Heavy Menstrual Bleeding (Menorrhagia)

by Christiane Northrup, M.D.

Pelvic Health

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.

Listen to Your Body

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.

What Causes This

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?

Healing Alternatives

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.

Spiritual and Holistic Options

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.

Learn More — Additional Resources

Last Updated: October 9, 2006

Christiane Northrup, M.D.

Christiane Northrup, M.D., is a visionary pioneer and a leading authority in the field of women’s health and wellness. Recognizing the unity of body, mind, and spirit, she empowers women to trust their inner wisdom, their connection with Source, and their ability to truly flourish.


Add comment
  1. Sandy
    3 months ago

    My Gyn said I have Adenomyosis after ordering a transvaginal ultrasound due to continued uterine bleeding after being on progesterone 100 mg twice daily days 15-28. I am also on estradiol .1 mg patch twice weekly and estradiol vag cream three times weekly .5. I am 60 years old. He said my uterus is large and boggy and has changed position slightly. He said I would most likely need a hysterectomy but said he could try a D&C first . I also have uterine polyps. He did do a endometrial biopsy recently and said it was okay. I really do not want a D&C or Hysterectomy unless it is absolutely necessary. I wanted to try to get my stress under control and diet and exercise, sleep improved to see if this would work, but I also don’t want to put things off and make the situation worse. My husband had Pancreatic Cancer and passed away this Jan after going thu surgery and treatments for past 2 years. I would really appreciate your opinion. I have been praying for guidance. Thank you.

  2. Warnez Patti
    8 months ago

    You are amazing! A true doctor for womens health. Your books have helped me in so many things going on with my body. I recommend your books to every woman i come across. Life saver.

  3. Arlene Valdes
    2 years ago

    Please help/advice. I 46 yrs old and I have regular periods that are heavy with blood clots, terrible PMS that subsides as soon as I start my period. I began using a bio identical progestogen cream on day 14 of my cycle and began bleeding five days later on the 19th of my cycle, this has never happened to me before. I am very confused on what to do now, do I use the cream every day or do I stop now and begin again when this period goes away?

  4. Latonya
    4 years ago

    I have fibroids and adynesmois and is 52 years old and still having a period. But want to have a baby with a 65 year old man. He is a diabetic could that could stop me from getting pregnant.

  5. LF
    5 years ago

    Try natural essential oil mixes such as Cyprus, rose and lavender mixed with organic coconut oil and rubbed on the lower abdomen twice a day a few days before period starts works great to reduce heavy flow.

  6. Priya
    6 years ago

    Dear Doctor, I am suffering from stage 4 endo with bowel, bladder and intestine symptoms, with 1 failed excision surgery to my credit. After trying to go natural with restricted diet, homeopathy, TCM and naturopathy, I am starting hormonal therapy. I am trying Crinone 8%, I started it on day 8 of my cycle, it didn’t help much. I ovulated very painfully, had a really painful luteal phase, and now I got my period too. Should I try Prometrium vaginally or rectally at a higher dose? What do you think? I want to suppress my period and ovulation at least for 6 months without Lupron shot.

  7. Lisa
    6 years ago

    I have menorrhagia. Is there a cycle to this…???? After 2 years of heavy bleeding due to fibroids and age (54). It stopped for 3 months totally. It started up again this week.. 2 days of heavy bleeding and 2 days with none…2 days of heavy bleeding…. should it be near the end now… is this finally the last hurrah??? Just wondering if there are any indicators…..

  8. Amie
    7 years ago

    I hope you will look further into the option of Ablation. My sister had this done and for the first few years it was great. And then she began having horrible pain. Come to find out, it is a side effect of this procedure. She said the pain is worse than labor pains and she ends up in the hospital each month. It may be the only option to fix it is a hysterectomy. Please do not recommend this procedure. It is ruining women’s bodies.

  9. E.W
    7 years ago

    I had history of long heavy periods and bad cramps that last about 8 days with lots of thick blood clots and have to change the sanitary napkins once every hour.

    However about 2 years ago my period stopped completely and only recently in Feb after my marriage, it started regulate back again with heavy periods. The cramps are also that bad that my lower back also hurt.

    What can I do to relieve these and reduce the period and bleeding without contraception as I am also trying to conceive now?

    1. DIANA Pearce
      5 years ago

      Try black cohosh @ whole foods . I’m 50 and last year had heavy cycle like 45 days straight. The hospital wanted to do hysterectomy but thank God for my OBGYN she said no they the size of a pea! So I did take ibprophen 500mg but a close friend told me about black cohosh it’s a capsule I take one a day my Dr is okay with me on it and I haven’t had no more problems as of yet ..praying I can make it threw these next 5 years before I hit menopause.

      1. Jenny
        10 months ago

        Hi there! It’s been 5 years. How’s your journey going? I’m having a similar experience right now.

  10. Jayanthi Rangaraj
    7 years ago

    i have been bleeding for over 2 months… in between i get a break for few days .. 1st time after 19 days of bleeding my doctor prescribed progestrone for 10 days.. i took it for 4 days along with shepards purse. it stopped… it again started in few days… used shepards purse again with advil and apple cider vinegar.. reduced to spotting… picked up again within 5 days.. taking progestrone for past two days…

    what are my options if i don’t want to go for ablation? my dr herself told me hysterectomy is kinda extreme since i don’t have polyps, fibroids or anything abnormal. please help

    may i use 2% progestrone cream? if so how?

  11. kb
    8 years ago

    HI there I recently stopped natural progesterone as I was gaining weight but now I have started my cycle for the 2nd time this month. Should I have weaned off it? I stopped right when I started the first time per doctors orders

  12. Nicole
    8 years ago

    I have been put on Provera 10mg for ten days. I had been bleeding for the past 38 days. The Provera at first slowed the bleeding down drastically! I stopped after the 4th day of taking Provera. On the 9th day I started spotting and now I’m bleeding again. But no clots and now the cramps are really bad. Is this how it works? Will the bleeding stop? Just wanting to know. It will be three more weeks till my obgyn can see me.

  13. He is an on time God
    8 years ago

    I took organic unsulphured black strap molasses. Worked great for me.

    1. Bumzy
      7 years ago

      Did you take this to stop heavy bleeding, how did you use it?

    2. Susan
      7 years ago

      Thank you for this tip! It took about a week and a half, but I implemented this along with a tablespoon of apple cider vinegar (with “the mother”) every day; took them separately and my 3 1/2 week period stopped.

  14. Joy
    8 years ago

    Dr. Northrup,
    My 15 year old daughter has had heavy periods and non-stop (less heavy) bleeding in between periods. She has seen her doctor and GYN. They recently ordered an ultrasound in pelvic area and it shows normal. GYN prescribed 5m Provera for 7 days, 14 days after first period for 2-3 months/cycles until periods become more regular. Would you recommend we try the 2% natural progesterone cream for her first? and use the dose you recommend in article above?
    Thanks so much. I appreciate your feedback!

  15. anna
    9 years ago

    I have had extremely heavy but monthly periods until now. My periods just wont stop doctors are offering me norethesterone which makes migraines much worse I never am able to take it long enough and therefore not sure if it works for me, Been diagnosed with enarlged bulky uterus with two 4 cms fibroids. I have now been in twice for blood transfusion and really dont want the hysterectomy on offer as i am extremely scared of being operated on. I was wondering if you could give me some advise Please.

    1. Special k
      4 years ago

      Hi Anna. We share similar symptoms. What was your result ? Did you find a solution ?

  16. cindy
    9 years ago

    Hi i have been experiencing heavy periods the last 2 weeks. I have gone to the dr and emergency room and nothing been done. I literally change my pads every 15 mins and i wear double pads. I also have Lot of blood clots with increase of bleeding. I was wondering if b12 can be a cause of this. I was going to a clinic and getting B12 everyweek. I started taking this shots at the end of may after a regular period. When i started those shots i didnt have a period for the month of june or july and in this month i started discharging mucos with slightly blood. After it became heavy and heavier. I stopped taking those b12 shots at the end of july. Thats my only guess. Can you please help me.

  17. Andrea
    9 years ago

    I really need some questions answered and not having much luck with my doctors and the wait is making me anxious not to mention the medication side effects.
    My period came as normal on June 5th, stopped for two days and begun heavily again lasting 10 days with floods and gushes and clots. Used shepherds purse and eventually it stopped. Three days later it started again and hasn’t stopped no matter what I’ve been doing. I am on 100mg of synthetic progesterone per day and 2500mg of traxemix acid. It slowed but not much. An initial ultrasound showed a suspected polyp but nothing concrete. I had a sonohysterogram yesterday and now I have to wait for results. This is affecting my life in so many ways. I am 38, have a child and a career. At the very least I need to stop the bleeding as I am weak and tired despite taking supplements etc. My intuition is telling me the progesterone is not doing very much except making me feel awful. Any advice? Anything? Please, if you can help!

  18. cathy
    9 years ago

    I am working with a nurse practitioner who has prescribed 400 mg of Prometrium vaginally daily to stop my heavy periods due to fibroids and andeomyosis. Just wondering if you feel this dose is safe and if you have seen it stop bleeding. I would be taking it all at night due to how tired it makes me. I have had four blood transfusions and this is the first time I am trying hormones to stop the bleeding. I do not want suregery.

  19. Theoni
    9 years ago


    I am reading womens bodies womens wisdom, there is talk of castor oil packs. I am very interested in trying it out. PLEASE can you let me know how it is done, I am unable to find it anywhere in book or on website.

    Thank you in advance

    1. Chris
      6 years ago

      Put good quality castor oil on the lower belly, also on a clean, cotton rag, or clean cheesecloth. Put the cloth over your belly, and place a hot water bottle on top of that. Cover up with a blanket, and read or rest. Try to leave in place for at least an hour. *If nothing else, this really helps to calm everything down. Some say not to do this when menstruating – always calmed my cramps, but each to their own, I suppose. Good luck with it <3

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