Menorrhagia is the medical term used to describe prolonged or excessively heavy menstrual bleeding. Many women experience heavy bleeding, but it may not be severe enough to be classified as menorrhagia. Heavy menstrual bleeding can make it difficult to go about your usual daily activities because of the pain and excessive blood loss that can leak from sanitary pads.
Sometimes no cause can be found but common reasons include hormonal imbalances, uterine fibroids, endometriosis and polyps. Painful menstrual cramps and iron deficiency are common problems associated with menorrhagia.
Signs and symptoms of menorrhagia
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
- Needing to use double sanitary protection to control your menstrual flow
- Having to wake up during the night to change sanitary pads
- Bleeding for longer than a week and/or losing more than 80ml of blood
- Heavy menstrual flow that interferes with regular lifestyle
- Passing large blood clots
- Painful menstrual cramps (dysmenorrhea)
- Symptoms of anaemia, such as tiredness, fatigue or shortness of breath
The menstrual cycle
During the menstrual cycle levels of oestrogen, progesterone and other hormones fluctuate to allow for healthy ovulation and fertilisation of an egg. Oestrogen and progesterone contribute to the thickening of the endometrium which is shed during menstruation. If the levels of oestrogen and progesterone are out of balance the endometrium can develop to excess and sheds by the way of heavy menstrual bleeding.
There are essentially four types of menorrhagia:
Anovulation menorrhagia—this if the most common form of menorrhagia which is due to high unopposed oestrogen and progesterone deficiency. Bleeding can be prolonged and profuse, with large clots and pain. Bleeding may occur every 2-3 weeks and bleeding can last for seven days, often resulting in anaemia.
Luteal phase defects—the second half of the menstrual cycle is affected by high levels of oestrogen compared to progesterone. This unbalanced ratio leads to a shorter cycle of 23-26 days, spotting in between the cycle and heavy periods for the first 2-3 days.
Prolonged luteal phase—this commonly occurs in perimenopausal women where there is high progesterone and possibly androgen levels compared to oestrogen. Bleeding is usually scanty and prolonged.
Ovarian atrophy—low levels of both oestrogen and progesterone can cause irregular bleeding with a non-existent or variable cycle.
Common causes
There are many causative factors that can contribute to heavy and/or prolonged menstrual bleeding, including:
- Hormone imbalances—PCOS, endometriosis, obesity, thyroid problems and insulin resistance are conditions which can lead to an imbalance of hormones.
- Dysfunction of the ovaries—if you don’t ovulate during a menstrual cycle, your body doesn’t produce enough of the hormone progesterone.
- Uterine fibroids—these are large noncancerous tumours which occur in the wall of the uterus.
- Polyps—small, benign growths on the lining of the uterus.
- Adenomyosis—a condition where glands from the endometrium become embedded in the uterine muscle.
- Contraceptive intrauterine devices (IUD’s)—and certain medications including anti-coagulants, anti-inflammatories and hormonal medication.
Other causes include abnormal pregnancy and miscarriage, cancer (uterine and cervical), inherited bleeding disorders, infection, hypothyroidism and stress.
Healthy hormonal diet
There are many components to a diet that can be adjusted to reduce prostaglandins, promote hormonal balance, balance blood sugars and assist in weight loss.
Eat low GI foods
Adopting the principles of a low glycaemic index (GI) diet and ensuring adequate protein intake can assist in blood sugar balancing, reducing anxiety and assisting weight loss if needed. This diet is especially useful for people with PCOS, insulin resistance and type 2 diabetes.
Low GI foods include: beans, chickpeas, brown basmati rice, oats and certain vegetables and fruits.
High GI foods to avoid: include white bread, sugary drinks, lollies, white short-grain rice, dates and potatoes.
Nutrients which assist in regulating blood sugars include gymnema, cinnamon, chromium, B vitamins and lipoic acid.
Phyto-oestrogens
These are natural compounds found in foods and herbs which mimic the activity of oestrogen. They provide the body with mild oestrogenic activity and can assist in balancing high or low levels of oestrogen. If there are excessive amounts of oestrogen they bind to the same receptors and block their activity, resulting in a milder outcome.
Herbs which can assist in hormonal balancing include vitex, black cohosh and red clover. Foods which naturally contain phyto-oestrogens include lentils, soy, linseeds, oats and sesame seeds.
Reduce prostaglandins
Prostaglandins are compounds in the body that contribute to inflammation and exacerbate the symptoms of menorrhagia.
Foods to avoid that contribute to this process include refined foods, white flour, chocolate, alcohol, caffeine, sugar, salt, dairy and meat (particularly processed meats, poultry and red meat).
Nutrients which help to reduce prostaglandins include omega-3 and turmeric.
Herbal medicines traditionally used for painful menstrual cramps include chamomile, peppermint, dong quai, corydalis and valerian.
Liver support
Cruciferous vegetables such as broccoli, cauliflower, kale and brussels sprouts enhance glutathione activity which is important in the detoxification of excessive hormones such as oestrogen. Other detoxifying foods include beetroot, carrots, garlic, dark leafy greens, lemons and apples.
Nutrients which assist in liver detoxification include St Mary’s thistle, dandelion root, N-acetyl cysteine, B vitamins and selenium.
Heavy bleeding
There are certain herbs which are traditionally used for heavy menstrual bleeding. They include:
- shepherd’s purse
- beth root
- vitex
- peony
In randomised, controlled trials, ginger capsules and pomegranate showed great efficacy in reducing menstrual flow and duration.
Iron stores
A deficiency in iron is common in menorrhagia due to excessive blood loss. Foods which are rich in this essential mineral include lean red meat, green vegetables, lentils, beans, nuts, seeds and dried fruit.
If your iron stores are too low your practitioner may recommend an iron supplement. Well absorbed formulas that are gentle on the stomach and less likely to cause constipation contain iron amino acid chelate and bisglycinate.
References
https://www.betterhealth.vic.gov.au/health/healthyliving/menstruation-abnormal-bleeding
https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
Rae C, et al. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia. 2013 May;19(3):385-91https://www.ncbi.nlm.nih.gov/pubmed/22994803
Duncan AM, et al. Phyto-oestrogens. Best Pract Res Clin Endocrinol Metab. 2003 Jun;17(2):253-71 https://www.ncbi.nlm.nih.gov/pubmed/12787551
Javan R, et al. Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review. Phytother Res. 2016 Oct;30(10):1584-1591 https://www.ncbi.nlm.nih.gov/pubmed/27397554
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