Why am I bleeding so much? Understanding Heavy Periods
Heavy periods are also known as menorrhagia, and it's one of the most common conditions in people who menstruate. When it feels like your changing a pad, tampon, or emptying a cup every hour - it can have a big impact on your quality of life!
Symptoms of Heavy Periods
You might have heavy periods if you experience:
- Losing more than 80mL of blood during the cycle
- Bleeding lasting more than 7 days
- Changing a pad or tampon less than 1-2 hours
- Needing to wear more than one pad at a time, or using double hygiene protection (pad + tampon or pad + menstrual cup)
- Waking up at night to change pads or tampons
- Frequent soiling of clothes or bedsheets
- Blood clots that are as big as a quarter or larger
- Periods that interfere with daily activities (aka. standing up from a chair might be terrifying)
- Iron deficiency (ie. cold hands and feet, hair loss, overall feeling fatigued, dizziness and lightheadedness).
Tracking the amount of pads or tampons you're using throughout the day might be difficult to do, but it is quite important. Ideally, this should be done while you're on your period as opposed to trying to remember a week or two later.
If you score over 100 using this above chart, it's likely that you can be diagnosed with menorrhagia.
Tracking with a menstrual cup might be a better method, because most of the cups have gradients that tell you how much blood you've lost (at least mine does!). While menstrual cups are often rated better in terms of comfort, collection, and appearance (when compared to pads and tampons), sometimes there's a steep learning curve in terms of insertion and removal, and some clients don't love emptying them as frequently - especially in public places.
Risk factors of heavy bleeding
Risk factors include:
- Relative with bleeding disorders/has been treated for excessive bleeding
- History of anemia (aka. low iron)
- Period longer than 7 days
- Frequent brusing/nosebleeds/gum bleeding
- Recurrent miscarriages
- Bleeding during pregnancy
Causes of Heavy Bleeding
There are many causes of heavy menstrual bleeding, these include:
Hormonal Causes
- Anovulatory bleeding
- Polycystic ovary syndrome (PCOS)
The most common cause of heavy periods in teens is anovulation - which is basically a period where ovulation does not happen. When teens begin their period, they may experience months to years of unpredictable ovulation. In fact, up to 85% of cycles are anovulatory in the first year after menstruation initially begins.
Once ovulation happens and progesterone is produced, it's thought that the heavy periods may begin to decline. Estrogen is the hormone that's in charge of building the endometrial lining, so if progesterone is not there to balance it then that may be why you're experiencing heavy periods.
Bleeding Disorders
- von Willebrand disease
- Platelet dysfunction
- Thrombocytopenia
- Clotting factor deficiency
Infections
- Sexually transmitted infections
- Cervicitis
- Endometritis
Pregnancy
- Abortion
- Ectopic pregnancy
- First trimester bleeding
- Gestational trophoblastic disease
- Postpartum bleeding
Medication
- Anticoagulants/blood thinners
- Depot medroxyprogesterone
- Intrauterine device (IUD)
Uterie
- Adenomyosis
- Malignancy
Other
- Trauma
- Foreign body
- Hemorrhagic ovarian cysts
Testing for Heavy Periods
Naturopathic doctors can run most blood tests for heavy periods, but not all. Also, because we want to look at the uterus itself - you should have a medical doctor order further structural testing to rule that out as a potential cause.
Blood Tests
- Bleeding disorders - von Willebrand panel, platelet function, coagulation studies
- CBC and ferritin test
- Blood type
- Thyroid panel - TSH, free T3, free T4
- Screen for PCOS - FSH, LH, Total testosterone, DHEA-S, fasting insulin, fasting glucose
- Pregnancy test
- STI screen - Chlamydia and gonorrhea
Structural Testing
- Pelvic exam
- Transvaginal ultrasound
- Sampling of the endometrium
Treating Heavy Periods
Conventional Treatment
Treatment of heavy periods depends on a person's age, their desire to maintain fertility, and the presence/absence of pelvic pathology. This may involve hormonal therapies like an IUD or birth control pill, hemostatic therapies that decrease blood loss, or simple medication like NSAIDs.
Alternatively, surgical therapies are also an option, and may be utilized when medications have not shown to be helpful. This may include endometrial ablation or a hysterectomy.
Naturopathic Treatment
Obviously there are many reasons why someone may be experiencing heavy periods. As a naturopathic doctor, one of my primary jobs is to discover the root cause of the problem and treat based on that.
Iron
As anemia is very common in women with heavy periods, you need to get your ferritin and CBC tested before you supplement. I like supplementing with iron, rather than increasing iron rich foods because blood changes will happen more quickly this way. Nevertheless, eating your fair share of leafy greens will have it's own healthy benefits.
Vitamin C
This vitamin helps to increase iron absorption, especially when you're eating iron-rich food sources. A really easy way to incorporate greens and vitamin C together is by eating a salad! Add some red pepper, lemon juice, cabbage and even parsley to a salad can help increase iron and help with absorption!
Ginger
Ginger has been shown to be helpful in reducing blood flow particularly around the menstrual cycle. Compared to a NSIAD (Ibuprofen), it was found to reduce bleeding time and days.
Chaste Tree (Vitex agnus castus)
Because anovulation may be a problem in adults (recall that it can be normal in teens once they first begin their period), chaste tree can be a great herb to use to support ovulation. It's a progesterogenic herb, that helps to balance estrogen and progesterone in the body.
Final Thoughts
Heavy periods can happen for a variety of reasons and while everyone would prefer to use Dr. Google to figure out the right supplement to take to stop it, it's incredibly determine why it's happening. Once you have that piece of the puzzle figured out, then you can choose the right treatment to get you back to feeling 100%.
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References
Davies, J., & Kadir, R. A. (2017). Heavy menstrual bleeding: An update on management. Thrombosis Research, 151 Suppl 1, S70–S77.
Eshaghian, R., Mazaheri, M., Ghanadian, M., Rouholamin, S., Feizi, A., & Babaeian, M. (2019). The effect of frankincense (Boswellia serrata, oleoresin) and ginger (Zingiber officinale, rhizoma) on heavy menstrual bleeding: A randomized, placebo-controlled, clinical trial. Complementary Therapies in Medicine, 42, 42–47.
Kashefi, F., Khajehei, M., Alavinia, M., Golmakani, E., & Asili, J. (2015). Effect of ginger (Zingiber officinale) on heavy menstrual bleeding: A placebo-controlled, randomized clinical trial. Phytotherapy Research: PTR, 29(1), 114–119.
Moon, L. M., Perez-Milicua, G., & Dietrich, J. E. (2017). Evaluation and management of heavy menstrual bleeding in adolescents. Current Opinion in Obstetrics & Gynecology, 29(5), 328–336.
Updated July 2020.