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Signs and Symptoms of Heavy Menstrual Bleeding and How to Treat It

I see many women in my office with a primary concern of heavy menstrual bleeding. It is a common concern that women don’t always bring up with their health care provider. It can significantly impact your quality of life and create anxiety around leaving the house, especially when cycles become unpredictable. This blog post will shed some light on common signs and symptoms of heavy menstrual bleeding, potential causes, and some integrative treatment options.

Heavy menstrual bleeding is defined as bleeding greater than 80mL. One of the main challenges with this is that it is likely you do not know how much you are bleeding unless you are using a collection method like the diva cup. Here is information that your health care provider will find very useful when it comes to your menstrual cycle:

  • Clots: If you pass clots, please journal on what day of your cycle this occurred and the approximate size of the clot (ie. size of a dime, quarter, loonie.)

  • Bleeding between periods: If you experience bleeding between periods that requires sanitary protection, journal what specific day of your cycle this occurred.

  • Flooding: If you experience any episodes of overflow/staining of underwear or bed sheets, please indicate the number of episodes and the relevant menstrual cycle day.

NOTE: Day 1 of your menstrual cycle is the first day of bleeding.

Signs of heavy menstrual bleeding

Any of the following can be a sign of heavy menstrual bleeding:

  • Bleeding that lasts more than 7 days.

  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.

  • Needing to wear more than one pad at a time to control menstrual flow.

  • Needing to change pads or tampons during the night.

  • Menstrual flow with blood clots that are as big as a quarter or larger.

What are some causes of heavy menstrual bleeding?

The assessment is the most important part of diagnosing heavy menstrual bleeding. As Naturopathic Doctors we have the time to spend with our patients to get to the root cause of heavy menstrual bleeding. Here are some of the most common causes of heavy menstrual bleeding:

  • Iron deficiency

    • You may have heard of iron deficiency causing fatigue, but that’s not the only symptom of iron deficiency. It can also cause heavy menstrual bleeding because iron is a part of the clotting cascade and it helps to slow blood loss. Other common symptoms of iron deficiency anemia include: headache, palpitations, shortness of breath, dizziness, fatigue. I always tell my patients that I cannot tell if and how iron deficient you are by looking at you. It’s important to get iron checked through bloodwork!

  • Anovulatory cycles

    • What does anovulatory mean? This is a menstrual cycle in which ovulation (the release of an egg from the ovaries) does not occur. This can be due to various causes, such as being underweight or overweight, exercising excessively, experiencing significant stress, or due conditions like Polycystic Ovarian Syndrome (PCOS). These anovulatory cycles can increase the amount of blood that is lost during menstruation. How? Well we need ovulation to happen in order to for our bodies to release progesterone. If progesterone is not released, then the uterine lining is often thicker and more inflamed because progesterone is responsible for maturing the uterine lining. Anovulatory cycles can also be common as women approach menopause as ovarian function declines. In this case, follicles are still developing, but despite increase follicle-stimulating hormone (FSH) levels, the follicles do not produce enough estrogen to trigger ovulation. Talk to your health care provider about simple ways that you can know if you are ovulating or not.

  • Structural causes

    • Fibroids, polyps, and adenomyosis are all common structural causes of heavy bleeding. These can be assessed with a transvaginal ultrasound. It is important to get these structural causes ruled out. The size and severity of uterine fibroids do increase with age, so you may notice heavier bleeding as you approach menopause.

  • Other causes to explore: endometriosis, medications, bleeding disorders, hypothyroidism, non-alcohol fatty liver disease (NAFLD), hyperprolactinemia, coagulation disorders

What are some lab tests I should run to assess heavy menstrual bleeding?

Here are some lab tests you can run with your health care provider to assess the cause of your heavy menstrual bleeding:

  • Complete blood count (CBC)

  • Ferritin

  • Thyroid function tests

  • Coagulation panel (ie. INR, fibrinogen)

  • Prolactin

  • Gonadotropins (LH, FSH)

  • If PCOS is suspected, then male sex hormones should also be run

  • Imaging: transvaginal ultrasound

How to stop menstrual bleeding?

While investigation for the cause of heavy menstrual bleeding occurs, it is important that you are provided support to halt significant blood loss. Here are some integrative options you can explore with your health care provider:

  • Ginger

    • Ginger has been studied on its own for heavy menstrual bleeding in adolescent women and has shown a statistically significant reduction in menstrual blood flow when used around the menstrual cycle (link to study here.)

    • Ginger has also been studied alongside a prescription of ibuprofen, and was found to further reduce bleeding time and reduce the number of bleeding days compared to ibuprofen alone (link to study here.)

  • Bowswellia

    • Boswellia has been compared against ginger and placebo as an addition to ibuprofen and was found to further enhance the effect of ibuprofen and shorten the number of bleeding days versus ibuprofen alone (link to study here.) The Boswellia treatment group reported an improved quality of life over ibuprofen alone during the 3 months of study.

  • You can also discuss using a herbal formulation with your practitioner using herbs such as Capsella bursa-pastoris, Achillea millefoium, Viburnum opulus.

If you are noticing changes in your monthly menstrual blood flow, be sure to address it with your family doctor, your gynaecologist or your Naturopathic Doctor. Simple blood tests and thorough history taking can help your doctor understand the cause of your heavy menstrual bleeding and if further investigation is needed.

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