“My periods are so heavy I find myself wearing a tampon and pad, but that barely contains it. Using a menstrual cup was a complete failure. I feel hopeless. When I told my doctor I was having heavy bleeding with clots she said birth control was my only option to control the flow, but my husband has a vasectomy and I’m a freaking 43 year-old woman. I don’t think I need birth control just for when Aunt Flo arrives,” Tori shared. She was desperate to end her heavy periods and came to my naturopathic medical clinic seeking help to understand why her flow was increasing so dramatically.
“Heavy periods should never be considered normal and you’re right to feel concerned,” I explained.
Doubling up with a tampon and a pad is considered too heavy of a flow, after all. But most women don’t know what’s considered heavy bleeding by doctors. Here’s the rundown I gave to Tori on how doctors diagnose heavy periods (also known as menorrhagia) and what I look for in my medical practice.
How Heavy Is Too Heavy for a Period?
- Bleeding for more than 7 days
- Changing menstrual products less than every 2 hours
- Needing to double up on menstrual products
- Heavy bleeding with clots larger than a quarter
- Waking to change menstrual products at night
In this article I am going to share with you why your period may be heavy, what conditions your doctor should be investigating, and why the pill doesn't actually doesn’t fix periods.
What is Abnormal Uterine Bleeding?
Abnormal uterine bleeding (AUB) refers to periods that too long, too heavy, or bleeding outside of when you should be having your period. There are several terms that medicine uses to describe the different variations, but collectively, they are all known as AUB.
Abnormal Uterine Bleeding Includes:
- Heavy bleeding during your period
- A period that is longer than 7 days
- Bleeding or spotting after sex
- Bleeding or spotting after menopause
- Bleeding or spotting between periods
- Menstrual cycles greater than 38 days or less than 24 days
- Irregular periods (where your periods are sporadic or unpredictable)
Let's take a look at some of the medical terms physicians and other licensed medical providers use to describe AUB so you can understand what they mean.
Menorrhagia (Heavy or Long Periods)
Menorrhagia is a form of abnormal uterine bleeding. Simply put, menorrhagia is a medical term that means bleeding too much or for too long during your period. The term is also applied to women who experience clots larger than the size of a quarter during menses.
Metrorrhagia (Bleeding Between Periods)
Metrorrhagia is a term that is used to describe bleeding that occurs between periods or at irregular times.
Menometrorrhagia (Menorrhagia + Metrorrhagia = Miserable) 😖
Menometrorrhagia is a combination of menorrhagia and metrorrhagia, which means you bleed for too long or too heavy at unpredictable or irregular times in your cycle. This term also applies if you are getting heavy periods too frequently.
Oligomenorrhea (Infrequent Periods)
Oligomenorrhea is when your periods are infrequent, as we sometimes see with PCOS. If you’re period comes more than every 35 days then you may be diagnosed with this.
Polymenorrhea (Frequent Periods)
Polymenorrhea is when periods come too frequently. While less than 24 days can be a concern, this term generally applies to periods that come sooner than every 21 days.
Why Are My Periods So Heavy?
There are several conditions, including hormone imbalance, that can cause heavy periods, long periods, or too frequent of periods. Because of this, it is important to meet with your doctor to discuss your symptoms so that you can be sure to address the underlying issue. Only a licensed healthcare practitioner can help you navigate this and ensure there isn't anything scary going on in your uterus.
While your doctor may recommend hormonal birth control as a treatment, it is important to find out why you have these symptoms to begin with. Birth control can stop or slow the flow, as can over-the-counter progesterone creams, but in some conditions, masking symptoms can be dangerous.
Yes, natural treatments can mask symptoms just like a pharmaceutical and that is a game I am never willing to play with a patient.
Causes of Abnormal Uterine Bleeding
- Hormone imbalance, like estrogen dominance
- Bleeding disorders
- Fibroids (non-cancerous tumors or growth in the uterus)
- Ovulatory dysfunction
- Endometrial polyps
- Blood thinning medications, like aspirin
- Certain birth control
- Cancer (why you need a doctor for sure)
- Pelvic Inflammatory Disease (PID)
- Liver or kidney disease
- Iron deficiency
For Tori, she had a combination of hormone imbalance and iron deficiency anemia. I explain how iron deficiency can lead to heavy periods in this article. In Tori’s case, she had estrogen dominance driving her heavy periods, which eventually led to anemia. Then the anemia led to even heavier periods and she was caught in a vicious cycle.
Heavy Periods and Estrogen Dominance
Tori’s periods were heavy, but why they were heavy is what we needed to know so we could slow the flow and get her some relief. On top of heavy periods she was also having more cramping, PMS symptoms, and was experiencing night sweats the days leading up to her period.
We did lab testing, which revealed elevated estrogen relative to her progesterone during the luteal phase of her cycle (the phase after ovulation). She was ovulating when we tested, but her estrogen was just too high.
Had Tori experienced heavy periods that seemed to come out of nowhere, been postmenopausal, had signs of lack of ovulation, or bleeding that happened with sex or between periods I would have sent her to her gynecologist for an endometrial biopsy. But Tori had just been to her gynecologist for a pap and had a trans vaginal ultrasound. Everything was found to be normal at that visit and her doctor did not recommend a biopsy at that time.
To be clear, women over 35 who have abnormal uterine bleeding needs a doctor’s visit. It’s never ok to just guess at what is going on.
For Tori, her labs and symptoms were clear—estrogen dominance was at play.
This is common, In fact, many women experience heavy bleeding, severe cramping, and PMS symptoms because of imbalances in their estrogen.
What is estrogen dominance?
Estrogen dominance refers to having too much estrogen, which can be due to poor clearance (detox), environmental toxins, overproduction, lack of ovulation, and increased adiposity (fat cells), as a few examples.
There are two kinds of estrogen dominance (frank and relative), and both have to do with having too much estrogen.
Frank estrogen dominance refers to a situation where you have too much estrogen in general in your body. Relative estrogen dominance means you have too much estrogen relative to progesterone.
It’s important to point out that estrogen is not bad. Estrogen is an important hormone, and an important part of our health. However, when estrogen (or any hormone) is out of balance, that results in symptoms that can leave you feeling pretty bad.
Symptoms of Estrogen Dominance
Estrogen dominance can manifest in many ways:
- Heavy periods
- Painful periods
- Ovarian cysts
- Tender breasts
- Fibrocystic breasts
- Weight gain
- Mood swings
How does estrogen dominance cause heavy periods with clots?
When estrogen is in excess, it stimulates your uterus (the endometrium specifically) to grow thicker, which can result in heavier periods. And because that lining is thicker, we often also see clots. But it is possible to have heavy periods without clots due to estrogen dominance.
Causes of estrogen dominance
There are a few things that can result in and exacerbate estrogen dominance. The question is, what is true for you and your body?
Factors that contribute to estrogen dominance:
- Increased adiposity (Fat cells can produce estrogen)
- Gut dysbiosis
- Sugar (e.g. candy, soda)
- Refined carbohydrates (e.g. white bread, white rice)
- Non-organic meat (i.e. conventionally raised meat)
- Conventional dairy products (e.g. milk, cheese)
- Caffeine (found in coffee, some teas, energy drinks)
- Environmental toxins
- *Endocrine disrupting chemicals (EDCs, also called xenoestrogens, e.g. phthalates, BPA; found in plastic containers, skincare products, body care products, and more)
*For more information about EDCs—types, where they are found, and what they do—check out my article, “How Endocrine Disrupting Chemicals Cause Hormone Imbalance & What to Do About It”. Click here to check it out.
How to Balance Estrogen and Reduce Heavy Periods
Estrogen dominance sounds scary and intimidating with all those contributing causes and resulting symptoms. But it is reversible! In Beyond the Pill, I explain exactly how you can go about balancing your hormones and restoring estrogen harmony.
When we looked into Tori’s daily habits there were clues as to why her heavy periods were increasing. Firstly, heavy periods alone can lead to iron deficiency anemia, which in turn makes periods even heavier.
Tori was eating a vegetarian diet, low in iron rich foods and high in refined carbs. She wasn’t ready to go back to eating meat, so we made shifts that included eating iron rich vegetables coupled with sources of vitamin C to increase the bioavailability of the iron (or in other words, help her absorb it).
We also started her on a prenatal because her labs were showing she was in need of many nutrients, including iron.
No, Tori wasn't looking to get pregnant, but she was in need of extra iron. The nice thing about a prenatal is that it not only provides a higher dose of iron, but also other nutrients that help optimize hormones like B6, folate, magnesium, and Vitamin D.
The refined carbs that were loading her plate at every meal meant she wasn’t getting enough fiber and it explained why she only had a bowel movement about 4-5 times a week. We increased her vegetables to 5 servings daily and she found she was pooping daily, which helps with eliminating estrogen.
Supplements for Heavy Periods
We also got Tori supplementing with Balance Women’s Hormone Support at 2 caps twice daily. This provided her liver the nutrients it needs to process estrogen and calcium d-glucarate ensured her body could remove her estrogen with her daily bowel movements.
Here’s a few of the ways I encourage women to approach symptoms of estrogen dominance:
- Heal your gut
- Nourish your liver
- Get enough fiber
- Reduce stress
- Get enough sleep
- Take a supplement that supports estrogen. My supplement, Balance Women’s Hormone Support by Dr. Brighten, contains ingredients such as DIM and broccoli seed extract, which help move estrogen out of harmful pathways and onto helpful ones.
Click here to learn more about Balance by Dr. Brighten.
The Pill Won’t Fix Your Period
Sometimes the pill or other forms of hormonal birth control can be helpful to control heavy bleeding while we work on the root cause, but this should not be the only treatment women are provided.
In Tori’s case, giving the pill would only mask her underlying issues. Her iron was low. The pill can’t fix that, in fact, it depletes other blood building nutrients like B12 and folate. With the diet she had been eating before coming to see me she would have been at significant risk for nutrient deficiencies caused by the pill.
She had gut imbalances, which are often only made worse by birth control. And really, we had to work on getting her bowels moving, her gut bugs balanced, and boosting the nutrients her liver required to detoxify estrogen.
How to Fix Heavy Periods Without Birth Control
If your doctor wants to prescribe the birth control pill for your heavy periods, it is important to ask why they think you have a heavy period in the first place. Use the list above to reference for causes of heavy periods.
In my clinic, we take a full history—I want to know everything about your hormone history and current symptoms. It is from there I can determine the best testing to evaluate your health.
Lab Testing for Heavy Periods
As I talk about in Chapter 4 of Beyond the Pill, lab testing is important to understand what is driving your symptoms. In that chapter I give you labs to ask your doctor for and help you troubleshoot all kinds of period problems with tools to help them vanish!
The testing days I refer to below are based on a 28-day cycle. If your cycle is a bit longer or shorter than that or you ovulate on a different day, then the days you should get tested will be different. A hormone expert can help you pinpoint when would be the best time in your cycle to get some of these tests.
For someone on a 28-day menstrual cycle, here are the tests I recommend:
On day three of your period (day one is the first day you have your period), test follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (a type of estrogen). These tests will tell us what your brain is communicating to your ovaries, and how your ovaries are responding. In a menstruating female, 80 is a healthy level of estradiol on day three.
On days 19 through 22, we run a DUTCH panel at my clinic. Alternatively, we do a comprehensive test that includes estrogen and progesterone. This will indicate whether you have frank estrogen dominance (too much estrogen in the body), or relative estrogen dominance (high estrogen relative to progesterone). Frank and relative estrogen dominance are very different and therefore need to be addressed differently.
Lab Testing While On Birth Control
Once you start the pill, sex hormone testing becomes less helpful because the pill works by suppressing ovarian function and in turn, your hormone production. So your practitioner won’t be able to see what your body is doing naturally.
The pill also has other negative effects on the body, so it’s important that you monitor your symptoms, check in with your doc and make sure it is right for you.
Birth Control Side Effects to Monitor
- Mood swings
- Increased risk of suicide
- Antioxidant and nutrient depletion
- Nutrient malabsorption
- Weight gain
- Breast tenderness
- Leaky gut
- Thyroid problems
- Adrenal problems
Using birth control to treat symptoms isn't wrong and it doesn't make you a bad person. You just need to be in the know about both the pros and cons and always evaluating what is true for you.
It is important for you to meet with your doctor to discuss why you have heavy periods. In some cases, eating a hormone balancing diet, reducing stress, optimizing progesterone, and supporting estrogen elimination will be enough to eliminate heavy periods. If you're looking for more support on your journey, please check out my Period Problems Solution Course.
- Menorrhagia (Heavy Menstrual Bleeding): Diagnosis and Tests.
By, Cleveland Clinic
- Abnormal Uterine Bleeding
By, The American College of Obstetricians and Gynecologists