woman with heavy periods heavy bleeding menorrhagia

Heavy Periods (Menorrhagia or Heavy Menstrual Bleeding)

Menorrhagia is either excessively long or excessively heavy periods.  It’s a common occurrence in teenagers, in women with uterine fibroids and in women at perimenopause. Being common does not mean that it is normal, nor healthy.

What causes heavy periods (menorrhagia)?

  1. Hormone imbalance – typically relatively higher estrogen compared to progesterone (or other hormones like DHEAs and testosterone), also known as estrogen dominance
  2. Uterine fibroids – fibroids are benign growths in the uterus that may be caused by some combination of inflammation and/or estrogen dominance
  3. Perimenopause/Menopause – as the ovaries are winding down, their production of progesterone decreases, while estrogen levels may remain higher
  4. Uterine polyps – polyps are also growths in the uterus.  They can be of greater concern than fibroids as they can become cancerous.  Estrogen dominance is considered to be a major factor in the development of polyps.
  5. Endometrial hyperplasia – this is thickening of the lining of the uterus that is also associated with estrogen dominance. It can be an early indicator of increased uterine cancer risk.

 Symptoms with heavy periods

  1. Weakness or tiredness
  2. Clots in the menstrual flow
  3. Iron deficiency anemia
  4. Infertility (due to estrogen dominance, polyps or fibroids)

What tests can be done for heavy periods?


This is one particular form of estrogen, there are 3 main ones: estriol, estrone and estradiol.  Measuring estradiol alone provides an incomplete picture of estrogen level and activity.  But, this test can provide some basic information.   Peak estradiol is best measured around ovulation, which should occur around day 14-15, assuming a normal menstrual cycle.

SHBG or Sex Hormone Binding Globulin

This is a protein that can bind to estrogen and decrease it’s activity.  Low SHBG will mean higher estrogen activity.  Higher estrogen activity means a thicker lining is built and more blood is lost with your period.

Testosterone, DHEAs and progesterone

These can compete for estrogen receptors and moderate estrogen activity.  Lower levels can mean increased estrogen activity.  Progesterone is best measured on day 21 of a 28 day menstrual cycle, the others can be measured at any point in the cycle.

Pelvic and transvaginal ultrasound

To determine uterine fibroids, uterine polyps and endometrial hyperplasia.  These can all be symptoms of estrogen dominance, a relative imbalance between estrogen and progesterone.  Endometrial hyperplasia is thickening of the uterine lining.  It is a common occurrence during perimenopause, however, it can be a sign of increased uterine cancer risk.  It should be monitored by your family physician.

Natural treatment for heavy periods

  1. Support healthy estrogen breakdown through the liver
  2. Balance endocrine hormone production through diet and nutritional support
  3. Support healthy progesterone 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.

by Dr. Pamela Frank, BSc(Hons), ND

Heavy Periods and Natural Treatment Research

Kashefi F, Khajehei M, Alavinia M, Golmakani E, Asili J. Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: a placebo-controlled, randomized clinical trial. Phytother Res. 2015; 29(1):114-9.
● 92 women, 6 consecutive menstrual cycles, 3 of which were the intervention cycles – measure was Pictorial Blood Assessment Chart (PBAC); ginger vs. placebo
● Level of menstrual blood loss dramatically declined during the three intervention cycles in ginger-receiving group

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