After 6 years of flooding, then anxiety and adenomyosis in early perimenopause: symptoms down by 73% in 15 weeks, bleeding normalised

Nadia’s story

Nadia was a 42-year-old nurse with heavy bleeding in perimenopause so severe that she was living in her pads, needing iron transfusions, and losing control of her moods.

Her periods could come every 14 days and last seven days, with clots, as she described them, “the size of tennis balls”. She was bleeding so constantly that she couldn’t have sex. Twice, the bleeding was so heavy that her hormonal coil was pushed out. A private scan diagnosed adenomyosis. She was a size eight with tiny arms and legs, but her stomach was so swollen that she was offered a seat on the train because people thought she was pregnant.

The week before each bleed brought dark moods, anxiety, irritability and sugar cravings. Her brain fog was bad enough that she worried about dementia, which her grandmother had had. She had been prescribed tranexamic acid, coils and the pill, but no one had looked at why she was bleeding.

“I am not being managed very well in the NHS and the last straw was that the second coil fell out. I’m bleeding, I’m a size eight but look pregnant all the time, and I’m trying to manage my moods. I feel I have lost six years of life.”

— NADIA, AT HER FIRST CONSULT

Bleeding timeline

How the bleeding unfolded

Nadia’s heavy bleeding began in her mid-30s. Every form of contraception she tried left her with dark, “mucky” bleeding, so at 35 she had a copper coil fitted as a last resort. It made everything much worse.

• Age 35 – copper coil fitted. The flooding became severe, sometimes with two bleeds a month. She could taste copper in her mouth. Her moods changed: she felt angry, forgetful, made rash decisions and was “not happy with life”, with weeks every month of feeling terrible. Her doctor offered antidepressants. She developed body aches and lost a lot of weight.
• Age 36 – iron transfusions. The blood loss left her needing iron infusions roughly every three months. This was the last time she felt well. “I feel I have lost six years of life.”
• Age 41 – copper coil out, Mirena in. “Like a weight was lifted – I felt so chill.” Her brain fog lifted, she slept better and felt like herself again.
• December – the Mirena fell out. A huge bleed, with clots “like tennis balls”, pushed the coil out while she was in a shop. A private scan diagnosed adenomyosis. She was given tranexamic acid and the progestogen-only pill. When her next appointment was delayed, she took her daughter’s combined pill, Lucette, and felt fine.
• February this year – Mirena refitted. Her doctor advised putting the Mirena back in. She was fine at first, with a little “mucky” bleeding.
• June – the Mirena fell out again from heavy bleeding. She put herself back on Lucette and was fine.
• Then – told to stop Lucette by her doctor because she smokes. Within days she was bleeding again and struggling to manage her anxiety.

At each step, the bleeding was managed with a device or a drug. No one asked why her womb was bleeding so heavily in the first place.

Health history

• Iron deficiency, low blood pressure and fainting since her first period at 16
• Long history of trouble with contraception: dark, “mucky” bleeding on the implant and progestogen-only pill
• Postnatal depression after her second child
• Heavy bleeding from her mid-30s, made much worse by a copper coil fitted at 35 as a last resort
• Iron transfusions roughly every three months
• Mirena pushed out by heavy bleeding twice; adenomyosis diagnosed on scan
• Tranexamic acid, the progestogen-only pill, then the combined pill (Lucette), which she was told to stop because she smokes
• Bloating within an hour of eating, alternating bowel habits
• A white, creamy vaginal discharge she had always had, with itching and dryness at times
• High stress, smoking and 7–10 alcoholic drinks a week

Nutrition history

• Breakfast — coffee with coconut milk, often a pastry, or nothing at all
• Lunch — sandwich on sourdough, or a packet-chicken salad
• Afternoon — pineapple chunks, sometimes walnuts or cucumber
• Dinner — pasta, pizza or a restaurant meal, often late at 8pm
• Drinks — Vimto, wine

Very little protein early in the day, then starch and sugar carrying her through to a late, carbohydrate-heavy dinner. The sugar cravings before her period added to the load. She often got home at 9pm and ate whatever was there, and drank Coca-Cola as well as wine.

“I love eating. I don’t want to be on a diet. I just hate how I feel after I eat – sometimes my stomach is just fat.”

— NADIA

Significant test results

What her blood tests and vaginal microbiome test showed

Root causes

Why heavy bleeding happens in perimenopause

Too much oestrogen, not enough progesterone

In early perimenopause, ovulation becomes less reliable, so there are more cycles where oestrogen is high and progesterone is low. Oestrogen grows the womb lining; progesterone is what keeps it in check. Without it, the lining keeps building. For Nadia, this was happening in a womb that also had adenomyosis.

What adenomyosis is

Adenomyosis occurs when tissue similar to the lining of the womb (the endometrium) grows into the muscular wall of the uterus (the myometrium). During each cycle, this trapped tissue thickens, breaks down and bleeds just like the normal womb lining, which increases overall menstrual blood loss.

Why adenomyosis causes flooding and clots

The womb also becomes enlarged, thickened and “boggy”. A womb like this cannot contract properly during a period to clamp down on its blood vessels. That is what leads to heavy flow, large blood clots and the sudden flooding Nadia described.

Injury first, then infection

In my view, adenomyosis develops from an injury to the uterus, and infections then develop in the injured tissue. Nadia’s history included two births, two terminations and a copper coil, all of which can injure the womb.

Her high-sugar diet made this worse, because sugar feeds yeast. Her vaginal test showed Candida, Ureaplasma and a weak, unstable lactobacillus population: the kind of environment that inflammation, high sugar and an inflamed, bleeding womb all encourage.

Why Ureaplasma matters

In my clinic, I see Ureaplasma come up again and again in women with adenomyosis. There isn’t yet a study that looks at the two together, but the surrounding research points the same way. Women with adenomyosis have a more mixed, less Lactobacillus-dominated vaginal microbiome than women without it (Kunaseth et al., PLOS ONE). Ureaplasma is more common in women with endometriosis, the sister condition of adenomyosis (Ata et al., summarised in this review), and is one cause of chronic inflammation of the womb lining (review in Frontiers). It also tends to turn up alongside a Lactobacillus iners-dominated microbiome (Wee et al., in this meta-analysis), which is exactly what Nadia’s test showed. This fits my view of how adenomyosis develops: first an injury to the womb, then an infection that settles into the injured tissue and keeps the inflammation going.

Insulin: a growth signal for the womb

Her diet was also making the bleeding worse. Her insulin was two times higher than optimal. High insulin is a growth signal: it amplifies oestrogen’s effect on the womb lining, drives inflammation (her CRP was raised) and pushes fat to the stomach.

Cortisol and the apple shape

Insulin was only half of the picture. Nadia was living with constant stress, and high cortisol works with high insulin to store fat around the middle while the arms and legs stay thin. That is exactly the apple shape she had: a size-eight woman with tiny arms and legs who looked pregnant.

The copper coil and her moods

Her moods changed the moment the copper coil went in, and that was not a coincidence. A copper coil releases copper into the body continuously. She could even taste it in her mouth. In my clinical experience, copper excess is a strong driver of anxiety, anger, irritability and racing thoughts, because copper stimulates the brain’s excitatory chemistry. It also pushes down zinc, which the brain needs to stay calm. Her anger, rash decisions and weeks of dark moods every month all began with the copper coil. They lifted when it came out and the Mirena went in: “like a weight was lifted”. This is why I included lithium in her protocol. In small nutritional doses, lithium steadies mood and supports the nervous system while the body clears excess copper.

Protecting her thyroid

Her thyroid needed protecting too. Her thyroid antibodies (TPO) were raised at 144, a sign of autoimmune thyroid activity. Gluten is a common trigger for this. Autoimmune thyroid disease is more common in people who react to gluten, and part of the gluten protein is thought to resemble thyroid tissue closely enough to keep the immune attack going. This is why I removed all gluten from her diet.

Why she felt so anxious

Her anxiety, dark moods and brain fog had several roots at once: copper excess, blood sugar swings, a severe B12 deficiency, years of iron depletion, an under-functioning autoimmune thyroid, and synthetic hormones that did not suit her. These were not a personality problem or a reason for antidepressants. They were a body under-resourced and inflamed.

First consultation protocol

What we changed

Nadia was clear about what she needed from me:

“Pushing me would be great. Be hard on me – sometimes I get overwhelmed with doing things.”

— NADIA

Initial symptoms

Where Nadia started

Severity is scored 0 – 3 points. A score of 3 indicates a symptom interfering with daily life.

Week 8 check-in

+8 weeks – flooding gone, cycles regular, symptoms halved

A few days before her eight-week follow-up, Nadia messaged me:

“I’m all good. I’m taking the tablets now and I actually feel much better. My bleeding has been less – last period, and I’m bleeding now, it’s just mucky.”

— NADIA, 17 SEPTEMBER

• Her flooding had stopped. Her last two bleeds had been “really calm”, with only a few small clots “like droplets”.
• Her cycles were regular. She no longer had two bleeds a month.
• She could wear period pants instead of changing pads every few hours.
• The lithium was really helping: her anxiety was much better and she was enjoying feeling calm.
• Her sleep was great and her hot flushes had reduced.
• Her vaginal microbiome and thyroid results came back, so we removed all gluten and added the multivitamin.

Week 15 results

+15 weeks – symptoms reduced by 73%

• Nadia’s bleeding had transformed. Her last period lasted three days, with a heavier bleed only on day 2 and no clotting at all.

“Last period was just amazing, because that’s just my third period now that I’ve just, like… I don’t have shares in Always pads anymore!”

— NADIA, AT HER WEEK 15 CONSULT

• Her anxiety and depression had gone completely, and mood swings and irritability were down to mild.
• Her brain fog and memory had improved from severe to mild.
• Her hot flushes, night sweats, weight gain and hair loss had resolved, and her bloating and water retention had eased.
• She told me she now felt the least stressed she had ever felt.
• Her lunches had been “impeccable”: vegetables, salad, mackerel and salmon. Not eating bread at work had been great, although she still missed bread, butter and pasta.
• Her bloating was better. Her stomach was not yet flat, but it no longer felt uncomfortable.
• Her nutrition and supplements were adjusted for the next phase to continue reducing the bleeding and support her thyroid and B12.

Her bleeding: before and after

From flooding to a normal period

What about the pill?

Nadia had been taking Lucette, a combined contraceptive pill, to hold back the bleeding. She stopped it on her doctor’s advice because she smokes, a week before her first consultation with me. The pill normally makes bleeding lighter, so coming off it would be expected to make her periods heavier again, not lighter. Every period she has had since starting her plan, including this light, three-day one, has been without the pill. It was her own cycle, without hormones, responding to the changes in her food and supplements.

Week 15 comparison

Where she was, and where she got to

Additional tracking

The symptoms that mattered most to her

I also track the symptoms each client cares about most, on a scale of 0 to 6.

Nadia’s review

In her own words

My reflection

I was so pleased for Nadia. For six years she had been told her bleeding was the problem, and handed one device or pill after another to manage it. No one had asked why she was bleeding.

Nadia’s story began with a copper coil fitted as a last resort. Nobody connected the copper with the anger, the dark moods and the flooding that followed. Contraception is a real need, but every option has a cost, and women deserve to be told what that cost might be.

Heavy bleeding in early perimenopause is not bad luck, and adenomyosis does not appear in isolation. Nadia’s womb was being driven by two growth signals at once: unopposed oestrogen as ovulation became less reliable, and an insulin level two times higher than it should be, fuelled by pastries, pineapple, pasta and pizza. Add inflammation, years of iron loss and a severe B12 deficiency, and you have the flooding, the anxiety, the brain fog and the swollen stomach.

Her vaginal infections were part of the same picture. Sugar feeds yeast, and an inflamed, constantly bleeding environment is not one where protective bacteria can thrive. I now think of adenomyosis as a wound that never fully healed: an injury to the womb, then an infection that settles in and keeps the inflammation going. That changes what we look for. Not just hormones, but the microbes, and the inflammation that keeps the cycle running. When I see adenomyosis, I now test the vaginal microbiome, because Ureaplasma is so often there.

When we took the sugar and starch out and supported her body to clear oestrogen and rebalance her microbes, her body did what it is designed to do. The flooding that had needed coils, tranexamic acid, the pill and iron transfusions settled into a three-day period with no clots, with no hormones at all. Her anxiety and depression didn’t need an antidepressant. They needed stable blood sugar and nutrients.

Nadia didn’t follow the plan perfectly. She worked late, ate late and missed her bread. But even before her diet was fully on track, the targeted supplements had calmed her bleeding and her anxiety. You don’t have to be perfect for your body to respond.

She can have sex again. She can go shopping without fear of bleeding through her clothes. She told me she feels the least stressed she has ever felt. That is what six years of flooding had taken from her.

She came to me afraid she was heading for dementia, like her grandmother. Her brain fog is now almost gone. It wasn’t her brain failing. It was a brain short of fuel and nutrients.

Nadia is 42, at the very start of the transition. Getting the foundations right now, with blood sugar, inflammation and her thyroid, sets her up for the next decade, when oestrogen falls for good.

We’re not finished. Her stomach isn’t flat yet, and we’ll retest her bloods and microbiome before Christmas.