Updated: Apr 5
Heavy periods are a big deal for women’s health, and not just for the inconvenience. Significant monthly blood loss causes a drop in iron each month, and it may be very difficult to keep up with it. Iron deficiency is associated with fatigue, hair loss, feeling cold, contributes to thyroid dysfunction and can also contribute to depression, anxiety and sleeplessness. What this means is that addressing heavy periods is a huge priority in women’s healthcare.
What is a heavy period?
First of all, let’s define what a normal period is in terms of menstrual blood loss because most of us do not have a frame of reference.
A normal amount of menstrual blood loss per period (not per day) is 15 to 40 ml. Each soaked normal-sized tampon or pad holds a teaspoon (5ml) of blood.That means it is normal to soak two to seven normal-sized pads or tampons (“sanitary products”) in a whole period. If you’re using a menstrual cup, it holds 20-30 mL (check your brand here: https://putacupinit.com/chart/), so this calculation can be much more exact. Passing large clots is also a sign of heavy bleeding, and may be harder to quantify.
Heavy flow is between 40-80mL per period, and extremely heavy is considered to be 80mL or more of menstrual blood loss total per period. In both of these scenarios, iron deficiency is a concern.
Possible causes of heavy periods:
There are many possible causes of heavy periods – many are functional imbalances, others are structural issues, and one can be inherited.
Blood clotting disorder (Von Willebrand Disease)
Also can be associated with uterine or ovarian cancer
As always, it is important to get thoroughly tested so we can first understand the cause of your heavy periods.
Testing may include:
Pelvic ultrasound: checking for fibroids, adenomyosis, polyps (polyps may require an addition test to look inside the uterus called a sonohysterogram).
Hormone bloodwork: Estradiol, Estrone, Progesterone, Prolactin, SHBG (sex hormone binding globulin) – tested on day 21 of your cycle.
Complete thyroid panel, especially if there are other thyroid symptoms present (TSH, fT4, fT3, thyroid antibodies, reverse T3).
Markers of anemia and iron deficiency: hemoglobin, red blood count, ferritin (and possible full iron panel).
Testing for Von Willebrand Disease (inherited blood clotting disorder – associated with heavy periods, nosebleeds and bruising).
Test for insulin resistance – fasting glucose and insulin.
Check estrogen detox pathways with comprehensive DUTCH urine test: measures both levels of estrogens (estrone, estradiol, estriol), and their metabolites. This is very helpful especially in cases where estrogen-dominant conditions like fibroids, endometriosis and breast cancer run strongly in families.
As always, testing is matched to your individual scenario – not all testing is required every time.
Steps to reduce period flow
Since many of the described issues centre around hormone balance and estrogen dominance, this is where we start.
Including ground flaxseeds – lignans contain fibre, and support estrogen clearance from the colon. Keeping the bowels moving regularly is essential!
Increase dietary vegetable intake – especially dark leafy greens and the brassica family of vegetables (broccoli, cauliflower, bok choy, cabbage, Brussels sprouts, kale, collard greens, chard).
Include turmeric and rosemary in cooking.
Eat organic – many pesticides are estrogen-mimicking and increase the body’s load of estrogens.
Avoiding cow’s milk dairy products can make periods less painful, and also less heavy. The form of casein in cow’s milk dairy (different from goat or sheep), has more hormonal activity.
Minimize sugar and simple carbohydrates to lower insulin levels.
Minimize alcohol intake.
Since all hormonal systems are connected, stress reduction is key to overall hormone balance. Also, when you’re under high stress this can have a direct impact on progesterone production, creating more estrogen dominance.
Regular exercise is highly recommended for body composition, stress reduction and overall hormone balance.
SUPPLEMENTS THAT MAY BE CONSIDERED:
Calcium-D-Glucarate – reduces enterohepatic circulation of estrogens, and inhibits beta-glucaronidase.
DIM and Indole-3-carbinol – support phase 2 detox pathways to clear estrogen through the preferred 2-OH-estrone pathway
Resveratrol – inhibits aromatase, inhibits estrogen-receptor activity
Turmeric – also inhibits aromatase which lowers estrogen levels, and lowers prostaglandins to reduce menstrual pain.
ADDRESSING LOW IRON:
It is essential to address low iron levels caused by heavy periods – increasing food sources of iron (red meat and dark leafy greens especially), and treating low iron with appropriate strength supplements. Strangely low iron levels can also contribute to further heavy periods, so it is important to bring the levels up.
Treating the thyroid: Hypothyroidism is an extremely common cause of heavy periods, and can be very easily treated.
Optimizing gut health: ensuring daily bowel movements, and rebalancing the gut microbiome (directly improves excretion of estrogen)
Addressing abdominal weight and visceral adipose tissue Adding bioidentical progesterone: This is especially recommended for heavy periods around perimenopause when hormone balance is more difficult to achieve with the steps above.
Using Ibuprofen to reduce flow: Although this is not a natural treatment, it is a treatment that can reduce period flow by up to 50%. (Dosage is 200mg every 6 hours during heavy days).
Consider fibroid or polyp removal: This depends on size and other risk factors.
If above strategies are not effective, consider hormonal IUD to lighten periods while you’re working on the underlying causes. Again this is not the most natural strategy, but may be considered for overall quality of life.
If you have heavy periods and are looking for support, the first step is to find out the cause. Blood tests and ultrasound are the best places to start, and then we may dig deeper. There are so many things you can do to reduce the intensity of your periods, and it can make a huge impact on your energy and overall wellness.
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