual bleeding and moderate-to-severe endometriosis pain, Alberta's published Special Authorization criteria specifically address heavy menstrual bleeding associated with uterine fibroids.
Coverage is not automatic. Patients must meet the applicable clinical criteria and be eligible for a participating drug benefit program.
Where Can I Check My Coverage?
You can review the published requirements through the following resources:
MYFEMBREE Provincial Coverage Information — See Alberta on Page 3
Alberta Blue Cross — Search the Drug Benefit List
Your physician or pharmacist can help determine whether you qualify for coverage and whether Special Authorization is required.
At MAUD Medical Clinic, our medical doctors provide assessments and management for heavy menstrual bleeding, uterine fibroids, and endometriosis. Your doctor can discuss appropriate medical treatment options based on your symptoms and medical history.
Beyond Heavy Periods: Supporting Your Pelvic Health Through Perimenopause and Menopause
Perimenopause and menopause can affect much more than your menstrual cycle.
As hormone levels change, women may also experience:
Vaginal dryness, irritation, or discomfort
Pain during intercourse
Bladder leakage or urinary urgency
Changes in pelvic floor muscle function
Vaginal and pelvic discomfort
Some vaginal and urinary symptoms may be associated with Genitourinary Syndrome of Menopause (GSM), a condition related to declining estrogen levels.
These symptoms are different from those caused by fibroids or endometriosis and may require separate treatment approaches.
At MAUD Medical Clinic, we encourage women to explore a comprehensive approach to vaginal and pelvic health, including medical assessments and complementary treatment options when appropriate.
Pelvic Floor Physiotherapy
Pelvic floor physiotherapy can help women experiencing bladder leakage, pelvic floor weakness, muscle tension, and discomfort during intercourse.
Treatment may include individualized exercises, muscle relaxation techniques, education, and strategies to improve pelvic floor function.
Pelvic floor physiotherapy can be especially helpful for women experiencing pelvic health changes during perimenopause, menopause, and after childbirth.
Learn More About Pelvic Floor Physiotherapy at MAUD
Vaginal Laser Therapy
Some women experiencing vaginal dryness or discomfort associated with menopause may be interested in vaginal laser therapy.
At MAUD, vaginal laser consultations begin with an assessment of your symptoms, medical history, and treatment goals.
Evidence supporting vaginal laser treatment for GSM remains limited. It is not an established first-line treatment, and potential risks, benefits, and uncertainties should be discussed with a qualified medical professional.
Established options, including vaginal moisturizers, lubricants, and local vaginal hormone therapy when appropriate, should also be considered.
Explore Vaginal Laser Consultations at MAUD
Emsella for Bladder Leakage
Bladder leakage is a common concern among women, particularly during and after menopause.
Emsella is a non-invasive treatment that uses electromagnetic stimulation to activate pelvic floor muscles.
It may be considered for selected women experiencing urinary incontinence. However, evidence of its long-term effectiveness is still developing, and it does not replace established first-line approaches such as pelvic floor muscle training.
A pelvic health assessment can help determine which treatment options are most appropriate.
Discover Emsella Treatment in Calgary
Medical Consultations for Fibroids, Endometriosis & Menopause
At MAUD Medical Clinic, our medical doctors assess and manage a range of women's health concerns, including:
Heavy menstrual bleeding and painful periods
Uterine fibroids
Endometriosis
Perimenopause and menopause symptoms
Vaginal dryness and Genitourinary Syndrome of Menopause (GSM)
Other vaginal and pelvic health concerns
Depending on your symptoms, your doctor may discuss medical treatment options, recommend further investigations, or coordinate additional care when needed.
Our goal is to help you better understand your symptoms and make informed decisions about your health.
Frequently Asked Questions About Heavy Periods and Perimenopause
Is heavy menstrual bleeding normal during perimenopause?
Menstrual changes are common during perimenopause, including irregular or heavier periods. However, consistently heavy bleeding, bleeding between periods, or significant menstrual pain should be medically assessed to rule out other conditions.
How do I know if I have uterine fibroids?
Fibroids may cause heavy periods, pelvic pressure, frequent urination, or discomfort, although some women experience no symptoms at all.
A healthcare professional may recommend a pelvic examination or ultrasound to help determine whether fibroids are present.
Is MYFEMBREE covered in Alberta?
MYFEMBREE is listed on the Alberta Drug Benefit List under Special Authorization for eligible premenopausal patients with heavy menstrual bleeding associated with uterine fibroids.
Patients should confirm their individual eligibility with their prescribing healthcare professional or pharmacist.
Can pelvic floor physiotherapy help during menopause?
Yes. Pelvic floor physiotherapy can help manage certain symptoms associated with pelvic floor dysfunction, including urinary incontinence, pelvic floor muscle tension, and discomfort during intercourse.
What treatments are available for vaginal dryness during menopause?
Treatment options may include vaginal moisturizers, lubricants, local vaginal estrogen, or other prescription therapies, depending on your symptoms and medical history.
Pelvic floor physiotherapy may also help when muscle tension or pelvic floor dysfunction contributes to discomfort. Vaginal laser therapy is sometimes discussed, but evidence remains insufficient to establish it as a standard treatment for GSM.
Can I book a women's health consultation without a referral in Calgary?
MAUD Medical Clinic offers self-referral appointments for eligible women's health concerns, including menopause and vaginal health symptoms.
Our medical doctors also provide assessments and management for heavy menstrual bleeding, fibroids, and endometriosis. Patients can contact the clinic to confirm the appropriate appointment pathway for their concern.
When Should You Seek Medical Attention?
It's important to speak with a healthcare professional if you experience:
Periods that are significantly heavier than usual
Menstrual pain that interferes with everyday activities
Bleeding between periods
Persistent pelvic pain or pressure
Vaginal dryness or painful intercourse
New or worsening bladder leakage
Any vaginal bleeding after menopause
If you're soaking through menstrual products every hour, feeling faint, or experiencing sudden severe pelvic pain, seek urgent medical assessment.
Women's Health Care in Calgary — Book a Medical Consultation
You don't have to navigate heavy menstrual bleeding, perimenopause, menopause, or changes in your pelvic health alone.
At MAUD Medical Clinic, our medical doctors provide assessments and individualized care for women's health concerns, including uterine fibroids, endometriosis, menopause, and vaginal health.
Depending on your needs, your care plan may include medical management, further investigations, or complementary pelvic health services.
Our goal is to provide education, personalized guidance, and access to appropriate care so you can make informed decisions about your health.
Book a Medical Consultation for Heavy Periods, Fibroids, Endometriosis or Menopause
MAUD Medical Clinic | Calgary, Alberta
Publicly funded medical consultations and private-pay treatment options are available, depending on the service.
Medical Disclaimer
The information provided in this article is for general educational and informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. It should not replace a consultation with a qualified healthcare professional. Every individual's health needs and medical history are different. Always consult your physician or qualified healthcare provider before starting, changing, or discontinuing any medication or treatment. MAUD Medical Clinic does not endorse any specific medication or treatment for all patients. Treatment suitability, risks, benefits, and eligibility should be discussed with your healthcare provider.
