Menorrhagia – doesn’t that word sound like some crazy illness or disease?

Like, “Whoa, you have menorrhagia, that could be serious girl!”

Menorrhagia is in fact, just the fancy term for “heavy periods”, which aren’t exactly life threatening, but can put a serious damper on life activities!

I used to have horribly heavy periods when I was younger, which was part of the reason I went on birth control. I remember years ago I was in Grand Central Station in New York, and I was rushing to catch a train. I was using a super tampon AND a pad, and within thirty minutes I was flooding through both of them. It was horrific. I ended up missing the train because I spent so much time in the bathroom trying to sort myself out!

I also remember being in high school and literally praying every month that my period wouldn’t leak through my uniform. I’d wear a tampon, pad, undies and boy shorts under my dress! It was bananas.

I figure you might be able to relate to these stories? If so, keep on reading!

What is a normal vs heavy period?

Normal periods are defined as vaginal bleeding that occurs every 25-35 days, and lasts for 3-7 days, with an average blood loss range of 10-35 milliliters. Each soaked regular pad or tampon holds roughly 5ml of blood, so it’s totally fine to soak 2-7 pads/tampons during each period.

If your period lasts longer than seven days and you’re losing more than 80 ml of blood per cycle, or you’re soaking more than 16 regular tampons or pads per cycle, then this is a sign of a heavier than average flow (menorrhagia). Other signs are flooding (like I described above) and clots that are the size of a quarter or bigger.

FYI – 80 milliliters equals about 5.5 tablespoons or 2.7 liquid ounces, or 16 soaked regular pads or tampons.

Another FYI – as always, it’s really important for you to determine what is normal for you. All these numbers are merely statistics based on the experiences of a small group of women, and don’t necessarily represent your body’s norm.

In this post I share what your period is really supposed to look like.

Calculate how much you are bleeding

So one soaked regular tampon or pad holds 5ml or 1 teaspoon of blood and a fully soaked super tampon holds 10ml. A half soaked regular pad or tampon equals 2.5 ml and a half soaked super tampon holds 5ml.

Make a note in your period tracking app every time you change your pad or tampon in a 24 hour cycle to determine if you have a heavy period. If the number of fully soaked or half soaked pads or tampons in any given cycle is more than 16, then you have a heavy flow.

What does a heavy period look like?

Women often describe heavy periods as a major disruptor in all areas of their lives. From work, to dating, to the beach and exercising – a heavy flow can feel really unmanageable. Women complain of constantly worrying about embarrassing leaks or accidents, ruining underwear and favorite outfits, stressing about simply leaving the house or doing normal activities, and the fatigue that comes with excessive blood loss.

Here are some other physical signs of a heavy period:

  • Your period consistently lasts more than 7 days.
  • You’re changing tampons or pads more than every 2 hours each day
  • You need a pad and tampon to control your menstrual flow.
  • You have to change your pads or tampons during the night.
  • You have a menstrual flow with blood clots the size of a quarter or larger.
  • You experience tiredness, you lack energy, or you are short of breath, or you’ve been diagnosed with anemia.

 

From a medical standpoint, what makes a woman have a heavier flow than average?

Heavy bleeding can occur at any age, but it is most common on either end of the reproductive age spectrum, during the teenage years and then again during perimenopause, when estrogen levels tend to be higher in relation to progesterone.

Progesterone is made in the ovaries after ovulation occurs. These two time periods are characterized by irregular ovulation:

  • Adolescents experience heavier periods likely because of the immature endocrine system, in particular, the immature hypothalamus function. (The hypothalamus talks to the ovaries and tells them when to ovulate, so if it’s still developing, there are likely to be hiccups in the system). In addition, estrogen receptors a very sensitive to estrogen (because they are still figuring things out) and will become less sensitive over time.
  • Perimenopausal women experience heavier periods because of waning ovarian function – as the ovary ages, it is less likely to complete the ovulation process.

Why do I have heavier than average flow? The causes of heavy periods and the related conditions to heavy periods fall into three categories:

  1. Hormonal imbalances –
    1. A period that is heavy, dark, clotted, clumpy, or looks like frozen crushed up blueberries, is indicative of higher estrogen levels. Estrogen is a proliferative hormone, responsible for stimulating the growth of the uterine lining and breast tissue. Breast tenderness, stubborn weight, acne, PMS, headaches or migraines can result from too much estrogen in relation to progesterone, which is known as estrogen dominance.
    2. Another imbalance that may contribute to heavier flow is low thyroid function, or hypothyroid. Thyroid hormone and progesterone are intricately connected – if your body is not producing adequate thyroid hormone, your progesterone levels may drop as well, causing estrogen to become dominant over progesterone. And, hypothyroid also causes poor estrogen detoxification.
  2. Uterine problems or conditions –
    1. Endometriosis and Adenomyosis
    2. Uterine fibroids – interestingly fibroids don’t actually cause heavier bleeding, but they are related to heavy bleeding because high estrogen/low progesterone causes both fibroids and heavy bleeding. Fortunately, the type of fibroids that cause heavy bleeding (submucus fibroids) only account for 5-10% of all fibroids.
    3. Polyps – these can cause abnormal bleeding, but it is not usually heavy.
    4. Miscarriage, ectopic pregnancy or postpartum.
  3. Other illnesses diseases or medications
    1. Medications like the depo provera shot, as well as the Paragard (copper) IUD.
    2. A bleeding disorder known as von Willebrand disease – known as a coagulopathy, this condition is associated with problems in how the blood clots. Twenty percent of adolescent girls with severe menorrhagia have a blood coagulation problem.
    3. Liver, kidney and pelvic inflammatory disease.

Note: Endometrial cancer may cause irregular bleeding in the form of spotting, but it is not a cause of heavy bleeding.

How does your flow change over the course of your life?

Your menstrual cycle and flow definitely change throughout the course of your life. There are four distinct stages of the menstrual cycle throughout a woman’s lifetime.

  • Puberty that brings on a girl’s first period, and includes the teenage years
  • Adult menstruation stage
  • Perimenopause
  • Menopause.

Each of these stages brings about varying hormonal fluctuations and accompanying symptoms. Most teenagers have a heavy flow when they first get their periods because of higher estrogen, but that usually regulates as a girl gets older.

Diet (including caloric intake), exercise, hormonal contraceptives, pregnancy, miscarriage and birth can change a woman’s hormones and flow significantly throughout her life.

Women in perimenopause tend to have heavier flow because this is when ovulation starts to sputter, which lowers progesterone. This leads to estrogen becoming dominant again and increasing flow. Some women even experience flooding during perimenopause.

Read about five surprising things that can disrupt ovulation other than perimenopause.

Is having a heavier flow a sign of being less fertile?

Not necessarily, but it can indicate an underlying hormonal imbalance that could negatively impact a woman’s fertility. The two hormonal imbalances linked to heavier flow are high estrogen/low progesterone and low thyroid function, as I mentioned before.

Healthy, regular ovulation is crucial for having optimal fertility, but it can’t happen if your sex hormones and your thyroid are out of whack. The right amount of progesterone is critical for implantation of a fertilized egg because it keeps the uterine lining intact. If there isn’t enough progesterone, it can lead to a shortened luteal phase (the second half of the cycle after ovulation occurs), which can prevent implantation from happening. A luteal phase should be a minimum of 10 days, and ideally should be 12-16 days long.

Low thyroid function can mean lower body temperatures, which can affect a growing embryo because it needs to be at a certain temperature in order to grow and develop.

Does a heavier flow mean worse PMS symptoms?

The two are often linked because of the estrogen dominance/low progesterone imbalance. Too much estrogen and too little progesterone can lead to increased emotional and physical PMS symptoms. Progesterone is the feel-good, keep calm and carry on hormone, and when it’s low during the second half of the cycle, you may suffer from anxiety, anger, low mood disorders like depression, mood swings and snappiness, bloating, breast tenderness, and acne.

Is your flow heavier after you lose your virginity?

No, losing your virginity or having sexual intercourse for the first time does not have an impact on your period flow. However, regular sexual intercourse does have an impact on your sex hormones, and can actually make your period come more consistently!

Why is it recommended to use the lightest tampon you need for that day?

It is recommended to use the lightest absorbency tampon because conventionally-made tampons contain a whole host of chemicals like dioxin (which is a byproduct that comes from the chlorine bleaching process), and pesticides that have been sprayed on the cotton.

FYI – cotton is one of the most heavily sprayed crops. You do not want these ingredients in your vagina.

Additionally, most conventional tampons are made with a blend of cotton, rayon, and wood pulp. Yes, you read that right! Rayon tends to absorb not only menstrual blood but your natural vaginal fluids as well, leaving your vagina dry and irritated in many cases. Finally, your vaginal tissue is the most permeable tissue in your body, which means it is especially vulnerable to chemicals and toxins.

Organic tampons are the way to go! There has not been one case of TSS with the use of 100% organic cotton tampons. I recommend Maxim Hygiene Organic Tampons, Cora Organic Tampons (with BPA free plastic applicators), and Lola Organic Tampons. Or try a menstrual cup, pads, or period underwear instead.

Testing and recommendations for heavy periods

Please see your doctor if you are experiencing any of the symptoms I described.

  1. She will want to do a pelvic exam to determine if there are any physical issues. This should also include a pelvic ultrasound to check for fibroids and endometrial thickness.
  2. I would also recommend a full thyroid panel, a pap smear, a pregnancy test, STI testing, and a complete blood count to determine if you have anemia
  3. There may be a need for other procedures like an endometrial biopsy, to determine the presence of endometrial hyperplasia, uterine cancer or infection. Or a SIS (saline infusion sonohystogram) to get a 3D view of the uterine cavity

The conventional treatments for heavy periods include the birth control pill (I don’t recommend that!), Mirena IUD (progesterone-releasing), D&C (Dilation & Curettage) to remove the uterine lining temporarily, endometrial ablation and hysterectomy (these last two are permanent so if you want kids, they are not for you).

The ABC’s of natural treatments for heavy periods

  • Vitamin A – from liver or cod liver oil preferably. I like Rosita Real Food Cod Liver Oil or Cod Liver Oil Capsules. Vitamin A deficiency has been found in women with menorrhagia and vitamin A supplementation has been shown to reduce heavy periods significantly.
  • B Complex – The liver does not inactivate estrogen effectively if a woman is deficiency in the B complex of vitamins. This leads to higher estrogen, and heavier periods. Supplementing with the B Complex will help restore the proper metabolism of estrogen. I like Thorne Research Basic B Complex and Seeking Health B Complex.
  • Vitamin C – One study found that vitamin C was able to reduce heavy bleeding in 87% of it’s participants. It’s also important in preventing and treating anemia because it helps improve the absorption of iron. I like Livon Labs Lipospheric Vitamin C or Rainbow Light Buffered Vitamin C Powder. 2000-4000mg a day.

Sources:

http://www.cemcor.ubc.ca/resources/very-heavy-menstrual-flow
http://www.cemcor.ubc.ca/resources/healthcare-providers-managing-menorrhagia-without-surgery

https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
https://www.ncbi.nlm.nih.gov/pubmed/27884916 – conventional treatments for menorraghia
https://www.ncbi.nlm.nih.gov/pubmed/27841443 – additional conventional treatments
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077876/ – natural treatments

 

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