by Marcelle Pick, OB/GYN NP
The causes of menorrhagia can vary greatly between women, but some problems are commonly root causes of the unusually heavy bleeding. Such things as fibroids, low progesterone relative to estrogen (both common in perimenopause), polycystic ovary syndrome (PCOS), or other hormonal imbalances are usually to blame.
Occasionally an intrauterine device (IUD) could cause excessive menstrual bleeding, but his is not the norm unless there is an infection. Other less common problems, but certainly need to be thought of , include a thickened build up of tissue also called a thickened endometrium, uterine hyperplasia, polyps, uterine or cervical cancer, ectopic pregnancy, cervical lesions, pelvic inflammatory disease (PID), hypothalamic dysfunction, hyperprolactinemia, parathyroidism or other thyroid problems, even premature ovarian failure (POF).
Some practitioners when doing the initial workup will test a woman for vitamin K deficiency, a vitamin necessary for maintaining blood-clotting platelets. A woman with bleeding issues may also have a coagulation problem (coagulopathy), or other blood-related (hematologic) causes. For example, genetic variants such as Von Willebrand’s disease, factor VIII, or factor XI deficiency are relatively uncommon, autosomal traits that may be suspected in a woman who has had heavy periods since menarche, bruising issues, or prolonged bleeding after surgery, childbirth, or trauma. In fact it is the first thing I will do if someone comes to me with heavy bleeding as this is often overlooked and helps greatly with the patients understanding of what is going on. Heavy menses may be the only sign of this genetic condition. See your practitioner if you suspect you have a clotting disorder as it is only a simple blood test and often goes undiagnosed.
The truth is that we see heavy bleeding often but rare disorders and not usually the cause. Rare disorders aside, our first and major concern for women with menorrhagia is anemia. A (CBC) better known as a complete blood count tells us if you are indeed anemic and need to add an iron supplement and more hormonal support. If hormone levels are imbalanced, especially in perimenopause, we may want to try a combination of nutritional intervention and endocrine support for you. Though rarely our first-line choice, when the bleeding needs to be kept under control, we will prescribe a synthetic form of progesterone like Aygestin or Provera. It does work extremely well and has its place when necessary.
We are happy to say that in our experience, most cases of heavy periods can be brought under good control with diet and exercise modifications, along with a medical-grade nutritional supplement and progesterone support. Of note is that the time we see the most problem with heavy bleeding that is not the usual pattern for our patients is around the holidays when the stress level is often over the top for women.
Gentle phytonutrient support and the use of a pharmaceutical grade multivitamin such as ours can also help keep your estrogen-to-progesterone levels on a much more even keel. But we always place equal weight on looking at addressing the impact your emotions and stress have on your hormonal symphony once a woman’s body gets the support it needs, it usually resumes its normal menstrual cycles—without having to resort to surgery. We see this on a daily basis in the clinic and online.