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Why Winter Nosebleeds Strike More Often After 50 — And How to Keep Them at Bay
Cold air, dry heat and aging blood vessels can make nosebleeds more likely. Here’s why they happen — and how to stop them before they start
Maryam Khaleghi Yazdi
For some, winter is a warm welcome to stunning, snowy landscapes, holiday decorations and cherished family traditions. For others, it’s dry skin, watery eyes and runny-nose season.
The moment the furnace kicks on and winter settles over your home, you might notice something unwelcome that isn’t one of the common symptoms of cold and flu season: a sudden drip of blood from your nose. It’s a familiar scenario.
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For countless adults, especially those in their 50s and 60s, this shift in winter weather ushers in what ENT (ear, nose and throat) specialists jokingly but accurately call “nosebleed season.”
The combination of dry indoor heat and midlife changes to our nasal tissues creates the perfect storm for those sudden, surprising bursts of blood. Here’s why, and what you can do about them.
What causes winter nosebleeds?
Though nosebleeds can occur any time of year, they tend to be more common in winter. According to Dr. Erich Voigt, director of general otolaryngology and sleep surgery at NYU Langone, dry air and home heat are two major influencers. He explains that the cluster of blood vessels in the nasal septum is designed to moisturize and warm the air entering our noses, but if one of those vessels is right at the surface and bursts or gets scratched, it will bleed a lot.
What’s more, he says, people are more likely to catch colds and other respiratory illnesses during the winter months, “which can make their nasal tissues irritated, and they tend to blow their nose more, and they’re rubbing their nose more and their nose is irritated. So when you put those three factors together, nosebleeds exponentially go up in the winter.”
Dr. Kanwar Kelley, an ENT otolaryngologist in Orinda, California, echoes this, noting that this dryness also causes the nasal lining to thin. “As your nasal mucosal linings dry out, the blood vessels that live underneath the mucosal linings become more susceptible to bursting and bleeding.”
Aging makes the nose more vulnerable
By our 50s and 60s, the nasal lining naturally becomes thinner and more delicate, similar to the way aging skin loses elasticity. The timeline for this process can vary, Kelley says, but generally, people begin noticing an acceleration around midlife.
Kelley adds that hormonal changes can also affect the mucosal lining, so women going through menopause and postmenopause may have thinner nasal linings.
Common medications can increase bleeding
Another contributor: Many people begin taking medications in their 50s and 60s that can make them more susceptible to nosebleeds, Kelley says. For instance, common blood thinners, anti-inflammatories and even some supplements “make you more susceptible to bleeding by decreasing your ability to form blood clots,” he explains.
They include:
- Blood thinners: rivaroxaban (Xarelto), apixaban (Eliquis), warfarin (Coumadin)
- NSAIDs (nonsteroidal anti-inflammatories): ibuprofen (Advil), naproxen (Aleve), aspirin
- Supplements: fish oil, ginger, garlic, ginkgo biloba, feverfew
Other contributing factors
Numerous variables — from common anatomical conditions to personal habits — can also increase the likelihood that a person experiences nosebleeds. According to Voigt, these are some of the most frequent:
- Deviated septum: Air will dry out the nose of someone with a deviated septum faster than it will in someone with a straight septum.
- Colds, viruses and allergies: These can inflame the nasal lining and lead to more blowing and rubbing.
- Nose picking: A habit few will admit to, it can easily break fragile surface vessels.
Simple strategies to prevent winter nosebleeds
1. Humidify the air you breathe most
Running a humidifier in the rooms where you spend the most time — be it the bedroom, living room or a home office — helps counteract dry indoor air.
Humidity dissipates quickly, Voigt notes, and air will dry up if the humidifier is not running. He also cautions against overuse if you have mold allergies and stresses the importance of cleaning humidifiers regularly to prevent mold buildup.
2. Moisturize the inside of your nose
In cases of severe dryness or repeated serious nosebleeds, doctors may prescribe a topical antibiotic ointment like mupirocin (Bactroban), but both doctors say that routine nasal hydration should be sufficient for most people.
- Topical moisturizers: Kelley recommends petroleum jelly (Vaseline), Aquaphor or natural moisturizers like shea butter or cocoa butter, which can be applied every two hours while awake.
- Saline sprays and gels: Instead of topical moisturizers, Voigt recommends saline sprays and gels like Ayr, Ocean, and NeilMed, which can be used several times a day to keep nasal tissues supple.
How to stop a nosebleed
Despite best efforts, a winter nosebleed can still strike. Here’s what both experts advise:
Step 1: Sit up and lean forward.
Never lean back; that just sends blood into the throat. Lean forward slightly, and breathe through your mouth.
Step 2: Pinch the soft part of your nose.
Pinch firmly on the soft cartilage of your nose (not the bony bridge) for at least 5 to 10 minutes, without checking to see if it has stopped.
“It takes about 10 minutes for platelets to reach the bleeding area and for clots to form,” Kelley explains.
Step 3: If bleeding continues, consider a nasal decongestant spray — but use it wisely.
A squirt of the nasal decongestant oxymetazoline (Afrin) can shrink blood vessels and help control bleeding. But both doctors emphasize that it should be used only during an active nosebleed and not regularly. What’s more, you shouldn’t use it for more than three consecutive days, as overuse can lead to rebound swelling and worsening congestion over time.
Step 4: Choose the right packing material.
If pressure alone doesn’t stop the bleeding, Voigt says you may want to do something to cause more compression inside by using something called “packing material.” He suggests using something like a large cotton ball, which is soft and won’t get lost in the nose or get inhaled.
He warns against using something dry and abrasive (which could scrape and worsen the bleeding), and he suggests coating whatever packing material you use with a little antibiotic ointment.
Kelley warns against using facial tissue, because the clot forms around whatever you use to stop the bleeding. The clot congeals onto the tissue fibers, so when you pull out the tissue, you pull the clot out with it.
Instead of tissue, he suggests a product like Nampons, which expand and absorb blood when inserted into the nose and can come out more easily without ripping off the scab.
When it’s time to see an ENT
Most winter nosebleeds are benign and respond well to at-home care, but Voigt recommends seeing an ENT specialist if nosebleeds happen frequently.
“The majority of the nosebleeds are going to be from the front, from the dry air, but rarely, there could be some other problem, like a mass or a growth or a hemangioma, or something in the nose that’s bleeding.”
Other reasons to call an ENT include:
- Bleeding lasts more than 20 to 30 minutes.
- You’re on blood thinners and experiencing recurrent bleeds.
- You bleed from both nostrils at once.
- There is concern that a growth or mass may be involved.
- You have a progressive nasal breathing obstruction.
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