See my updated 2018 blog post: Progesterone for Heavy Periods.
Here’s a story about very heavy periods. It’s 7pm on a Friday night when I get a panicked call from my patient Karen. She’s bleeding so heavily that she cannot leave the bathroom. She’d been at work earlier when she soaked through three super tampons in an hour and then ruined her favorite pair of jeans. Her work colleague had to help her into a taxi. Karen is understandably frightened. I send her to a local medical center for the clotting drug tranexamic acid, which will slow her bleeding.
I know what will happen next. Karen will meet with her gynecologist who will tell her that her only options are the pill, the hormonal IUD, or surgery. Karen had always tried to use natural treatments. She never imagined she would end up in a situation like this.
There is hope. Natural treatment can work to prevent heavy periods and did eventually work for Karen. The key to success is to start natural treatment early—as soon as you notice your periods getting heavier, and before they get too bad. This is especially true if you are forty or older and your mother or older sisters suffered very heavy periods. You know what’s coming.
How heavy is heavy menstrual bleeding?
A normal bleed is anywhere up to 80 mL (millilitres). One soaked regular pad or tampon holds 5 mL. A super tampon holds 10 mL. So, 80 mL equates to 16 fully soaked regular tampons, or 8 fully soaked super-tampons over all the days of the period.
Very heavy bleeding is much, much more than 80 mL. Some women report that they lose up to 500 mL (2 cups) of blood. Frightening. As we saw in Karen’s case, that means blood-soaked clothing. It can mean serious iron deficiency, and sometimes a trip to the hospital.
Heavy periods can occur at any age, but they are more common in young teenagers and perimenopausal women. For both age groups, heavy bleeding is usually the result of too much estrogen (which thickens the uterine lining), and not enough progesterone (which reduces the uterine lining).
Natural treatments for the heavy periods of teenagers
Heavy periods are a temporary thing for teenagers. They happen because:
- estrogen receptors are quite sensitive for the first few years of periods
- cycles are often still anovulatory, so there is no progesterone being made to lighten the period.
As estrogen receptors become less sensitive and girls start to ovulate, periods should lighten.
Here are some simple ways to reduce heavy menstrual flow in teenagers:
- Conventional anti-inflammatories such as ibuprofen (Advil or Nurofen) block prostaglandins and reduce menstrual flow by half. I learned this simple treatment from Canadian endocrinologist Jerilynn Prior. The recommended dose is 200mg every 6 hours during the first day or two of the period. Ibuprofen is not a natural treatment as such, but in my view, it is a very sensible and practical solution. Two days of ibuprofen per month is a better strategy than the pill.
- Turmeric also works to reduce bleeding. Take it every day throughout the month.
- Avoid cow’s milk products to reduce inflammation and lighten periods. Dairy-free really works for some girls, but it might take 2-3 months to see the full benefit. A2 milk (like Jersey, goat, and sheep) is usually ok. Read: What Dairy Does to Periods.
- Supplement iron. Heavy periods cause iron deficiency and iron deficiency worsen heavy periods. Use a good quality, gentle chelated iron (like iron bisglycinate). The dose is 15-50 mg and is best taken after the evening meal.
Natural treatments for the heavy periods of perimenopause
Perimenopausal heavy periods are more serious than the temporary heavy periods of the teenage years. Without treatment, perimenopausal periods can become heavier and heavier as menopause approaches.
Natural treatments for perimenopausal heavy periods include all of the above treatments:
- Dairy-free diet
Plus the following:
- Get a medical diagnosis. Heavy bleeding is usually caused by anovulation, but your doctor needs to rule out issues such as endometriosis, coagulation disorders, uterine polyps, infection, adenomyosis, and fibroids. Fibroids are benign growths in the muscle wall of the uterus. They are common during perimenopause and often occur in women who also report very heavy bleeding. Only rarely are fibroids the actual cause of the bleeding.
- Identify and treat underlying thyroid disease. Under-active thyroid like Hashimoto’s autoimmune thyroid disease can cause or worsen heavy periods. Please see my post: When Heavy Periods Are a Thyroid Problem.
- Enhance estrogen detoxification. Estrogen is normally cleared through your liver and bowel. To support this process, avoid as much as possible the alcohol and antibiotics that damage gut bacteria. You can further enhance estrogen detoxification with vitamin B6, and the nutritional supplement calcium-d-glucarate.
- Eat phytoestrogens. Phytoestrogens such as nuts, soy, and flaxseeds make periods lighter. Phytoestrogens compete with stronger endogenous estrogens and therefore reduce estrogen stimulation of the uterine lining.
- Get enough iodine. As discussed in my iodine post, iodine down-regulates estrogen receptors in the breasts and uterus and reduces the thickness of the uterine lining.
- Keep insulin low. Women who are overweight or who have insulin resistance are more likely to suffer very heavy periods. That’s because insulin is a growth hormone and thickens the uterine lining. Insulin resistance also causes obesity, which causes high levels of an estrogen called estrone (made by body fat). The best way to improve insulin sensitivity is to quit sugar and supplement with magnesium and berberine. Please see my Insulin Resistance post.
- Micronized (natural( progesterone. The standard medical treatment for heavy periods is a synthetic progestin such as medroxyprogesterone tablet, or levonorgestrel (Mirena) IUD (see below). Micronized progesterone is a viable alternative to synthetic progestins. It thins the uterine lining as well as other progestins but has fewer side effects.It can be used as a topical cream or a capsule such as Prometrium. See Dr. Jerilynn Prior’s Doctor’s Guide for Managing Menorrhagia.
Conventional treatment of heavy periods:
Hysterectomy (surgical removal of the uterus) has been the standard medical treatment for heavy bleeding for many decades. It is still necessary for some women, but I encourage my patients to keep their uterus, if at all possible. Hysterectomy doubles the long-term risk of vaginal prolapse and urinary incontinence. It can also reduce sexual response and ability to orgasm. If hysterectomy improves underlying gynecological symptoms like pain, then it can have the end result of improving sexual function.
Progestin-secreting IUD (Mirena) decreases menstrual flow by 90 percent. Mirena delivers a very small dose of the synthetic progestin levonorgestrel directly to the uterine lining. Some of that synthetic hormone does enter the blood but at one-tenth the dose of most contraceptive Pills. Mirena can, however, cause acne or depression. For more information about Mirena, please see The Pros and Cons of the Hormonal IUD.
Endometrial ablation is the surgical scraping or destruction of the uterine lining. It is effective, but 22 percent of women require a repeat procedure, and 20 percent experience long-term pelvic pain.
I mention these medical treatments only because they are sometimes required, despite all of your best efforts. To resort to a medical treatment is not a failure. No one can be expected to endure very heavy periods for long. It is still worth trying natural treatment before resorting to a hormonal IUD.