Menorrhagia (Heavy Periods)

Menorrhagia (Heavy Periods): Overview

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.

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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 and 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 and 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.

Signs, symptoms & indicators of Menorrhagia (Heavy Periods):

Symptoms - Reproductive - Female Cycle

Counter-indicators

Conditions that suggest Menorrhagia (Heavy Periods):

Lab Values

Neutrophilia

Loss of blood cells through excessive bleeding can cause neutrophilia.

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Risk factors for Menorrhagia (Heavy Periods):

Circulation

Hormones

Progesterone Low or Estrogen Dominance

In a normal menstrual cycle, estrogen and progesterone regulate the buildup of the endometrium (uterine lining of blood and tissue), which is shed each month during menstruationMenorrhagia can occur because of an imbalance between estrogen and progesterone.  As a result of the imbalance, the endometrium keeps building up resulting in heavy bleeding when it is eventually shed.  Since hormone imbalances are often present in adolescents and in women approaching menopause, this type of menorrhagia (dysfunctional uterine bleeding) is fairly common in these groups.

Hypothyroidism

Prolonged and/or heavy periods are a sign of hypothyroidism.

Metabolic

Problems Caused By Being Overweight

Chronic menorrhagia and PMS is usually the result of deficient progesterone secretion or constant adipose-released estradiol from obesity or recent substantial weight loss.

Nutrients

Vitamin A Requirement

One study found serum retinol levels (a measure of vitamin A levels) to be significantly lower in women with menorrhagia than in healthy controls.  92% of those with lower levels experienced either complete relief or significant improvement after 25,000 IU of vitamin A was taken twice per day for 15 days.

Iron Requirement

Chronic iron deficiency can be a cause of menorrhagia, creating a cycle of more blood loss (iron loss) making the condition worse.

Reproductive

Tumors, Benign

Fibroids

Fibroids can lead to heavier bleeding during periods.

Menorrhagia (Heavy Periods) suggests the following may be present:

Metabolic

Problems Caused By Being Overweight

Chronic menorrhagia and PMS is usually the result of deficient progesterone secretion or constant adipose-released estradiol from obesity or recent substantial weight loss.

Nutrients

Vitamin A Requirement

One study found serum retinol levels (a measure of vitamin A levels) to be significantly lower in women with menorrhagia than in healthy controls.  92% of those with lower levels experienced either complete relief or significant improvement after 25,000 IU of vitamin A was taken twice per day for 15 days.

Reproductive

Recommendations 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.

Diet

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.

Lab Tests/Rule-Outs

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

The association of hypothyroidism with menstrual disturbances is well known.  However, even minimal thyroid dysfunction may be responsible for menorrhagia and other menstrual disturbances.

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.

Nutrient

Essential Fatty Acids

Omega 3 EFAs may reduce bleeding in adolescent girls and improve other menstrual symptoms generally in women.

Vitamins

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 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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