Heavy Periods or Heavy Menstrual Bleeding
Menorrhagia is either excessively long or excessively heavy periods. It’s a common women’s health problem in teenagers, in women with uterine fibroids and in women at perimenopause. Being common does not mean that bad periods are normal or healthy. Heavy periods often lead to iron deficiency anemia. Correcting the cause of heavy bleeding is vital to maintaining healthy iron levels.
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.
What causes heavy periods (menorrhagia)?
These factors cause heavy periods:
- Hormonal imbalance such as that seen in PCOS and endometriosis
- Uterine fibroids
- Uterine Polyps
- Endometrial hyperplasia
- Very early miscarriage
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.
As your ovaries wind down at perimenopause, 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.
Endometrial hyperplasia is an abnormal thickening of the lining of your uterus. It is also associated with estrogen dominance. It is an early indicator of increased uterine cancer risk.
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?
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 day 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 OHIP.
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. The others are measured at any point in the cycle.
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 thickening of the uterine lining. It is a common occurrence during perimenopause, however, it is a sign of increased uterine cancer risk. Your family physician should monitor endometrial hyperplasia and advise you accordingly.
Natural treatment for heavy periods
- 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.
- Balance hormone production through diet and nutritional support. Certain dietary constituents cause excessive estrogen production. Following our healthy diet recommendations, helps reduce excess production.
- Support healthy progesterone production. Making progesterone requires vitamin B6 and magnesium. Stress decreases your progesterone level. I use herbs to improve progesterone production.
- Research shows that treatment with vitamin B1 can help reduce heavy periods in women with a copper IUD.
- Vitamin A therapy helps relieve heavy periods by supporting normal hormone production.
For help with this or any other health problem, book an appointment here or call the office for more information at 416-481-0222.
Authored by Dr Pamela Frank, BSc(Hons), ND
Heavy Periods and Natural Treatment Research
Kashefi F, et al. The effect of ginger (Zingiber officinale) on heavy menstrual bleeding: a placebo-controlled, randomized clinical trial. Phytother Res. 2015; 29(1):114-9.
Lithgow DM, et al. Vitamin A in the treatment of menorrhagia. S Afr Med J. 1977 Feb 12;51(7):191-3.
Jafari A, et al. The effect of vitamin B1 on bleeding and spotting in women using an intrauterine device: a double-blind randomised controlled trial. Eur J Contracept Reprod Health Care. 2014 Jun;19(3):180-6. doi: 10.3109/13625187.2014.893425.