- Normal period
- Heavy periods
- What are the treatment options for heavy periods?
- What is the aim of treating heavy periods?
- How to stop heavy periods naturally?
- Medical measures
- Surgical options
- Things to remember
Heavy periods (e.g. heavy menstrual bleeding or menorrhagia) is a very common condition among females. In this post you will learn about the difference between normal and heavy periods and how to stop and cure this disorder both naturally as well as by taking medicine.
During normal menstrual bleeding, there is a blood loss between 30-40ml. An average duration of periods in a typical female is five days. There is a slight variation in the menstrual cycle in many women. In some women, it can last up to 7 days normally.
Heavy periods or menorrhagia is a condition in which a woman loses an excessive amount of blood during her periods. It can also be a bleeding that lasts more than 7 days. Usually, most of the blood loss occurs in the first 3 days of this duration. The average blood loss in it is 60-80 ml but can even go beyond this level in some cases.
Well, it is difficult to estimate your blood loss quantitatively, right?
So, an easy way to estimate heavy periods is by estimating your need to change a pad or tampon.
During heavy bleeding, there is a need to change the tampons or pads every hour or after less than two hours.
The requirement of sanitary protection may become twice than normal. You may pass large blood clots in these days, which is again a symptom indicating this condition.
Another important symptom is heavy night bleeding, normally when you sleep your bleeding decreases but this does not occur in this condition.
Other symptoms include flooding through to your clothes or bedding. It may interfere with your daily routine life activities like shopping, going out and working.
Periods become very annoying when they are on the heavier side. As it disturbs your lifestyle so it is normal to become very irritated in these days. There is good news for every victim of heavy menstrual bleeding that it is a manageable condition. It can easily be managed with dietary and lifestyle changes. Medical and surgical options are also there. You should see the doctor if your symptoms are severe and not resolved by ordinary treatments, as doctor can provide you the best guidelines. First he will take your detailed history, personal as well as family, then after ultrasound and pelvic examination he will make an appropriate diagnosis.
Appropriate diagnosis is very important because you can only cure an illness when you know its cause. For example, if iron deficiency is a cause you need iron supplementation above all treatment options.
Your doctor can better guide you in this regard; he will tell you the best treatment option, its effectiveness as well as its effect on your fertility. Especially young women should be very careful regarding management sometimes wrong medications can affect your life badly.
Whenever you go for treatment of any disease your purpose of starting it should be very clear. The aim of treatment of this condition is to:
Heavy bleeding is the most disturbing symptom so it should be managed first. There are a number of ways to achieve this target that will be discussed later in this article. It is often a cause-related treatment, when your cause will be corrected obviously your symptoms will disappear. The average adult body contains 5 liters of blood; constant heavy loss of blood can decrease this level.
As blood provides nourishment to all cells in the body, a decrease in it will result in less availability of nutrients leading to retarded growth. Anemia is the most common complication. Excessive bleeding if continued for months without treatment or blood transfusion can even lead to shock.
No person can afford the disturbance of lifestyle. Periods, when extremely heavy, can disturb life miserably so it should be managed as soon as possible to improve the quality of life of women and to help them go to their previous normal routines.
One of the most popular natural treatment options for heavy menstrual bleeding are dietary modifications. You may try the following (1):
Adopt a Mediterranean-style diet: Diet rich in fruits, vegetables, fish, meat and whole grains fall in the Mediterranean style of diet. According to latest research, this diet has a large influence on period in females. It affects the flow of the menstrual blood in them. The reason why Mediterranean diet is recommended lies in the fact that it is low in sodium, processed carbohydrates and saturated fats. Eat eggs, dairy products, legumes, bean are the major constituents of this diet.
Take iron: Iron is a mineral that plays a critical role in the red blood cells formation. Iron is a main component of hemoglobin (blood carrying protein). Hemoglobin combines with the inhaled oxygen in the lungs to form a compound called as oxyhaemoglobin. This oxygen containing compound is carried by the blood cells to the whole body. All cells in the body need oxygen for energy formation. Blood flow is the source of fulfillment of this need. When blood reaches cells, they pick up oxygen from it. So a deficiency of iron can lead to tiredness and lack of energy. Iron also plays a role in the production of blood cells. When iron deficiency is high, there will be decreased formation of hemoglobin leading to “iron deficiency anaemia”. Decreased levels of iron can significantly raise the menstrual blood loss, resulting in heavy periods. To prevent this excessive loss iron supplementation as well as a diet rich in iron is recommended. Adult daily requirement of iron is 1.8mg. During periods in female iron higher than this level is required to compensate blood loss. Diets rich in iron include chicken, beef, fish, all green vegetables, sweet peas, tomatoes, potatoes, cabbage, corn and beats.
Try Vitamin C: Vitamin C is an essential water soluble vitamin that helps in the absorption of iron from the gut. It increases iron absorption by two ways. Iron is present in the diet in ferric form and human body is unable to absorb this form. Vitamin C converts ferric ion to ferrous form that can be easily absorbed by the body. Second, vitamin C supplementation can prevent the formation of difficult to absorb iron complexes in the gut. It also provides strength to your blood vessels, especially arteries by producing collagen (a tough and fibrous protein) and makes them resistant to damage. These resistant arteries are less liable to rupture and bleeding. One study showed that intake of 200mg of vitamin C thrice a day lessened bleeding in 87 percent of the women tested.
You may need Vitamin K: Vitamin K is a group of compounds that help in the formation of clot and prevention of excessive bleeding. Its low levels can increase the risk of bleeding. In females heavy and prolonged periods can occur as the result of vitamin K deficiency. Deficiency can either be dietary (prolonged intake of foods poor in vitamin K) or infectious (due to gastrointestinal infections which impair its absorption) in origin. So there is a need to improve the intake of vitamin K in your diet since it puts a stop to abnormal bleeding. Food sources of vitamin K include leafy green lettuces, cruciferous vegetables like cabbage, broccoli and kale, yogurt, kefir, egg yolks, fermented soy products and fruits i.e. pears, strawberries and papaya.
Try Vitamin A: Vitamin A acts as an antioxidant that helps to protect your cells against damage. This vitamin uplifts the healthy cells proliferation, such as red blood cell proliferation. Its deficiency can cause heavy periods. A study revealed that prescription of vitamin A to those females with heavy periods resulted in either cured or alleviated heavy bleeding in 92 percent of women. Good sources of vitamin A include green leafy vegetables and carrots.
Use Vitamin B supplements: Vitamin B complex contains 8 groups of vitamins. They serve several functions such as production of red blood cells and energy metabolism. Even though they are needed in small amounts and are found in a number of foods, they are delicate, water soluble and are easily destroyed during cooking. These vitamins are particularly important for women suffering from heavy periods. Stress disturbs the hormonal system badly and increases the production of estrogen. In the liver excessive estrogen is broken down to less dangerous and weaker forms. B-complex regulates estrogen levels and reduces painful muscle cramps. Through multiple researches it is proved that it is beneficial in managing post menopausal symptoms, endometriosis, heavy periods and fibroids. Of all B vitamins, B-6 is especially helpful in relieving abdominal cramping and fatigue. It is also needed for the synthesis of beneficial prostaglandins which reduce inflammation, relax uterine wall and lessen unnecessary blood flow. Beneficial prostaglandins are produced by the conversion of essential fatty acids (EFAs). Vitamin B complex plays a key role in this conversion. On the other hand, bad prostaglandins are produced in the absence of vitamin B complex. Bad prostaglandins particularly increase the amount of bleeding leading to heavy period. B-complex supplements with extra quantities of vitamin B-6 should be taken for treatment. B6 should never be taken alone. Foods such as whole grains, beans, peas, and liver are also good sources.
Zinc supplementation: This mineral is necessary for the proper working of the reproductive system and normal hormonal balance. It greatly prevents dysmenorrhea in females. Zinc affects a hormone called insulin-like growth factor-I (IGF-I), which plays a role in the regulation of red blood cell production. The latest studies have shown that zinc when combined with iron increases hemoglobin levels more than iron alone. To put in simple words, zinc not only puts a stop to bleeding but also helps in making up for the lost hemoglobin.
Eat food rich in potassium: Potassium is an important mineral. It is required for proper functioning of heart and digestion. It plays a leading role in the contraction of smooth and skeletal muscles in the body. The human body needs 4700 mg of the mineral per day. Poor dietary intake leading to low levels of potassium in your body can cause irregular, heavy periods, painful cramping and many other symptoms. You body demands potassium during the entire menstrual cycle, but it is markedly increased in days of the period. So, try to consume foods high in potassium to regulate your flow of periods. Bananas, sweet potatoes, chicken, lentils, citrus fruits, yogurt, salmon, tomatoes, and raisins are all potassium rich foods. Be careful that boiling can deplete potassium in the food so just steam or bake foods to enjoy the full benefits.
Heavy menstrual bleeding often is accompanied by painful contraction of abdominal muscles known as cramps. Painful periods is a condition known as dysmenorrhea. From the ancient time hot packs are in use for pain relief. Nowadays, hot water bottles are used for this purpose. These bottles can be filled with hot water when needed. Place these bottles at the site of pain and enjoy temporary pain relief (2).
An ice pack is a plastic sack of ice, or of refrigerant gel. Ice packs are effective at numbing and reducing pain. Cold packs reduce bleeding as they cause blood vessel constriction and subsequent reduction in the loss of blood. These packs ease inflammation and swelling too. Painful cramps can also be managed with ice packs. Effectiveness of ice packs lies in the time gap in its application. The sooner you place a cold pack, the sooner it can relieve pain and swelling (3).
Place an ice pack on your abdomen for 20 minutes. When you start to feel numb, it is a time to give a break for two or four hours to your body. Repeat the process after that break. Keep repeating this procedure for two days or for as long as the symptoms persist.
Regular moderate exercise plays a vital role in the regulation of normal periods and can even lighten heavy periods (4). Exercise maintains your body weight and health. Fat fluctuations in the body can cause irregular, heavy periods; but if you are exercising properly, you are less likely to experience this. Moderate exercise of 30 minutes 3-5 times per week is recommended. Light exercises like swimming, walking or jogging can make your periods shorter and lighter.
If natural remedies are not working, you can go for medical treatment. Possible medical options are:
Non-hormonal agents used for treatment of heavy and painful menstrual periods are NSAIDs and Tranexamic acid (5):
Nonsteroidal anti-inflammatory drugs: These drugs include ibuprofen (Motrin), naproxen (Aleve), mefenamic acid (Ponstel) and diclofenac. They reduce period pain. These medications decrease prostaglandin levels in the uterus, which is the cause of your heavy period and dysmenorrhea. NSAIDs can lower blood loss up to 25%. Menstrual cramps can also be relieved. However, the number of days the period lasts will remain the same. In some people side effects can occur. The most common side effect is stomach upset. In some women, they can increase the risk of bleeding. NSAIDs are not recommended if you have stomach or duodenal ulcer.
Tranexamic acid: Tranexamic acid enhances blood clotting and is a synthetic form of lysine (an amino acid). It can reduce blood loss by 29-58%. It is advised to take tranexamic acid thrice a day for 3-4 days to lower heavy bleeding. It can lead to some side effects like headache, nausea, diarrhea and indigestion. There is a concern regarding use of tranexamic acid that it may increase the risk of blood clots. If there is no improvement seen in the last three months it should be stopped.
Hormonal therapies for heavy menstrual bleeding include:
Combined oral contraceptive pill: They are commonly known as the “pill” and contain estrogen and progesterone. It is preferred by those women who also want contraception. These medicines regulate normal menstrual cycle and help reduce heavy period pain. They also prevent ovulation and pregnancy. These drugs can cause a fall in the bleeding up to 60%. Natazia (combined estrogen-progesterone pill) is the first FDA-approved drug for the treatment of heavy bleeding. Common side effects of the combined oral contraceptive pill include nausea, mood changes, malaise, fluid retention, headache, dizziness, fatigue, decreased sex drive, acne and breast tenderness. Directions: Take one pill daily for 21 days. Give a seven-day break during which you will get your periods. After the end of periods restart the pills.
Progestin: Progestins can reduce bleeding up to 15 percent. These drugs work by minimizing the effects of estrogen in the body. They slow down or prevent the growth of the lining of the uterus. Medroxyprogestrone, a type of progesterone can be used in injectable form for the treatment of heavy periods. A number of side effects can occur with them. These include headache, weight gain, bloating, depression, fluid retention, swelling, acne, irregular bleeding, cessations of periods (amenorrhoea) and a delay in pregnancy for 6-12 months after stoppage of treatment. Norethisterone is a kind of man-made progestogen (a female sex hormone). It can be used to treat heavy periods. It is taken in the form of tablet on days 5-26 twice or thrice a day taking the first day of your period as day one. Norethisterone does not work as a contraceptive and is not very effective. Its action and side effects are same as mentioned above.
Gonadotropin-releasing hormone agonists (GnRH agonists): They can reduce menstrual blood loss in women with a heavy period. They work by interfering with estrogen in the body. This treatment can be used only for short term because of severe side effects and high cost. They may send a woman into menopause temporarily with effects like hot flushes, vaginal dryness or increased sweating. They may lead to osteoporosis.
Danazol: Danazol is a substance that resembles male hormone testosterone. It blocks the action of estrogen in your body. It can stop periods in four to six weeks. It can be used to reduce dysmenorrhea, heavy periods, symptoms of endometriosis and fibroid size. Facial hair, acne, deepening of the voice, reduced breast size, weight gain or dandruff are the possible side effects. It may cause birth defects and can increase the levels of unhealthy cholesterols.
The LNG-IUS (such as Mirena) is similar to an intrauterine contraceptive device. It is a small plastic device which is directly inserted into your womb (uterus). It slowly releases tiny amounts of levonorgestrel, a progesterone hormone. This small amount of hormone is sufficient to prevent the growth of the lining of the womb. It can lessen bleeding and is also a form of contraception (6).
It is preferred as a first-line treatment and has shown control of heavy bleeding by 71-96%. Within 3-6 months of this treatment periods either become very light or stop completely. Period pain can also be reduced. The LNG-IUS is a long-term treatment. Each device can last for five years, but can be taken out at any time when desired. It is a reliable form of contraception as well. Possible side effects of using this device are acne, breast tenderness, amenorrhoea (no periods) and irregular bleeding that may last more than six months (here is a detailed article on LNG-IUS risks).
Hysterectomy is a surgical procedure in which uterus and cervix are removed. Vaginal hysterectomy is usually done, however abdominal can also be performed if appropriate. Healthy ovaries are conserved during hysterectomy. It is not considered as a first-line procedure as you will not be able to become pregnant after this. It is very effective in treating uterine bleeding as there will be no uterus and ultimate cessation of periods. Hospitalization is necessary for this treatment and recovery time is several weeks.
Hysterectomy is considered as first line treatment when (7):
All other treatments have failed or are contraindicated
Amenorrhoea is desired
The woman is fully informed and she does not want to retain her fertility and uterus.
Complications of hysterectomy can occur in some women
These include infections, urinary dysfunction, hemorrhage, thrombosis, gastrointestinal disturbances and menopause-like symptoms.
These are the surgical procedures in which all or some part of the lining of the uterus is destroyed or removed to control heavy periods (8). The uterus lining is destroyed via electricity, freezing, microwaves, hot water or radio waves. Endometrial ablation is carried out under mild local or general anesthetic. Recovery is very quick in this procedure. Some patients may stop having periods altogether while others may continue, but blood loss will be reduced. It can prevent women from pregnancy in the future. Pregnancy is not recommended due to high risk of miscarriages. Vaginal bleeding and abdominal cramps are the problems that can occur in some women.
Endometrial ablation is of two types
Microwave endometrial ablation: In this technique a probe, which uses microwaves, is inserted into the uterus to heat up and destroy its lining.
Thermal balloon ablation: In this process a balloon is implanted into your womb, which is then inflated and heated to destroy the lining of the womb.
Dilation and curettage are procedures in which the outer layer of the uterine lining is removed. It involves dilation of the cervix by the use of an instrument known as a dilator. Then, the uterus lining is lightly scraped off with the help of a spoon-shaped device known as a curette.
This procedure is useful in treating heavy periods as it reduces menstrual blood flow, but it might need to be repeated (9). D&C is generally not recommended in women younger than 35 unless there is no other option. Recovery time is about 1-2 days.
Slight vaginal bleeding and mild pelvic cramping can occur during this period. Use of tampons and intercourse should be avoided for 2 weeks following D&C. Complications of this procedure are perforation and infection of the uterine wall. Scarring of the wall of uterus and hemorrhage are the rare unwanted consequences. Scarring can hinder pregnancy and make it difficult for the placenta to adhere to the uterus.
If a woman with large size fibroids and heavy periods wants a cure while retaining her uterus, then the available treatment options is uterine artery embolisation (10). In this procedure a small tube known as catheter is inserted into your genital. Some chemicals are injected through this tube into the arteries carrying blood to the fibroid. This results in blockage of arteries and shrinkage of the fibroid over the next six months. The whole process is guided by X-ray and should only be performed by a trained doctor, expert in interpreting X-rays (radiologist). Pain is the most frequent complication and strong painkillers are needed to prevent pain. Fertility may also be adversely affected by this procedure.
If fibroids are the cause of your heavy menstrual bleeding, then a surgical procedure that can help you is myomectomy (11). Not every type of fibroid can be treated by this procedure; it is suitable for only some types. In myomectomy fibroids are removed through abdominal operation or laparoscopy. Usually fibroids are approached laparoscopically in which instruments are passed and a small camera attached to them provides images of the interior. Infections of the uterus, scarring, bladder or bowel injuries and rupture may follow this procedure.
Heavy menstrual bleeding affects lots of women worldwide. You should always see your physician (an obstetrician) for proper examination and treatment.
There are three possible treatment options, e.g. lifestyle (dietary) changes, pharmaceuticals (hormonal and non-hormonal agents or IUDs) and surgical methods (such as endometrial ablation).
Ask your doctor for help.
|Written by:||Michal Vilímovský (EN)|
|Education:||Medical student, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic|
See numbered references within the article body
|Published:||May 15, 2014 7:20 PM|
|Last updated:||February 26, 2017 11:50 AM|
|Next scheduled update:||February 26, 2019 11:50 AM|