A natural approach to heavy periods (menorrhagia)?

Authored by BreAnna Guan, ND and Chelsea Preiss, CNS One of the most common concerns women have is heavy bleeding (also called menorrhagia). It affects nearly 1 in 5 women in the United States1. A normal amount of blood loss is around 50-60 ml for the entire duration of the period2,3. That translates to changing a regular tampon or pad every 4 hours (although heavier flow is expected at the onset). Heavy bleeding sounds ambiguous but there are ways you can check to see if your periods fall into this category. Some ways to assess if you have heavy bleeding is having one of the following:

• Your period lasts for more than 7 days
• You pass large clots (roughly the size of a quarter)
• You soak through more than 1 super tampon or heavy pad an hour for 2 or more consecutive hours
• If you’re using a menstrual cup you lose 80 ml of blood during your period

Common Causes

Heavy bleeding typically occurs in adolescent girls during the first year after their first menstrual period (menarche), and is also common in perimenopausal women. This condition does not include postpartum heavy bleeding which has separate risk factors. There are several reasons why heavy bleeding occurs, you may have one or a combination of factors that contributes to heavy bleeding during your period:

• Hormone Imbalance. Hormone imbalance is the overarching reason why heavy bleeding occurs. Hormones estrogen and progesterone help regulate a woman’s menstrual cycle, when these hormones are out of balance it can create a buildup in the endometrium and lead to heavy bleeding. Usually, when we think of heavy bleeding we think of estrogen dominance (where estrogen levels are higher in ratio compared with progesterone levels). Some common hormonal imbalances are endocrine disruption caused by (plastics, shampoos and other environmental chemicals), ovulatory dysfunction, luteal phase defect, and hypothyroidism.
• Underlying Conditions. Common conditions that contribute to heavy bleeding include obesity, insulin resistance, and clotting disorders. Less common causes include liver disease and cancer.
• Benign polyps, cysts, adenomyosis or fibroids. These are growths that occur usually due to hormonal causes but are not cancerous.
• Medications. Hormonal and non-hormonal (IUD) birth control can cause heavy bleeding. Blood-thinning medications (Lovenox, Coumadin, Aspirin) can also lead to heavy bleeding.

Symptoms

Heavy blood loss can put a strain on a woman’s body. Blood helps distribute essential nutrients and oxygen to every cell in the body. When excess blood is lost so are oxygen-carrying cells (red blood cells). To compensate, the body uses stored iron to build more red blood cells. When this is occurring every month iron stores get depleted and lead to iron deficiency anemia.

Symptoms of iron deficiency anemia (and heavy bleeding) are

• loss of color, pale complexion
• shortness of breath (even just going up a short flight of stairs)
• hair loss and thinning
• dizziness
• extreme fatigue
• headaches
• heart palpitations
• reduced memory and work recall – brain fog
• muscle soreness
• feelings of coldness

Feeling weak and tired can lead some women to not want to go outside or do anything. This takes a toll on your quality of life and is why it’s so important to notice what your body is experiencing and talk to a professional about it so you can be guided towards a treatment plan that works for you.

Diagnostic Tests

Once you have noticed a trend with heavy bleeding during your periods, there are several diagnostic tests your practitioner may perform to diagnose and treat heavy bleeding:

• Blood test to check for anemia, blood clotting, and thyroid disease, pap test, pelvic exam, ultrasound, and endometrial biopsy.

Medical Therapies

When heavy bleeding is treated by a healthcare provider, they will assess your health history, severity, and personal preference before picking a treatment option. Medical treatment includes drug therapies and surgical treatments. If you are also anemic, they will recommend iron supplements to take.

Drug Therapies

Nonsteroidal anti-inflammatories can help reduce blood loss by up to 20-50%. Birth control pills or IUD, hormone therapies, desmopressin nasal spray for some bleeding disorders, antifibrinolytic medicines, dilation and curettage, endometrial ablation or resection to remove uterine lining, operative hysteroscopy to remove growth and hysterectomy.

Natural Therapies

The most important part thing to address with a heavy period is the underlying causes. While some herbs can reduce the blood flow each month (find recommendations in the bundle below), this is not a long term solution. If the cause is hypothyroidism, perimenopause, or PCOS, resolving these issues will ultimately be the best way to address heavy menstrual flow. While working on supporting the underlying cause, there are things we can do to support the overall health of the body and replace important nutrition that has been depleted due to blood loss.

Foods as Medicine

There have been several nutrients identified in helping women to reduce blood loss during her period. Fat-soluble vitamins A, D, E, K and water-soluble vitamin C, B vitamins, and iron have all shown to alleviate heavy bleeding4. These nutrients help by enhancing capillary integrity, removing excess estrogen, eliminating toxicants built up in the body, and lowering inflammation. These nutrients can be found in a wide range of plant-based foods and organic meats such as:

• Sweet potato
• spinach
• grass-fed beef
• pasture-raised chicken
• wild-caught salmon
• pasture-raised eggs
• sunflower seeds
• broccoli
• almonds
• edamame
• carrots
• avocado
• banana
• mango

With heavy periods month after month special attention is need to support repletion of lost iron. Iron deficiency can also be a cause of menorrhagia. While food based iron is essential (dark meat poultry, red meats, egg yolks, legumes, apricots, raisins, spirulina, chocolate, blackstrap molasses, and nuts) iron supplementation is often necessary to help bring levels up much more quickly (see bundle below with Dr. Guan’s favorite iron, that doesn’t cause digestive issues).

Herbal Medicines

Herbal therapies can improve heavy bleeding by preventing and treating anemia, restoring hormonal balance, and reducing inflammation5. Herbs are a useful way of treating heavy bleeding but it’s important to consult with a practitioner who has experience with herbal medicine. Some herbs that have been shown to be effective are

• Chasteberry
• ginger
• shepherd’s purse
• yarrow
• lady’s mantle
• black haw
• dong-quai
• bayberry bark
• black cohosh
• cinnamon

Bioidentical Hormone Replacement

Hormone therapy can often help provide significant relief for heavy menstrual bleeding. Progesterone is the hormone that helps prevent the thickening of the uterine lining and reduce the heaviness of menstrual flow-Its common with anovulatory cycles in peri-menopause and PCOS for bleeding to become heavier due to insufficient or lacking progesterone. Supplementing with progesterone therapy can reduce menstrual flow.