Menstruation

Menorrhagia and hypermenorrhagia (excessive menstrual bleeding)

Heavy menstrual bleeding and clotting are common problems for many women. When a woman soaks a pad or a tampon an hour for several hours or more or bleeds for more than a week and a half each month, this is called menorrhagia. If she soaks through two or more pads or tampons an hour, this is generally considered hypermenorrhagia.

Excessive bleeding of this nature can be very troubling when it occurs and, as any woman knows who has experienced it, terribly inconvenient. So much so that it is a leading cause of elective hysterectomy. As with most other menstrual irregularities, however, the underlying cause of heavy periods is oftentimes hormonal and/or nutritional imbalance resulting from diet, lifestyle, and stress. This means that in many cases, heavy menstrual bleeding can be relieved without a hysterectomy.

Nearly all women experience heavy bleeding and clotting at one point or another, and some women regularly have a very heavy menstrual flow. If your periods are on the heavy side but repeat in a regular pattern on a cyclical basis, that would be considered normal for you. Or, if you have some irregularities in your flow that dissipate the following month, there is probably nothing too serious going on. We generally consider one or two “odd” periods a year to be normal. But if you experience excessive menstrual bleeding for two consecutive months, or if your periods are heavy and ongoing in an erratic fashion, it would be wise for you to check in with your gyn care provider.

Other signs and symptoms associated with menorrhagia and hypermenorrhagia include:

• A menstrual period that lasts longer than 10 days
• Menstrual flow that includes large blood clots
• Heavy periods that interfere with your regular lifestyle
• Constant pain in your lower abdomen combined with heavy menstrual periods
• Tiredness, fatigue, or shortness of breath (symptoms of anemia)

Causes and treatment of menorrhagia

Causes of menorrhagia vary widely between women, but some problems commonly at the root of unusually heavy bleeding include fibroids, low progesterone relative to estrogen (both common in perimenopause), PCOS (for more on this, see our articles on insulin resistance), or other hormonal imbalance.

Occasionally an IUD could cause excessive menstrual bleeding. Other less common problems, but which nonetheless need to be considered, include 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 problem, or premature ovarian failure (POF).

Some practitioners will consider testing a woman with heavy bleeding 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. But then again, heavy periods or dysfunctional uterine bleeding (DUB) may be the only sign that a woman has one of these genetic traits, and therefore they frequently go undiagnosed. Genetic variants of this type are easily identified with simple blood testing, though, so you may want to bring this up with your healthcare provider if you think you fit the description for a clotting disorder.

Rare disorders aside, our first concern for women with menorrhagia is anemia. A complete blood count (CBC) tells us if we need to add an iron supplement and more hormonal support. If hormone levels are low in perimenopause, we may try a combination of nutritional supplementation and endocrine support. Though rarely our first-line choice, when we really need to get the bleeding under control, we will prescribe a synthetic form of progesterone like Aygestin or Provera.

The good news is 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. Gentle phytotherapeutic support such as our Herbal Equilibrium can also help keep your estrogen-to-progesterone levels on a more even keel as you cycle through the months. But we place equal weight on addressing the impact that your emotions and stress may be having on your hormonal cycles. Once a woman’s body gets the support it needs, it usually resumes its normal menstrual cycles — without having to resort to surgery.

 

Original Publication Date: 08/24/2005
Last Modified: 02/16/2010