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.
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
Causes
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.
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. 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.
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.
Signs, symptoms & indicators of Menorrhagia (Heavy Periods)
Having light periods
Conditions that suggest Menorrhagia (Heavy Periods)
Risk factors for Menorrhagia (Heavy Periods)
Low Progesterone 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 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.
Problem 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.
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.
Fibroids
See links from Constipation and Anemia to Fibroids.
Menorrhagia (Heavy Periods) suggests the following may be present
Problem 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.
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.
Recommendations for Menorrhagia (Heavy Periods)
Vitex
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 (Capsella bursa pastoris)
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 (Symphytum officionale)
Comfrey has an astringent action which helps stop hemorrhages wherever they occur.
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.
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.
Iron
The following observations have been made regarding iron and menorrhagia:
Essential Fatty Acids
Omega 3 EFAs may reduce bleeding in adolescent girls and improve other menstrual symptoms generally in women.
Surgery
The NovaSure System provides an effective and minimally invasive outpatient alternative to hysterectomy, while avoiding the potential side effects and long-term risks of drug therapy. The patented NovaSure System is a next-generation endometrial ablation device that delivers precisely measured electrical energy via a slender, hand-held device to remove the endometrial lining.
This quick, simple to schedule procedure requires no incisions, can be performed in an office or outpatient setting, and generally takes less than five minutes to perform. This is significantly shorter than any other endometrial ablation procedure.
According to recent studies, most women feel that endometrial ablation relieves the problem with their period. Up to 90% of women who have this procedure are satisfied with the results. After the procedure, the women who were satisfied with it reported lighter periods or normal periods. Some women said that their periods stopped completely after endometrial ablation.
Vitamin A
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.
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 E
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.
Vitamin K1/K2
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.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Menorrhagia
Abnormally heavy menstrual period.
Metrorrhagia
Any irregular, acyclic bleeding from the uterus between periods.
DUB
Dysfunctional Uterine Bleeding (DUB) is any abnormality of menstruation or bleeding caused by a hormonal disorder. DUB is a diagnosis of exclusion. The following conditions should be ruled out in order to diagnose DUB: endometrial polyps, uterine fibroids, adenomyosis, endometrial or cervical cancer, pelvic infection including endometritis (infection of the lining of the uterus), endometriosis, polycystic ovarian disease, ovarian cyst or tumor, thyroid dysfunction or blood clotting abnormalities. Hormone testing may indicate abnormalities which replacement therapy would then resolve. If the dysfunctional bleeding disappears, then no further testing may be necessary. Failure to perform sufficient testing may result in an incorrect diagnosis of DUB because the true cause of the abnormal bleeding has been overlooked. A premature diagnosis of DUB may lead to improper and failed treatment. DUB accounts for approximately 20% of all hysterectomies in the U.S.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Estrogen
One of the female sex hormones produced by the ovaries.
Prolactin
An anterior pituitary peptide hormone that initiates and maintains lactation.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Endometriosis
A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Ectopic
Located outside normal position, e.g., location of fetus in pregnancy.
Vitamin K
Helps the blood clot when the body is injured.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Premenstrual Syndrome
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
IU
International Units. One IU is 1/40th (0.025) of a microgram (mcg).
Constipation
Difficult, incomplete, or infrequent evacuation of dry, hardened feces from the bowels.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.