Menorrhagia (Heavy Periods)

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

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 menstruation.  Menorrhagia 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.

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

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.

Fibroids can lead to heavier bleeding during periods.

Loss of blood cells through excessive bleeding can cause neutrophilia.

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

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 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 has an astringent action which helps stop hemorrhages wherever they occur.

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.

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.

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

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.

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

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.

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.

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.

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.