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Heavy Menstrual Bleeding


Heavy menstrual bleeding is a concern that I hear about often from women in my practice and, it is something naturopathic doctors can help with! It can be uncomfortable, inconvenient and sometimes embarrassing for women. Heavy or prolonged menstrual bleeding can also be emotionally and physically exhausting and is the most common cause of iron deficiency in the west.


Since most of us don't go around comparing notes, understanding what is normal can be a bit of a challenge. Normal menstruation is defined as 5-80 ml of blood over an entire period. Some menstrual cups come with measurements on the side but if you use the more conventional products, that won't be very helpful. Other symptoms include: changing your full, super pad or tampon every 1-3 hours on heavy days, needing to change at night, passing large clots (more than 2.5 cm) and bleeding for more than 7 days. Another way to look at it is, if your heavy bleeding is interfering with your physical, social or emotional quality of life, it may be considered abnormal.


If you experience heavy, prolonged or irregular periods, it's time to visit your doctor. This is especially true if you've noticed a change in your periods. It is important to have a physical exam including a pap (for those who have been sexually active) and your doctor may want to order tests such as an ultrasound and blood work to check your thyroid, iron levels, screen for infections and possibly check for bleeding disorders.


Iron! From both a conventional and naturopathic perspective, increasing low iron is an important aspect of treatment. Not only can your low iron cause you to feel tired and unwell, but having low iron reserves may also increase your heavy bleeding.

Aside from iron, conventional treatment may include drugs to help temporarily slow bleeding, hormonal intervention (in the form of pills, an IUD or injections), or surgery: to remove fibroid/polyp, endometrial ablation (a treatment that removes much of the lining of the uterus) or a hysterectomy (removal of the uterus).


Naturopathic doctors look at each individual situation and treat accordingly so our approach will vary from person to person.

For acute heavy bleeding, there are several herbs that I might combine to help slow bleeding while we work on the underlying issue. These herbs are called styptics and include plants such as yarrow, shepherds purse, ladies mantle and cinnamon. In other cases I have used natural progesterone pills to help slow/stop bleeding.

For a more long term solution, I may use a combination of herbs to help the body achieve better balance and regulate cycles. This is different than using the birth control pill or a hormonal IUD because the goal of the herbs is to assist the body in finding it's own balance, rather than giving external hormones with the goal of controlling the cycle. One of my favourite herbs that I include frequently for this purpose is Chaste Tree. This herb is helpful for many menstrual concerns including irregular and heavy periods as well as PMS symptoms.

Many (but not all) of the causes of heavy menstrual bleeding centre around estrogen/progesterone balance. Estrogen levels may be too high, creating the imbalance so treatment may focus on supporting healthy estrogen breakdown and removal from the body.

Natural progesterone cream or pills may also be used to help regulate the cycle. Whenever possible I prefer natural (bio-identical) hormones as they are made to be identical to the hormones that are in your body. In my opinion, they produce less side effects and may be safer than non bio-identical hormones.

Treating the whole person means looking at how our patients are living and other health concerns they may have; optimizing the thyroid and stress hormones can be very helpful. Additionally, I find that periods are easier when we work with diet, and generally decrease inflammation in the body. Helping to create ease in the body makes most things better including heavy flow. :)

Dr. Alexis Blanks is a naturopathic doctor who is clinically trained and naturally focused. She is co-owner of Flourish Naturopathic at Moss Street Healthcare Centre. Learn more at