A Functional Medicine Approach to Menorrhagia

The number-one reason women seek the care of a gynecologist is for heavy menstrual bleeding, medically referred to as menorrhagia. Approximately 30% of women experience this issue, accounting for two-thirds of all hysterectomies. This health concern can significantly affect the quality of life and shouldn't be overlooked. While heavy menstrual bleeding may be a common issue, it isn't something that women have to accept without seeking help.

In this article, we'll explore what menorrhagia is, what the potential root causes are, what functional tests can help identify a root cause, and what conventional and integrative medicine approaches may include.

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What is Menorrhagia

Menorrhagia is defined as excessively heavy or prolonged menstrual periods and is otherwise referred to as heavy menstrual bleeding.

Heavy menstrual bleeding refers to periods that last longer than seven days or blood loss of over 80 mL during each period (double the normal amount of blood loss). Having to change your tampon or pad every hour for several hours in a row indicates heavy bleeding, as does passing blood clots that are the size of a quarter or larger.

This excessive bleeding can impact the quality of life. It's common for women with menorrhagia to alter their lifestyles during their periods and avoid doing what they usually do.

Severe heavy menstrual bleeding can lead to anemia. Anemia is a condition that results from low amounts of iron in the body and can cause symptoms such as fatigue and shortness of breath.

Menorrhagia Symptoms

Common symptoms associated with menorrhagia include:

• Menstrual periods lasting longer than seven days.
• Menstrual bleeding that soaks through one or more tampons or pads every hour for several hours in a row (losing over 80 mL of blood during your period)
• Menstrual flow with blood clots the size of a quarter or larger
• Constant lower abdominal pain during periods
• Fatigue or shortness of breath (symptoms of anemia)

What Causes Menorrhagia

Heavy menstrual bleeding can be caused by a multitude of conditions and imbalances in the body, as well as certain medications.

Uterine Dysfunction

Uterine causes of menorrhagia include:

• Fibroids
• Polyps
• Adenomyosis
• Endometrial hyperplasia
• Cancer (cervical or uterine)

Hormone Dysfunction

Hormone imbalances that can contribute to heavy menstrual bleeding include:

• An imbalance between estrogen and progesterone
• Anovulation
• Polycystic Ovarian Syndrome (PCOS)
• Thyroid disorders (hyperthyroid or hypothyroid)

Infection

Infections that can contribute to heavy menstrual bleeding include:

• Sexually Transmitted Infections (trichomoniasis, gonorrhea, chlamydia)
• Pelvic Inflammatory Disease (PID)
• Endometritis

Other Health Issues

Other health issues in the body that can contribute to heavy menstrual bleeding include:

• Liver disease
• Kidney disease
• Diabetes
• Leukemia
• Coagulation disorders (such as Von Willebrand disease)
• Pregnancy complications (miscarriage or ectopic pregnancy)
• Chronic iron deficiency

Medications

Several medications that can contribute to heavy menstrual bleeding include:

• Oral & injectable contraceptives (birth control)
• Intrauterine devices (IUDs)
• Hormone replacement therapy (HRT)
• Anticoagulant and antiplatelet drugs
• Steroid hormones

Differential Diagnosis for Menorrhagia

For Functional Medicine or Integrative Medicine practitioners evaluating a patient with menorrhagia, a differential diagnosis list should include the following:

• Fibroids
• Polyps
• Adenomyosis
• Endometrial hyperplasia
• Cancer (cervical or uterine)
• An imbalance between estrogen and progesterone
• Anovulation
• PCOS
• Thyroid disorders
• Sexually Transmitted Infections (trichomoniasis, gonorrhea, chlamydia)
• PID
• Endometritis
• Liver disease
• Kidney disease
• Diabetes
• Pituitary tumors
• Leukemia
• Coagulation disorders
• Pregnancy complications (miscarriage or ectopic pregnancy)
• Hormone medication use (oral & injectable contraceptives, IUD, HRT, or steroids)
• Anticoagulant or antiplatelet drug use
• Iron deficiency

Functional Medicine Labs to Test for Root Cause of Menorrhagia

When evaluating for root causes of menorrhagia, pregnancy testing should be done before imaging tests to rule out pregnancy-associated complications.

Your provider will perform a physical examination, including a pelvic exam, a pap smear to assess for cervical cancer or a cervical culture to rule out infection. An endometrial biopsy may be performed to rule out changes in the uterine tissue (such as cancer).

Your provider may order or perform various tests or procedures to view your reproductive organs and tissues to check for growths or abnormalities. These tests may include pelvic ultrasound, MRI, sonohysterogram, or hysteroscopy.

In addition to these physical evaluations, your Functional Medicine or Integrative Medicine practitioner may order various functional tests to uncover the root cause of your heavy menstrual bleeding.

Hormone Testing

The DUTCH Cycle Mapping™ PLUS test maps the patterns of progesterone and estrogen throughout the different phases of the menstrual cycle, offering valuable insight into the balance between these hormones and information about ovulation. This test also evaluates steroid hormones, which can help rule out PCOS as a root cause.

Sex hormones can also be evaluated in the blood, providing a helpful first look at whether there is dysfunction in these hormones, including whether ovulation is occurring.

Nutrient Testing

Nutritional testing is a helpful way to identify deficiencies of nutrients associated with sex hormone and thyroid hormone imbalances, such as magnesium, zinc, iodine, selenium, iron, Vitamin A, and Vitamin D.

Other Blood Tests

Comprehensive blood analysis can help evaluate conditions like liver disease, kidney disease, diabetes, PCOS, infection, leukemia, and pituitary tumors. Markers such as CBC with differential, Comprehensive Metabolic Panel, Insulin, hemoglobin A1c, and prolactin can provide insight into these potential causes for menorrhagia.

In addition to a CBC to look at platelet levels, tests such as prothrombin time, activated partial thromboplastin time (aPTT), and fibrinogen is initial tests to run if coagulation disorders are suspected.

An anemia panel will help determine whether menorrhagia is impacting your iron status.

A comprehensive thyroid panel will determine whether thyroid disorders are the root cause of your heavy menstrual bleeding.

Conventional Treatment for Menorrhagia

Conventional treatments for menorrhagia typically include medications or procedures.

Medications commonly used to help manage heavy menstrual bleeding include:

• Iron supplements if you are showing signs of anemia.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs) to help reduce pain, cramping, and bleeding.
• Birth control, such as oral or injectable contraceptives or IUDs, to help lighten flow.
• Hormone therapy (drugs containing estrogen and/or progesterone) to help reduce bleeding.
• Desmopressin Nasal Spray to help manage bleeding in those with bleeding disorders, such as von Willebrand disease.
• Antifibrinolytic medications help reduce bleeding by stopping a clot from breaking down, which helps prevent excessive bleeding.
• Thyroid hormones if thyroid dysfunction is found to be a contributing factor.

Procedures commonly used to help manage heavy menstrual bleeding include:

• Operative hysteroscopy. This procedure is used for diagnosis as it provides a view of the inside of the uterus. However, it can also be used for treatment to remove detected polyps, fibroids, the lining of the uterus, or other abnormalities.
• Endometrial ablation or resection removes all or part of the uterus lining to help control menstrual bleeding. Some patients stop having periods after this procedure, whereas others have periods with a light menstrual flow. Although this procedure does not remove the uterus, it prevents women from having children in the future. If you do become pregnant after this procedure, it can put the fetus at risk of severe complications.
• Hysterectomy. This is a major operation that involves surgical removal of your uterus. After this procedure, you will stop having periods and cannot get pregnant.

Integrative Medicine Treatment for Menorrhagia

Moderate-intensity exercise is excellent for overall health. It is also shown to support hormone regulation and improve the regularity and quality of menstrual cycles in those with PCOS.

Nutrition

An important nutritional approach for women experiencing menorrhagia includes an anti-inflammatory diet focusing on Omega-3 essential fatty acids and foods high in vitamins, minerals, and phytonutrients. This style of eating eliminates inflammatory foods like processed foods, trans fats, refined sugars, and carbohydrates, which are foods that are associated with conditions like PCOS and diabetes.

A nutritional approach should also include foods that balance nutrient imbalances identified with nutrient testing to optimize hormone health and support overall well-being.

Avoiding gluten-containing foods is an important consideration, especially if thyroid conditions are identified as a contributing factor to menorrhagia.

There should also be a focus on iron-rich foods since iron deficiency can be both a symptom and a contributing factor to menorrhagia. Foods rich in iron include organic organ meats (liver and kidney), eggs, beef, beans, cooked spinach, and chicken.

Complementary and Alternative Medicine

Supplements

Chaste Tree (vitex agnus castus), Ginger (zingiber officinale), and Shepherd's Purse (capsella bursa-pastoris) are herbal supplements that have been shown to help manage heavy menstrual bleeding.

If fibroids are a suspected contributing factor to menorrhagia, Chaste Tree, Gui Zhi Fuling Tang, and the bioflavonoids in green tea (EGCG) are shown to help manage fibroids.

Iron supplementation should be considered for those with iron deficiency anemia, and nutritional supplementation specific to any nutritional imbalances identified with nutrient testing should also be part of the plan to support improvements in hormone health and well-being.

Vitamin C and bioflavonoid supplements have shown benefits in helping manage menorrhagia. Vitamin C can also support women with iron deficiency anemia by increasing iron absorption.

Yoga Nidra

Yoga Nidra is a meditative relaxation practice that has been shown to be helpful for hormone imbalances and menstrual irregularities, including for those experiencing menorrhagia.

Acupuncture

Acupuncture therapy has also been shown to be effective in helping manage menorrhagia.

Summary

Heavy menstrual bleeding is an issue many women experience and can impact the quality of life and activities of daily living. However, that doesn't mean you have to accept it without seeking help if you, too, are experiencing this issue.

There are many conditions or imbalances in the body that can contribute to menorrhagia. Working with your Functional Medicine or Integrative Medicine Practitioner is a way to begin the process of identifying the root cause of this issue by utilizing a combination of physical examination, imaging, and functional testing.

Depending on the root cause of your heavy menstrual bleeding, your unique care plan may require conventional care or a combination of traditional care and functional medicine. You can work with your practitioner to devise the right strategy to manage your flow, support your body, and improve your quality of life.