28/05/2026
Is it ‘Just Perimenopause’ or could it be something more sinister?
May is Women’s Health Month. I have been meaning to write all month, but it has not been easy to start. This May, I could not end this month without honouring my dear late friend Fiona Stewart – who died of an aggressive cancer on January 30 this year, just 5 days after her 44th birthday survived by her partner and her two beautiful young children.
It just so happened that I had to clear out my message bank last Wednesday and I got to hear her voice again, she was checking in on me after my last cat had died. This was Fiona, she had a deep appreciation of the bond between humans and their animals, and she was always picking up strays – I was blessed to be one of those strays when living interstate in VIC, she took me under her Earth-Angel wing, befriended me and cared for me like a sister.
For several months before her diagnosis, Fiona experienced heavy, relentless bleeding – flooding, as we call it in Chinese medicine. She, like many women assumed it was just a normal part of perimenopause. She believed it too. Who wouldn’t? Perimenopause has become the cultural catch-all for any woman in her 40’s who feels unwell: irregular periods, flooding, sleeplessness, weight gain, low mood, brain fog, cysts, fibroids.
But here is the truth I must speak for Fiona: not everything is “just perimenopause”. And confusing the two can cost a life. This article is for her. And for every woman who has been told, “It’s just your hormones.”
What actually is perimenopause? (Western medicine view)
Perimenopause is the transitional phase before menopause, typically beginning in the mid‑40s, sometimes earlier. It lasts anywhere from 2 to 10 years. Ovarian function fluctuates and can lead to:
- Irregular menstrual cycles (longer, shorter, heavier, lighter)
- Heavier bleeding (menorrhagia) but rarely true flooding for months at a time
- Hot flushes and night sweats
- Vaginal dryness
- Sleep disturbance
- Mood changes (irritability, low mood, anxiety)
- Weight gain, especially around the waist
- Breast tenderness
- Worsening of pre‑existing PMS
- New or changing fibroids, ovarian cysts
Perimenopause is real, and it is challenging. But it is also a diagnosis of exclusion – not a dustbin for every pelvic or systemic symptom.
When ‘perimenopause’ hides something more sinister
Your symptoms matter. As women we are conditioned to believe that pain is just a normal part of everyday life for us – to suck it up and push on – but all symptoms are a sign of disharmony and Women’s Health is one of the areas where Chinese medicine really shines – we can address the earliest signs of disharmony before they have the opportunity to develop into something worse.
Fiona’s cancer likely started in her pelvis. Her prognosis was terminal upon diagnosis, so, as an ex-nurse with too much knowledge for her own good she chose not know, preferring to spend her numbered days with her children and partner.
Her flooding was not heavy periods – it was profuse and went on and on for months leaving her exhausted and anaemic. That is not typical perimenopause. I saw her in August while visiting my acupuncture guide in VIC, when she explained to me what had been happening and I encouraged her to seek help from a Chinese medicine practitioner, her GP was already aware, but due to living in regional VIC and not close to major biomedical health centres, her symptoms were not fully investigated in a timely fashion.
The following symptoms demand further investigation. Please do seek answers and medical imaging if you are experiencing any of the following:
Western medicine red flags (do not ignore)
Symptom / Possible sinister cause
- Flooding (soaking through a pad/tampon every hour for several hours): Endometrial cancer? large fibroids? Adenomyosis? cervical cancer?
- Intermenstrual bleeding (bleeding between periods): Cervical or uterine cancer? Polyps?
- Postcoital bleeding (bleeding after sexual in*******se): Cervical cancer?
- Pelvic pain that is constant or worsening: Ovarian cancer? endometriosis with adhesions? pelvic inflammatory disease?
- Bloating, early satiety, urinary urgency together: Ovarian cancer? (often called the ‘silent killer’)
- Unexplained weight loss: Malignancy?
- Night sweats that are drenching and persistent (not cyclical with your period): Lymphoma? Infection? TB? or cancer?
- New, severe fatigue not relieved by sleep: Leukaemia? colon cancer? chronic blood loss from uterine pathology?
A note on flooding: In Western medicine, flooding (menorrhagia + abrupt heavy flow) is never ‘just perimenopause’ without an ultrasound, biopsy, or hysteroscopy if persistent.
Classical Chinese medicine perspective: Blood, Qi, and the sinister shadow
In Chinese medicine, we do not have a direct word for ‘cancer’, but we describe malignant processes as accumulated stasis, toxin, and rebellious Qi that fail to transform. Perimenopause is a natural decline of Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) – the Sea of Blood and the vessel of Yin. Slight irregularities are expected. But flooding (Beng Lou) is a collapse of the body’s ability to hold blood.
Normal perimenopausal signs and symptoms in Chinese Medicine terms:
- Slight irregularity of cycle
- Mild heat signs (night sweats, irritability)
- Gradual decline of Kidney Jing (essence)
- Some damp accumulation (weight gain, phlegm)
Signs that something could be more sinister (from a Chinese Medicine diagnostic lens):
Sudden, profuse, dark purple flooding with large clots: Blood stasis with toxic heat? Malignancy? fibroids with necrosis? or endometrial hyperplasia?
Fixed, stabbing pelvic pain worse at night: Severe blood stasis? Ovarian or uterine tumour?
Purple‑black tongue with petechiae and dry yellow coating: Stasis with toxic heat consuming fluids? Cancer with inflammation or necrosis?
Wiry, choppy pulse in the left lower position: Extreme stasis in the lower abdomen? Pelvic mass?
Emaciation with abdominal distension: Spleen failure + Qi stagnation + yin/thoroughfare vessel blockage? Late‑stage ovarian or gastrointestinal malignancy?
Five‑day bleeding that returns heavily after stopping: Collapse of Chong Mai (Thoroughfare Vessel) – not just Kidney deficiency? Organic lesion (polyp, cancer, retained products of conception) ?
In the classics, “sudden flooding in a woman of forty with fixed abdominal pain is not a simple decline; stasis with toxin must be ruled out before tonifying.” Too often, well‑meaning practitioners tonify Qi and blood before clearing stasis – and that can feed a malignancy.
My firm, caring warning: If a woman in her 40s presents with flooding, intermenstrual bleeding, or persistent pelvic pain – do not automatically give Gui Pi Tang or Wen Jing Tang without modern imaging or a gynaecological referral. Chinese medicine is brilliant for functional disorders, but we must know when a mass or malignancy is present.
What Fiona taught me
Fiona dismissed her flooding as “perimenopause gone wild”. She was too young, too busy, too vibrant for cancer. By the time she sought further help, the disease was advanced.
I am not writing this to frighten you. I am writing to empower you.
If you are between 35 and 55 and any of the following applies, demand a second opinion, an ultrasound, a CA‑125 blood test (for ovarian cancer), an endometrial biopsy, or a referral to a gynaecologist:
- Flooding (changing a pad/tampon every hour)
- Bleeding after in*******se or between periods
- Persistent pelvic pain or bloating for more than 2 weeks
- Unexplained fatigue with heavy bleeding
- A family history of breast, ovarian, or uterine cancer
Perimenopause is not a diagnosis of laziness. It is a clinical transition. And it coexists with other conditions – some benign, some not.
How I can help – in person
I offer Chinese medicine consultations for women’s health: period problems, perimenopause support, post‑cancer recovery, and fertility. But my first question to any new patient in her 40s with irregular bleeding will be: “Have you had a recent ultrasound or gynaecological exam?”
If the answer is no, I will help you find one before we begin herbs or acupuncture. That is the ethical, life‑saving path.
If you have already been cleared of sinister pathology, Chinese medicine is exceptional for managing real perimenopausal symptoms – calming flooding, lifting fatigue, cooling night sweats, and stabilising mood through diet and lifestyle adjustments, acupuncture and herbs.
To book a consultation or a 15‑minute chat with me about your symptoms, contact: Biophilia Health on 0489 015 747 or Stirling Holistic Health on 8339 4322
This Women’s Health Month, please listen to your bleeding. It is your body speaking. Sometimes it says “hormones”. Sometimes it says “help”. Don’t guess. Get checked.
*In loving memory of Fiona Stewart (25 January 1982 – 30 January 2026)*
Disclaimer: This article is for educational purposes and does not replace individual medical advice. Always consult a GP or gynaecologist for abnormal bleeding. Chinese medicine should be used alongside – not in place of – conventional diagnosis when serious pathology is suspected.