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Menorrhagia is the term for excessive menstrual bleeding i.e. blood loss greater than 80ml during a menstrual period. Population studies show that the typical menstrual blood loss is 30-40ml, and that 90% of women have losses of less than 80ml.
Related conditions that may overlap with menorrhagia include: - Metrorrhagia - irregular or frequent flow, noncyclic
- Menometrorrhagia - frequent, excessive, irregular flow (menorrhagia plus metrorrhagia)
- Polymenorrhea - frequent flow, cycles of 21 days or less
- Intermenstrual bleeding - bleeding between regular menses
- Dysfunctional uterine bleeding (DUB) - abnormal endometrial bleeding of hormonal cause and related to anovulation
Determining your blood loss
Studies that have measured blood loss have demonstrated that patients with menorrhagia have a considerable increase in menstrual blood flow during the first three days (up to 92% of their total menses being lost at this time). This suggests that the mechanisms responsible for cessation of menstruation are as effective in women who have menorrhagia as in normal women, despite the very high blood loss.
Although many women can tell if their blood loss is more or less than usual, it is difficult to accurately determine the actual blood loss using estimates based on the number of tampons or pads used. One study showed that 26% of women with normal menstrual loss considered their periods heavy, while 40% of those with heavy losses considered their periods to be moderate or light. [Acta Obstet Gynecol Scand 1966; 45: pp.320-51]
Causes & Development
Possible causes include those associated with hormone changes such as too much estrogen or prolactin, too little or poorly timed luteinizing hormone, and polycystic ovarian disease. Physical causes include obesity or the presence of fibroids, endometrial hyperplasia, polyps, cancer, endometriosis, ectopic pregnancy, and IUD use. Bleeding disorders such as a deficiency of vitamin K or the use of blood thinners can be contributing factors. hypothyroidism, iron deficiency, and vitamin A deficiency.
Heavy bleeding can be caused by too much estrogen or possibly too little progesterone. Too much estrogen causes excessive growth of the blood-rich endometrial lining which will be shed each month.
Diagnosis & Tests
When it has been determined that the cause is not organic (a physical condition), laboratory testing (bleeding time, complete blood count, and thyroid function) should be done, and any abnormalities corrected.
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Signs, symptoms & indicators of Menorrhagia (Heavy Periods):
Risk factors for Menorrhagia (Heavy Periods):
Menorrhagia (Heavy Periods) suggests the following may be present:
Recommendations and treatments for Menorrhagia (Heavy Periods): | | | | | Botanical |  Vitex / Chasteberry | Vitex is probably one of the most effective herbs in the treatment of menorrhagia. However, it needs to be used for several months before its effects are noticed. |
Shepherd's Purse| | Shepherd's purse has a long history of oral use in the management of obstetric and gynecologic hemorrhage. Uncontrolled studies have found intravenous and intramuscular injections to be effective in cases of menorrhagia that are due to functional abnormalities and fibroids. Its beneficial action in slowing blood flow is believed to be a result of its high concentration of oxalic and dicarboxylic acids. The use of botanicals should be reserved for difficult cases of menorrhagia, those cases where immediate cessation of blood loss is desired, and/or as a short-term aid to other therapies. |
 Comfrey| | Comfrey has an astringent action which helps stop hemorrhages wherever they occur. |
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Diet |
Animal/Saturated Fats Avoidance |
Hormone |
Natural Progesterone| | If progesterone levels are low or estrogen levels too high, avoid unnecessary estrogen use. The presence of hot flashes, night sweats, or vaginal dryness indicate levels of estrogen may be too low. Progesterone use at higher than normal doses for a few weeks may help resolve the excessive bleeding. |
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Lab Tests/Rule-Outs |
CBC (Complete Blood Count) Test
Test Iron Stores (Ferritin)| | Consistently excessive blood loss will result in a negative iron balance which will result in lowered serum ferritin levels. Iron deficiency is a cause as well as consequence of menorrhagia. Body stores of iron are best reflected by serum ferritin. Ferritin levels will drop before changes in the blood count begin. Anemia may not yet be present when serum ferritin levels are getting low. |
 Test Thyroid Function |
Mineral |
Iron| | The following observations have been made regarding iron:- Positive response to iron supplementation alone in 74 of 83 patients (in whom organic pathology had been excluded)
- A high rate of organic pathology found (fibroids, polyps, adenomyosis, etc.) in the patients who failed to respond to iron supplementation
- A decreased response to iron therapy when initial serum iron levels were high
- A correlation exists between menorrhagia and depleted tissue iron stores (bone marrow) irrespective of serum iron level, thus serum ferritin may be a better test than serum iron
- A well-controlled study showed improvement in 75% of those on iron supplementation, compared with 32.5% for a placebo group.
'Heme' iron (from meat) is 10 times more absorbable than most other forms of iron. |
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Nutrient |
Essential Fatty Acids| | Omega 3 EFAs may reduce bleeding in adolescent girls and improve other menstrual symptoms generally in women. |
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Vitamins |
Vitamin A| | In one study, serum retinol levels (a measure of vitamin A levels) were found to be significantly lower in women with menorrhagia than in healthy controls. One should not exceed 10,000 IU per day if at risk of becoming pregnant. |
Bioflavonoids| | Capillary fragility is believed to play a role in many cases of menorrhagia. Supplementation with vitamin C and bioflavonoids has been shown to reduce menorrhagia. As vitamin C is known to significantly increase iron absorption, its therapeutic effect could also be due to enhanced iron absorption. |
Vitamin E| | Free radicals may have a causative role in endometrial bleeding, particularly in the presence of an intrauterine device. One study showed that supplementation with 100 IU for 10 weeks resulted in improvement in all patients. [Int J Fertil 1983;28: pp.55-6] Caution must be exercised as higher doses have a blood thinning effect. |
Vitamin C (Ascorbic Acid)
Vitamin K| | Based on its ability to help blood clot normally, vitamin K has been proposed as a treatment for excessive menstrual bleeding and is beneficial for some women. Although bleeding time and prothrombin levels in women with menorrhagia are typically normal, the use of vitamin K (often in the form of chlorophyll) does have limited research support. Green leafy vegetables and other sources of vitamin K should be eaten freely. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Astringent
Agent causing contraction, especially after topical application.
Bioflavonoid (Bioflavonoids, Flavonoid, Flavonoids)
Vitamin P. Any of a group of colored flavones (crystalline compounds) found next to the peel in many fruits. Essential for the stability and absorption of ascorbic acid.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Capillary
Any of the smallest blood vessels connecting arterioles with venules and forming networks throughout the body.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Constipation (Constipated)
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Dysfunctional Uterine Bleeding (DUB)
Any abnormality of menstruation or bleeding caused by a hormonal disorder. DUB is a diagnosis of exclusion. The following conditions should be ruled out in order to diagnose DUB: endometrial polyps, uterine fibroids, adenomyosis, endometrial or cervical cancer, pelvic infection including endometritis (infection of the lining of the uterus), endometriosis, polycystic ovarian disease, ovarian cyst or tumor, thyroid dysfunction or blood clotting abnormalities. Hormone testing may indicate abnormalities which replacement therapy would then resolve. If the dysfunctional bleeding disappears, then no further testing may be necessary.
Failure to perform sufficient testing may result in an incorrect diagnosis of DUB because the true cause of the abnormal bleeding has been overlooked. A premature diagnosis of DUB may lead to improper and failed treatment. DUB accounts for approximately 20% of all hysterectomies in the U.S.
Ectopic Pregnancy (Ectopic Pregnancies, Tubal Pregnancies, Tubal Pregnancy)
A pregnancy in which the egg becomes fertilized but cannot pass into the uterus to grow. Instead, the egg usually attaches in the fallopian tube, which connects the ovary to the uterus. The fertilized egg cannot grow normally in the fallopian tube. This type of pregnancy is life-threatening to the mother, and almost always fatal to her fetus. It is the leading cause of pregnancy-related death in African-American women.
Endometriosis
A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Essential Fatty Acid (EFA, EFAs, Essential Fatty Acids)
A substance that the human body cannot manufacture and therefore must be supplied in the diet.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Free Radical (Free Radicals)
A free radical is an atom or group of atoms that has at least one unpaired electron. Because another element can easily pick up this free electron and cause a chemical reaction, these free radicals can effect dramatic and destructive changes in the body. Free radicals are activated in heated and rancid oils and by radiation in the atmosphere, among other things.
Hemorrhage (Hemorrhaging)
Profuse blood flow.
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Menorrhagia
Abnormally heavy and/or long menstrual period.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metrorrhagia
Any irregular, acyclic bleeding from the uterus between periods.
Milliliter (mL)
0.001 or one thousandth of a liter.
Pathology (Pathologist)
Disease, particularly one with clear and obvious changes in structure or function; the study of same.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Polyp (Polyps)
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Premenstrual Syndrome (PMS)
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Prolactin
An anterior pituitary peptide hormone that initiates and maintains lactation.
Prothrombin
Protein needed for clotting of the blood.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
Vitamin K
Helps the blood clot when the body is injured.
Vitex
Vitex agnus castus. Common name: chaste tree berry.
Last updated: Apr 13, 2008
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