Ask the doctor: Heavy bleeding, fibroids, and polyps

Q.I am 53. I've had fibroids for some time but have experienced heavy menstrual bleeding lately. A recent ultrasound showed fibroids and polyps. What are my options?

A. As you know, you're almost certainly in perimenopause, the four to eight years leading up to menopause and the complete cessation of menstruation. Every woman's script for the transition to menopause is a little bit different, but it's very common for the menstrual cycle to be irregular and the amount of blood flow to vary. Erratic ovulation — the release of eggs from the ovaries — may result in hormonal changes that cause the lining of the uterus (the endometrium) to become thicker than usual, so when it sloughs off, the menstrual bleeding is heavier and more prolonged than women are used to.