Hi @AzulOscuro you and I seem at a similar stage in life, I'm just about to turn 49 too.

I think I may have been in perimenopause a few years now because I get mid cycle spotting and apparently that can be caused by hormones shifting gear when we no longer ovulate but still have periods. I did consult a GP and this is what she told me.

I don't have hot flashes yet and my periods are very regular at 28 days interval 5 days length. Like yours mine are heavy especially first 2 days or so. I use a mooncup which helps a lot and also a towel because I flood. I did have low ferritin a few years back and have to watch (I am vegetarian too).

20 days sounds awful and my heart goes out to you! I have heard there can be many causes - my sister got told her uterus was enlarged, the lining can grow thicker because of altered hormones too. Fibroids are another possible cause of heavy painful bleeds. Sometimes it's worth getting a gynae referral to get checked out just in case.

I too have family history of breast cancer so I decline HRT.

I do feel sensitive in my period week, I am prone to crying and sadness then. I've always had anxieties so not sure that's any worse! I think there's a lot of other stuff happens in our midlife too - with jobs, parents, grown up kids. A lot of it can come at us all at once!

What's helped me has been self care, in my period week especially, gentle exercise only, doing things (crafts, reading) that calm and ground me. Eating well! Chocolate too in moderation!

Female friendship has also been incredibly supportive and valuable at this time too, and even this thread is a great example of that.

Hugs to you and hope things aren't too bad and keep manageable at least.