Heavy bleeding (menorrhagia) is often a symptom of perimenopause, when estrogen dominance causes the lining of the uterus to overgrow and then break down in a disordered way resulting in spotting or irregular heavy bleeding. Emotional stress of all kinds can make this worse.

It’s normal to experience a heavier flow on the first or second day of your period, but if your bleeding prevents you from leaving the house or participating fully in your life for more than two days per month, if you routinely soak through a couple of tampons and a pad all in place at the same time and then through your clothes or your nightgown, or if you’ve been diagnosed with iron deficiency anemia, you need to take action.

In addition to hormonal imbalance, physical conditions may impede the normal uterine contractions that help stop menstrual blood flow each month. Fibroid tumors are the most common physical reason for excessive bleeding. Whether or not a fibroid causes bleeding depends upon its location in the uterine wall. Bleeding is most often caused by submucosal fibroids, which are located right under the endometrium, the mucous membrane that lines the uterus. Adenomyosis is another condition that can cause heavy bleeding. Adenomyosis results when the endometrial glands that line the uterus grow into the uterine muscle (the myometrium). When this happens, little lakes of blood form in the uterine wall that do not drain during menstruation. Over time, the uterus enlarges and becomes boggy, spongy, and engorged with blood, disrupting the normal uterine contraction patterns. Since both fibroids and adenomyosis are associated with excess estrogen, minimal progesterone, too much prostaglandin F2-alpha, and frequently too much insulin, hormonal and physical factors are often present at the same time. Rarely, heavy periods are associated with a thyroid problem. Some women bleed heavily for no obvious reason.

Chronically heavy periods can be related to chronic stress over second-chakra issues, including creativity, relationships, money, and control of others. Abnormal uterine bleeding is nearly always connected to family issues in some way. Such bleeding can also be a sign that you are leaking your life’s blood into a dead-end job or relationship that doesn’t fully meet your needs. Are you giving more than you are receiving in return? Is someone or something draining your energy by being a kind of energy vampire?

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), naproxen sodium (Anaprox, Aleve), or ketoprofen (Orudis), often help. Take NSAIDs daily starting one to two days before your period, and continue regularly through your heaviest days. Use the lowest dose that gives you results. The NSAIDs have definitely been shown to decrease menstrual blood loss because of their ability to interrupt excess prostaglandin F2-alpha.

Although I prefer to try natural progesterone first, if that doesn’t work, a strong synthetic progestin such as medroxyprogesterone acetate (Provera) can help. (This is the only circumstance in which I recommend the synthetic.) This is especially true if you have a fibroid that bleeds and you haven’t been able to stem your problem with gentler approaches. Provera for heavy periods is prescribed at a dose of 10 mg once or twice per day for the two weeks before your period is due. Then you give your body a rest for two weeks and start over. Usually a three-month cycle of two weeks on and two weeks off will result in a significant decrease in excessive bleeding. Though Provera can have side effects, these are usually acceptable compared to losing your uterus.

Birth control pills work for many women who are having heavy, irregular periods due to fibroids, lack of ovulation, excess estrogen relative to progesterone, or a combination of these conditions. Although birth control pills do not result in a true cure, they are a good option when the alternative is surgery.

Dilatation and curettage (D&C) is a standard surgical treatment for heavy bleeding that involves scraping the uterine lining and removing excess tissue. It frequently decreases the problem, for reasons that aren’t entirely clear. It is often used also to diagnose the specific condition causing the bleeding.

Endometrial ablation is another surgical procedure that can help. With this, the lining of the uterus is obliterated with a laser or with cautery. Because the procedure destroys the endometrial lining, it often results in complete cessation of periods or very light periods. It should never be used by anyone who wants to maintain her ability to have children. Endometrial ablation works very well for many types of intractable bleeding and is usually done as an outpatient surgery. The procedure should be done by someone highly skilled, with extensive previous experience. For a referral, consult a university medical center or teaching hospital. You can also call your local hospital and ask who does the surgery. Make sure the surgeon you choose is a board-certified OB/GYN.

Before you start any treatment program for heavy bleeding, I recommend getting a physical exam and a Pap smear if you haven’t already had one within the year to make sure that no other condition is contributing to your problem. Then, try these suggestions:

• Follow a hormone-balancing diet that’s low in high-glycemic carbohydrates and high in protein and healthy fats. Eliminating all conventionally produced dairy foods (even low-fat ones) for at least three months often helps as well.
• Take the following supplements:
  
  - B vitamins: 60–80 mg per day of vitamin B6; 20 mcg per day of vitamin B12, and 700–1,000 mcg per day of folic acid, taken together with the other B vitamins.
  - Vitamin E (mixed tocopherols): 400 IU, twice per day.
  - Vitamin C complex with bioflavonoids: 1,000–5,000 mg per day.
  - Vitamin A (as beta-carotene): 25,000 IU per day.
  - Supplemental iron: In many women with heavy bleeding, the primary symptom is fatigue from iron deficiency anemia. Get your blood count checked, and if it’s low take 15 mg of iron per day. The best, most absorbable iron supplement I’ve found is ANR Iron 27+.
• A nonprescription 2 percent natural progesterone cream can be used to decrease heavy bleeding. Rub ¼ to ½ tsp into your palms or on the soft areas of your skin two times per day starting two to three weeks before your period is due. Stop when your period begins, then start again one to two weeks later. If this approach is going to work, you should see results after about three months. For some women, 2 percent natural progesterone isn’t strong enough to counteract their own estrogen. In this case, ask your doctor for a stronger prescription, such as Crinone gel, which comes in 4 percent and 8 percent strengths, or micronized oral progesterone tablets (brand name Prometrium). The usual dose of Prometrium is 100–200 mg once or twice per day for the two weeks before your period is due.
• Acupuncture and traditional Chinese medicine as well as castor oil packs can also help.