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Menstrual cycle health is a cornerstone of a woman's overall well-being. Heavy periods can significantly disrupt your quality of life.
Between 20-30 percent of women experience heavy bleeding, which is caused by a variety of conditions. Heavy periods can be particularly prevalent during perimenopause.
In this comprehensive guide, we'll delve into the causes of heavy periods and provide you with insights for reducing your flow from a conventional and holistic approach.
Understanding Heavy Periods
Heavy menstrual bleeding, known as menorrhagia, is defined by the National Institute for Health and Care Excellence (NICE) as excessive and/or prolonged bleeding.
Women lose less than 80mls of blood per typical period. Heavy periods are when more than 80mls of blood is lost.
Heavy bleeding can look like this:
needing to change tampons or sanitary pads every two hours or more frequently on the heaviest days,
needing to use double period products,
heavy periods with blood clots (bigger than 2.5cm diameter)
a heavy period that lasts over a week.
symptomatic due to significant blood loss such as dizziness or fatigue or low iron/anaemia
The medical term for heavy periods is menorrhagia.
Heavy periods can have significant consequences for health and wellbeing including:
iron deficiency or anemia from blood loss,
fatigue,
dizziness/fainting or
disruption to school/work/sport/recreation activities
reduced quality of life.
Heavy periods can be common during perimenopause. They can occur every cycle or you may experience some cycles with normal blood flow and some cycles with heavier blood flow.
What Causes Heavy Periods?
There are various causes of heavy menstrual bleeding, and your health provider can help determine what is causing your heavy periods.
Hormonal Imbalances
Although not a technical medical term, it encompasses the hormonal causes of heavy periods. This includes:
Ovulatory dysfunction such as anovulation: the absence of ovulation, and it is a common cause of heavy periods. This can be due to perimenopause and reduced ovarian function or other conditions such as polycystic ovarian syndrome.
Ovulatory dysfuncttion such as Luteal phase deficiency: where the luteal phase of the menstrual cycle is shorter or has a lower progesterone production across the phase. The luteal phase typically occurs in the last 2 weeks prior to your next period.
Puberty and Perimenopause: during this time the brain - pituitary - ovary axis is either ramping up or winding down and there is relative estrogen dominance during the cycles.
Thyroid Conditions: Hypothyroidism (low thyroid hormone) or Hyperthyroidism (high thyroid hormone) can interfere with ovulation and cause issues with periods.
Polycystic Ovarian Syndrome: Where elevated testosterone (androgens) and or insulin can inerfere with the normal hormonal cycle.
Anatomy Factors
Anatomical factors refer to physical changes or abnormalities in the reproductive organs that can cause abnormal uterine bleeding.
These include:
Endometrial polyps, which are overgrowths of tissue in the lining of the uterus that can cause heavy or irregular periods.
Uterine fibroids, which are non-cancerous growths in the uterus that can cause heavy periods, pelvic pressure or pain, frequent urination, and constipation.
Adenomyosis, a condition where the tissue that lines the uterus grows into its muscular wall. This can lead to prolonged and heavy bleeding, as well as severe cramps and pain.
Endometrial hyperplasia: this is where the endometrial lining of the uterus becomes thickened due to an excess of oestrogen compared with progesterone.
Uterine or cervical or vaginal cancer, which can cause abnormal bleeding or heavy bleeding.
Often polyps, fibroids, adenomyosis and endometrial hyperplasia are hormonally influenced, being driven by a higher estrogen environment and are more common around perimenopause.
Medical Conditions
You may have medical condition that impacts your periods: These can include:
Liver disease,
Kidney disease,
Thyroid dysfunction, hyperthyroid or hypothyroid
Insulin resistance interferes with the HPO axis to disrupt the menstrual cycle
Bleeding disorders such as von Willebrand disease or platelet dysfunction or leukaemia.
Chronic iron deficiency
Pelvic inflammatory disease (PID), sexually transmitted infections (STIs) or endometritis: an infection of the uterine lining. There can lead to inflammation and heavier bleeding with your periods.
Medications
Certain drugs may lead to heavier menstrual flow as a side effect. These can include:
Anticoagulants (blood thinners) such as aspirin, warfarin, clexane, clopidogrel, or heparin,
Nonsteroidal anti-inflammatory drugs (NSAIDs), used for pain relief, such as ibuprofen, naproxen, diclofenac.
Hormonal contraceptives, which may lead to breakthrough bleeding.
Antidepressants: SSRI such as sertraline and fluoxetine, tricyclic antidepressants
Antipsychotics such as olanzapine and quetiapine
Steroids
Some natural products can increase your blood flow like: fish oils, ginseng, garlic, and gingko.
Top Tips for A Holistic Approach to Heavy Periods
It is important to know what is causing your heavy periods.
Your health provider will take a history, often you will need a pelvic examination, cervical smear test, blood tests and sometimes imaging such as a pelvic ultrasound. If clinically indicated you may also need an endometrial biopsy.
Conventional treatment for heavy periods relating to hormonal causes commonly range from medications to surgical interventions.
Our holistic approach considers lifestyle factors that can contribute to heavy periods. These natural remedies for heavy periods can be implemented alongside any other treatments you may need.
1. Phytoestrogens To Support Estrogen Balance
Eating a diet high in plant foods contains an abundance of phytoestrogens which support hormone health. Aim for 2-3 servings of phytoestrogens per day. These include:
Nuts and Seeds: flaxseed, sesame seeds, pistachios, sunflower seeds, almonds.
Beans: edamame (soy beans), lentils, navy beans, kidney beans, pinto beans.
Fruit: dried prunes and apricots, peaches, raspberries, strawberries
Soy: miso, tofu, tempeh, soy milk
Vegetables: winter squash, green beans, collard greens, broccoli, cabbage.
Green Tea
Phytoestrogens can bind to the estrogen receptor but have a weaker effect than estradiol.
If phytoestrogens are consumed in abundance they can bind the estrogen receptors in preference to estradiol, reducing estradiol effects which can be beneficial for women who are having heavy bleeding due to higher estradiol:progesterone during their cycles.
So in women with higher estradiol, phytoestrogens can act anti-estrogenic to lower estrogenic effects in the body.
Related: Learn more about an anti-inflammatory diet for menopause
2. Eat Foods High in Diindolylmethane (DIM) to Support Estrogen Metabolism
DIM is a bioactive metabolite of indole-3-carbinol, a phytonutrient found in cruciferous vegetables, such as:
Broccoli,
Cabbage,
Brussel sprouts,
Cauliflower
Mustard greens
Arugula
Daikon radish
Collard greens
Horseradish
Kale
Kohlrabi
Radish
DIM has anti-inflammatory effects, anti-estrogenic effect by promoting the healthy metabolism and detoxification of estradiol. Aim to eat at least 1 serving of brassicas every day.
3. Foods To Support The Luteal Phase
During your luteal phase, you want to produce a healthy amount of progesterone to balance the estrogen of your follicular phase. You can support the luteal phase during the entire menstrual cycle by incuding the following foods in your diet:
Dietary Support with Phyto-gestins
There are a number of phytonutrients found in plant foods that have beneficial pro-progestogenic effects in the body. Another reason why eating a diverse plant-based diet can have positive impacts on your hormones.
Kaempferol: found in broccoli, spinach and kale, wild leeks or ramps, herbs such as dill, chives, and tarragon.
Apigenin in fruit such as cherries, apples, grapes, herbs (endive), vegetables (beans, broccoli, celery, onions, barley, tomatoes), and drinks (tea, wine).
Luteolin found in celery, parsley, broccoli, onion leaves, carrots, peppers, cabbages, and apple skins
Naringenin in grapefruit, bergamot, sour orange, tart cherries, tomatoes, cocoa, oregano, water mint, and beans.
These phytonutrients can also be supplemented.
These supplements have been found to support the luteal phase when they are taken during the entire menstrual cycle.
Vitamin B6 has been used clinically to treat luteal phase defect, including PMS and PMDD. It modulates expression of receptors to hormones and progesterone, especially when given in it's activated form. The dose is typically 50-100mg daily duirng the luteal phase.
Melatonin (1.5-3 mg at bedtime) is a powerful anti-oxidant and increases progesterone production in the luteal phase (Melatonin: shedding light on infertility, 2014). Sleep has an important association with menstrual health, with shift workers who have circadian rhythm disruption experience higher rates of irregular periods.
Magnesium: can help to reduce prostaglandins which are produced in abundance around your period and contribute to period cramps.
Vitex Agnus-Castus: This herb has been used for centuries and is taken throughout the cycle to reduce premenstrual symptoms and heavy periods. It is not a fast acting solution but over 4-6 months women may find a benefit.
Body Identical Progesterone can reduce heavy periods. 200-300mg of micronised progesterone orally or vaginally during the luteal phase of the cycle can reduce heavy periods (this is a prescription medicine).
Ginger and Turmeric: These spices are anti-inflammatory and can be used to reduce heavy periods. Typical doses of ginger include: 1-4 grams of dried ginger and Turmeric is 500mg twice daily.
5. Managing Stress
High levels of stress can disrupt the HPA axis (Hypothalamic-pituitary-adrenal axis), which controls the stress response. This can interfere with the HPO axis, (hypothalamic-pituitary-ovarian axis) contributing to anovulation, irregular periods or luteal phase deficiency. and can lead to dysregulated hormone levels.
Stress is linked increased severity of pre-menstrual symptoms, indicating it impacts the luteal phase of the cycle (Impact of stress on menstrual cycle, 2015).
It has also been connected with irregular cycles, indicating a disruption of the cycle that impacts ovuation (Effect of Perceived Stress on Menstrual Function, 2015).
There are many ways to manage stress so find the ones that work best for you.
Deep breathing can reduce cortisol and prolactin levels and help us feel more relaxed.
Gentle restorative yoga, walks in nature or along the beach can also help lessen our stress hormones.
Journalling,
Mindfulness, meditation
Gardening, fishing
Disconnecting from social media
Related: Take a deep dive into the 5 Pillars of Perimenopause Health and Wellbeing.
6. Restorative Sleep: Adequate Rest and Recovery
Getting a good night's sleep is also paramount for healthy hormone balance, as sleep deprivation can lead to increased cortisol levels which can disrupt other hormones in the body. It also disrupts melatonin and circadian rythm of the body and this impacts the menstrual cycle.
Try to aim for 7-9 hours of sleep per night and establish a bedtime routine to help you relax and wind down before bed.
Meditation and mindfulness practices have also been shown to reduce stress levels and improve overall well-being.
7. Exercise To Reduce Heavy Periods
Exercise supports healthy hormone balance and helps maintain weight and body composition that has a positive feedback to hormones. Women who exercise regularly are less likely to have heavier periods than women who do not (Physical Exercise and Heavy Menstrual Bleeding).
Exercise recommendations include 2.5 hours of moderate intensity exercise per week.
If you are not exercising you could start simply by increasing the number of steps you take y scheduling a 15 minute walk each day.
Finding some type of movement you love is the best way to make regular exercise and movement sustainable.
8. Protein and Iron: Building Blocks
It is essential to eat adequate protein for building blood cells that are lost, rebuilding the endometrial lining and hormones required to maintain the menstrual cycle. Protein should be consumed with each meal and for active menstruating women is 1.2-1.6mg/kg per day.
Protein dense animal foods include:
Lean meats such as beef, chicken, turkey,
Fish and seafood
Dairy products such as milk, yogurt, cheese and cottage cheese
Eggs
Protein dense plant foods include:
pumpkin seeds, hemp seeds, chia seeds,
flaxseeds
peanut butter and other nut butters
almond, walnuts, pistachios
chickepeas
lentils
beans
tofu
tempeh.
Iron is also an important nutrient for maintaining healthy blood levels. It is found in both animal and plant sources, with heme iron (found in animal sources) being more easily absorbed by the body. Plant-based sources of iron include:
dark leafy greens (spinach, kale, swiss chard)
dried fruits (raisins, apricots, dates)
legumes (lentils, chickpeas, kidney beans)
tofu
fortified cereals and breads
Always pair iron-rich foods with sources of vitamin C (such as citrus fruits or tomatoes) to enhance absorption.
Additionally, avoiding caffeine, tannins and calcium -rich foods (such as dairy) during meals can also help with iron absorption.
If you are experiencing heavy menstrual bleeding, you may also need iron and vitamin C supplementation to replace lost iron.
Related: Learn more about how to support your hormones if you have PCOS: A Complete PCOS Guide
The Takeaways: Natural Treatment For Heavy Periods
There are many causes of heavy periods in perimenopause, but often there is a hormonal influence.
You should seek medical advice if you are having heavy periods to determine the cause and the best treatment.
You can make lifestyle changes to both support your hormones in their healthy cycle and so you can feel and function better.
DIM and phytoestrogens from plant foods can lower your estrogen levels if high estrogen/progesterone ratio is contributing to your heavy periods.
Phytogestins from plant foods, herbs or natural progesterone can support higher progesterone in your luteal phase.
Support your iron intake with iron-rich foods eaten alongside vitamin C containing foods.
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References
Ibrahim NA, Shalaby AS, Farag RS, et al. Gynecological efficacy and chemical investigation of Vitex agnus-castus L. fruits growing in Egypt. Nat Prod Res. 2008 Apr 15;22(6):537-46.
Fernando S, Rombauts L. Melatonin: shedding light on infertility?--A review of the recent literature. J Ovarian Res. 2014 Oct 21;7:98.
Thomson CA, Ho E, Strom MB. Chemopreventive properties of 3,3'-diindolylmethane in breast cancer: evidence from experimental and human studies. Nutr Rev. 2016 Jul;74(7):432-43.
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