Menorrhagia is an abnormally heavy and/or prolonged menstrual flow. There are essentially four types of menorrhagia:
- Menorrhagia due to anovulation (no ovulation): this form of menorrhagia accounts for up to 70% of dysfunctional uterine bleeding. It is the result of unopposed oestrogen due to progesterone deficiency. Bleeding is prolonged and/or profuse, with pain and clotting. It may occur every 2-3 weeks for 7+ days, resulting in anaemia.
- Menorrhagia due to luteal phase defects: this form of menorrhagia results from increased oestrogen to progesterone ratios. There is often a shorter cycle of 23-26 days, spotting for 3-6 days before the menses proper and heavy periods for the first 2-3 days.
- Menorrhagia due to prolonged luteal phase: this form of menorrhagia may result from perimenopausal failure of feedback mechanisms, leading to relatively high progesterone to oestrogen ratio, with the possibility of raised androgen levels. Bleeding is usually scanty and prolonged.
- Menorrhagia due to ovarian atrophy: this form of menorrhagia results from low levels of both progesterone and oestrogen. Bleeding is irregular, with the cycle so variable as to be non-existent.
Major risk factors that can contribute to menorrhagia include:
- Perimenopause, due to annovulatory cycles (no ovulation) causing high levels of unopposed oestrogen
- Hormonal medications: HRT, Oestrogen administration (without progestogens)
- Anaemia; a cause and a consequence of heavy bleeding
- Increased prostaglandin production
- Environmental toxicity (xeno-oestrogen exposure) contributing to oestrogen load
- Overweight or obesity, increased fat mass leads to oestrogen excess via aromatisation
- Hormonal disorders involving the ovaries-pituitary-hypothalamus
- Blood disorders of platelets (e.g., ITP) or coagulation (e.g., von Willebrand’s disease)
- Use of anticoagulant medication (such as warfarin)
- Irritation of the endometrium may result in increased blood flow (e.g., from infection)
- Contraceptive intrauterine devices (IUD’s)
- Uterine fibroids
- Endometrial carcinoma
- Polycystic Ovarian Syndrome
- Abnormal pregnancy and/or miscarriage
- Recent genitourinary surgery
Common signs and symptoms associated with menorrhagia include:
- Menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours
- The need to use double sanitary protection to control menstrual flow
- The need to change sanitary protection during the night
- Menstrual period that lasts longer than seven days
- Menstrual flow that includes large blood clots
- Heavy menstrual flow that interferes with regular lifestyle
- Dysmenorrhoea (painful periods)
- Tiredness, fatigue or shortness of breath (symptoms of anaemia)
Hormone imbalance is present in most cases of menorrhagia. However, the possible cause of imbalance is manyfold (see risk factors above). Steps in treatment include identifying the cause. If medical conditions have been ruled out, peri-menopause or overweight may still contribute to extremely heavy periods. Jodie creates the treament plan based on the individuals symptoms and medical history. Herbal Medicine, diet, nutrition and lifestyle factors (such as reducing stress) are all potential strategies to support the female body to restore hormone balance and relieve symptoms.
Herbal Medicines, Diet, Specific Nutrients and LIfestyle factors play an important role:
- Herbal Medicines: Ladies Mantle, Paeonia, Chaste Tree, False Unicorn, Golden Seal, Kava, St John's Wort and others
- Nutrients: Iron, Zinc, Selenium, Iodine, Activated B Vitamins, Vitamin C, Magnesium, and others
- Lifestyle: Activities that help relieve stress e.g. bush walking, yoga, tai chi, meditation, relaxing baths. Regular exercise is also important
- Probiotics (if dysbiosis present): Lactobacillus rhamnosus GG (LGG), L. plantarum (299v) and others
- Diet: Anti-inflammatory diet, Identify food intolerances, Weight reduction if needed, low alcohol and caffeine, minimise processed foods