Heavy Menstrual Bleeding


Menorrhagia is the term used to describe periods that are either excessively long or excessively heavy. Heavy periods are a sign that the body is out of balance or that the body is going through a hormonal shift such as Perimenopause. Correcting the cause of heavy bleeding or helping to reduce the heaviness of the period is vital to maintaining overall health. Going on the OCP is NOT CORRECTING THE CAUSE. Heavy bleeding can often lead to low iron and low iron can lead to further heavy periods.

What is a normal menstrual flow?
Typically 1-2 days will be heavy, but not excessively so. Then there will be a couple of days of medium flow, followed by 1-2 days of light flow. So what is considered heavy?

  • passing lumps of blood (or clots) that are larger than a 20-50 cent coin
  • bleeding so much that you have to change your pad/ tampon every hour
  • having to get up most nights to change your pad/tampon
  • having to put a towel in your bed or use large maternity pads when you sleep
  • bleeding through clothing
  • bleeding that lasts more than eight days.

What causes heavy periods (menorrhagia)?
These factors cause heavy periods:

  • Hormonal imbalance such as that seen in PCOS and endometriosis
  • Uterine fibroids
  • Perimenopause/Menopause
  • Uterine Polyps
  • Endometrial hyperplasia
  • Very early miscarriage

Hormone imbalance
The hormone imbalance that causes heavy periods is typically higher estrogen compared to progesterone (or other hormones like DHEAs and testosterone). These hormones balance estrogen and keep it in check. This is also known as estrogen dominance. High estrogen or imbalanced levels can cause extremely heavy bleeding, bad cramps, and thick clots in the menstrual flow.

Low iron can cause heavy bleeding and also be caused by heavy bleeding. A type of anemia that’s common with heavy periods is iron deficiency anemia. Heavy periods lead to blood loss over a long time. This depletes your body’s iron stores. With iron deficiency anemia, you might feel tired all the time, weak, dizzy or short of breath, among other signs and symptoms.

Uterine fibroids
Fibroids are benign growths in your uterus. Inflammation and/or hormone imbalance like estrogen dominance cause or contribute to uterine fibroids. Fibroids cause heavy bleeding and clots. Fibroids may also cause back pain, leg pain, bleeding between cycles, frequent urination and constipation.

As your ovaries wind down at perimenopause (which can begin anywhere from our late 30s to early 40s and last 10-12 years) they produce less progesterone. Estrogen levels remain higher longer. Without progesterone to balance estrogen, you make a thick uterine lining. When you shed this lining during your period, it makes for a lot of bleeding. Sometimes there is also light bleeding or spotting between periods and irregular cycles at perimenopause.

Uterine polyps
Uterine polyps are growths, ranging from millimetres to centimetres in size, attached to the inner wall of the uterus and protruding into the uterine cavity. They most commonly occur in women in their 40s and 50s.

Although it is not known what causes uterine polyps, they increase in size when exposed to estrogen. Estrogen dominance is often a major factor in the development of polyps.

Endometrial hyperplasia
Endometrial hyperplasia is an abnormal thickening of the lining of your uterus. It is also associated with estrogen dominance.

Early Miscarriage
Early pregnancy loss (before you realize you are pregnant), may manifest as heavy bleeding. This type of heavy bleeding would occur as a “one-off” thing rather than a regular monthly occurrence.

Symptoms of heavy periods
Women with really heavy periods experience additional symptoms like:

  • Weakness or tiredness
  • Clots in their menstrual flow
  • Iron deficiency anemia
  • Infertility (due to endometriosis, PCOS, estrogen dominance, polyps or fibroids)

What are the tests for heavy periods?

Pelvic and transvaginal ultrasound
A pelvic and transvaginal ultrasound assesses ovarian cysts, uterine fibroids, uterine polyps, and endometrial hyperplasia. These are all symptoms of estrogen dominance. It is a relative imbalance between estrogen and progesterone. Endometrial hyperplasia is a thickening of the uterine lining. It is a common occurrence during perimenopause but can indicate a higher risk for more serious problems. Your family doctor should advise you accordingly about the process of having ultrasounds completed.

Iron Profile
The iron profile includes a measurement of serum iron and transferrin levels as well as a calculation of transferrin (iron) saturation. It is important to know what your iron levels are as this may be an underlying cause of heavy bleeding.

Hormone Testing
Estradiol is one particular form of estrogen. There are 3 main forms: estriol, estrone, and estradiol. Measuring estradiol alone provides an incomplete picture of estrogen level and activity. But, this test provides some basic information. Your peak estradiol is best measured around ovulation. Ovulation occurs around days 14-15 of your cycle, assuming that you have a normal menstrual cycle. A DUTCH test provides more detailed hormonal information but is costly to do and not covered by MediCare.

SHBG or Sex Hormone Binding Globulin
This is a protein that binds to estrogen and decreases its activity. Low SHBG means higher estrogen activity. Higher estrogen activity means a thicker lining builds up and so more blood is lost with your period.

Testosterone, DHEAs and progesterone
These compete for estrogen receptors and moderate estrogen activity. Lower levels mean increased estrogen activity. Progesterone is best measured on day 21 of a 28-day menstrual cycle. Day 21 should be a week after you ovulate. The others are measured at any point in the cycle.

Naturopathic treatment for heavy periods

  1. Support healthy estrogen breakdown through the liver. The nutrients your liver needs to properly process estrogen include vitamin B6, B12, L-5MTHF, glucarate, indole-3-carbinol and magnesium. Supplying these helps in some cases of heavy periods.
  2. Balance hormone production through diet and nutritional support. Certain dietary constituents cause excessive estrogen production. Following healthy diet recommendations, helps reduce excess production.
  3. Support healthy progesterone production. Making progesterone requires vitamin B6 and magnesium. Stress decreases your progesterone level. I use herbs to improve progesterone production such as Vitex Agnus.
  4. Vitex and Angelica are herbs for the management of, painful, heavy, clotting and/or irregular periods and PMS symptoms such as headaches, sore breasts, fluid retention and abdominal bloating.
  5. The warming properties of cinnamon can help to relieve menstrual pain and reduce heaviness by invigorating and moving stagnated blood in the abdominal and uterus
  6. Indole-3-Carbinol – This active compound from the brassica family helps to correct the 2:16 OH oestrogen ratio, therefore supporting and up-regulating healthy oestrogen metabolism and detoxification enzymes for healthy hormone activity. Broccoli sprout powder is also helpful.
  7. Red Sage is helpful for slowing heavy menstrual bleeding.

These are just a few ideas. In our naturopathic consultation recommendations will be given to suit your individual needs. If you are concerned about heavy bleeding or have had a recent diagnosis of a particular female hormonal related condition then a Naturopathic consultation may help to determine the underlying cause and re balance the body once more