Heavy periods. At least 50% of women struggle with them enough to, well, absolutely skip wearing white pants during that time of the month, and for 1 in 6 women, they’re severe enough to significant impact quality of life – from disruptive, frequent trips to the bathroom to change pads or tampons, to serious at-work period accidents, to staying home from work social engagements, and basically living life for fear of public period accidents. For one, I say to hell with worrying about what people thing. Women bleed. Period. But heavy periods are more than just awkward; they’re draining, exhausting, and are often accompanied by heavier cramping, too.
Maybe they’re something you’ve heard is “just a normal” part of having a menstrual cycle. (Nope!) Perhaps, like so many women, you’ve even heard this from your doctor! (Wrong!) Blowing through pads or tampons each cycle, stressing about ‘period accidents,’ arranging your life around your period, or feeling dang tired each month – or all the time – is anything but normal – and it’s certainly not something you should just have to ‘deal with, ’ever!
In this article, I’ll share the causes of heavy periods – along with what you can do to identify your underlying causes, lighten your flow, and take back your life if heavy periods have been getting you down.
How Do You Know if You Have Heavy Periods?
First things first – how do you know if you have a heavy period? Normal period blood loss is considered 30-80 mL, approximately 1-6 tablespoons. But what does that really mean?
Here are the most common signs that your period is truly heavy:
- Your period lasts longer than 7 days.
- You need to use more than 6 pads or tampons per day, not fully soaked, or you’re soaking through more than two pads or tampons in a day.
- You typically need to change your pads or tampons after only 1 or 2 hours.
- You’re regularly soaking through your clothes on your period, or you’re having to ‘double up’ on pads so you don’t.
- You have to change your tampon or pad during the night.
- You’re passing blood clots the size of a quarter or larger with your period blood.
- You’re having to plan your activities around your period.
If you consistently have a heavy period, you may also find yourself feeling weak, tired and sluggish during the day, which can be a sign of iron deficiency anemia due to a consistently heavy period.
Why is My Period So Heavy?
Heavy periods have a wide range of causes, most commonly, they’re due to hormone imbalances, particularly high estrogen levels or not ovulating, but they can be due to a variety of underlying causes from PCOS to an uncommon but not completely rare genetic bleeding disorder that can cause heavy periods (and I mean HEAVY).
You can read about the causes below and see if you can identify whether any of these sound similar to what you’re experiencing in addition to your heavy flow. The underlying cause will help you to find the best strategy for reducing your heavy flow once and for all. Depending on the cause, self-care strategies may be all you need; or you may need to pay a visit to your favorite medical provider to help you sort out a diagnosis and the next best steps.
Let’s start with the most common causes of heavy periods (and a few less common causes you should know about) and then I’ll walk you through what you can do – both natural options and some conventional medical ones, too. Then you can decide what’s best for you!
High Estrogen Levels
Estrogen is a marvelous hormone. At the right levels it plays a central role in our reproductive, brain, bone, and heart health. During the first half of each menstrual cycle, called the proliferative phase, your uterine lining naturally builds up (or proliferates, hence the name) under the influence of estrogen. This lining is then shed with each menstrual cycle, leading to our menstrual flow. Heavy periods can be a sign that this layer has been building up too thickly – as a result of estrogen levels that might be too high.
In addition to heavy periods, a few of the many symptoms of excess estrogen that suggest this might be a cause for you include: premenstrual breast tenderness, short menstrual cycles (<21 days between periods), water retention, mood swings, and menstrual migraines.
High estogen levels can result from:
- Environmental estrogen exposures: Endocrine disrupting chemicals from our food, water, cosmetics, body products, cleaning supplies, and homes are disrupting our hormones at every turn. In part because they’re so easily absorbable, they’re found in the body at much higher concentrations than your body’s natural hormones. Xenoestrogens (“foreign estrogens”) mimic naturally occurring estrogen, disrupting how it functions and creating higher levels of circulating estrogen. In one study, women’s pesticide exposure was linked to a 60-99% increased risk of having longer menstrual cycles, skipped periods, and mid-cycle bleeding compared with women with low to no exposure.
- Pharmaceutical sources of estrogen: From estrogen-containing birth control pills and other forms of estrogen-containing hormonal contraceptives, to hormone replacement therapy, medications containing estrogen can be a cause of heavy menstrual (or cyclic hormone withdrawal) bleeding.
- Under supported detoxification system: Detoxification is a nutrient dependent process – meaning it actually requires enough protein, vitamins, and minerals to function optimally. On top of endocrine disruptor overload, many of us aren’t getting enough supportive nutrients we need in our daily diets to help our bodies break down and eliminate estrogen effectively. The mismatch of high environmental toxin exposure combined with nutrient poor diets can result in an overwhelmed and underperforming detoxification system that can’t clear estrogen efficiently.
- A disrupted gut microbiome: Within your gut, there is a special collection of bacteria known as your estrobolome whose entire job is regulating estrogen levels. When your microbiome is out of balance, these bacteria might not break down and help you eliminate estrogen properly. Too much estrogen from a disrupted estrobolome is associated with heavy periods and other gynecologic symptoms.
Each month, around mid-menstrual cycle ideally, we ovulate – that is, release an egg from one of our ovaries. If you’re not ovulating regularly, there’s a good chance you’re having periods that are more than 35 days (or more) apart, and may occur irregularly. This allows your uterine lining more time to build up, with heavier bleeding when your period finally does start. Symptoms that you’re not ovulating include long menstrual cycles (periods >35 days apart), low or no mid-cycle ‘fertile-type cervical mucus’ discharge (it should be similar to egg whites and kind of stretchy around ovulation), sleep problems especially in the second half of your menstrual cycle (1-2 weeks before your period), and possibly difficulty conceiving.
One of the most common causes of both skipped ovulation and heavy periods is PCOS. Seventy-four percent of women with PCOS don’t ovulate regularly (or at all). Symptoms specifically suggesting PCOS include: infrequent periods >35 days apart, acne, hair loss, hair in unwanted places, depression, irregular cycles, darkened, velvety textured skin around the neck, arm pits, or groin, weight gain and difficulty losing it, skin tags, and difficulty getting pregnant.
Skipped ovulation can also be due to:
- Stress: When your body thinks you’re under too much stress, it triggers cortisol production which suppresses ovulation.
- Poor sleep: Chronically elevated cortisol that results from poor sleep loss suppresses melatonin. Low melatonin can reduce ovarian function and ovulation and can cause irregular cycles.
- Missing nutrients: A number of nutrients are critically important for your ovarian health and supporting ovulation, including B-vitamins, vitamin C, calcium, and vitamin D. Adequate levels can help improve ovulation and fertility, and reverse insulin resistance – both which impact PCOS as well.
- Low body weight: A BMI below normal (less than 18.5) can be another common cause of lack of ovulation – but in this case, periods are more likely to be very light than heavy.
Endometriosis / Adenomyosis
In endometriosis,, endometrial-like tissue, similar to that which normally lines the inside of your uterus, is found in other parts of your body, most commonly in your abdominal cavity. Estrogen causes thickening of this tissue both inside and outside of the uterus. When hormone fluctuations trigger this tissue to shed, bleeding can be especially heavy and periods quite painful. I talk about the symptoms of endometriosis here – take a look and see if these resonate with what's going on for you.
Uterine Fibroids and Polyps
Uterine fibroids – non-cancerous growths of muscle tissue in or on the uterus, or on the cervix – are known to contribute to heavy bleeding. A few theories as to why this happens include: increased pressure on the uterine lining, interference with the uterus’ ability to properly contract, stimulating the growth of blood vessels, and elevating certain hormone levels – all which can cause abnormal bleeding and irregular cycles. One thing we also know is that uterine fibroids are ‘fed’ by high levels of estrogen – so that brings us back to excess estrogen as a cause of both uterine fibroids – and heavy periods. Like fibroids, uterine polyps – growths off of the endometrial tissue that lines the uterus – can cause abnormal bleeding for much of the same reason as fibroids are thought to contribute to irregularities.
Less common causes of heavy periods include:
Inherited bleeding disorders
It’s estimated that up to 20% of women with very heavy periods may in fact have an inherited bleeding disorder, von Willebrand disease. It usually shows up in a woman's teens or early 20s, and a very heavy flow can be the first sign of it, so torrential periods in young women warrant a blood test for this condition.
Cervical and Endometrial Cancers
While uncommon, it’s important to know that heavy bleeding, along with irregular bleeding and spotting between periods, can be a sign of certain cancers and should be ruled out as part of your medical care.
Other Underlying Factors and Conditions
Heavy bleeding can also be a sign of other underlying conditions including premature menopause, pelvic inflammatory disease, diabetes, and less commonly thyroid problems. It can also be a side effect of medications or other interventions including: the Pill, copper IUDs, anti-clotting medications, and certain types of chemotherapy. Keep in mind, miscarriages are also commonly mistaken for a heavy period, so if this is a one-off heavy period and you could possibly have been pregnant, keep that in mind.
What You Can Do to Ease Heavy Periods
First things first, it’s critical to assess for and address underlying medical conditions. If you’re experiencing new onset of heavy menstrual bleeding – pain, fever, unpleasant-smelling vaginal discharge, or any other new or unusual symptoms – it’s really important to see your medical provider and rule out a more serious medical condition like a pelvic infection, endometrial cancer. Heavy bleeding can also be due to a miscarriage, which may sometimes require medical attention.
I also recommend getting checked for iron deficiency anemia if you have low energy, fatigue, low mood, or difficulty focusing around your period. Anemia can result from heavy blood that’s significant enough to require support. More severe anemia can also cause other symptoms such as breathing difficulties and a racing heart, particularly following strenuous physical activity. Getting your iron levels back to a normal level can make a world of difference in how you feel, even without any other interventions.
While most causes of heavy periods are benign or treatable with natural therapies, it’s important not to wait to get appropriate medical care.
Assuming more serious medical conditions have been ruled out, your symptoms have been going on for a long time, and you’re ready to roll up your sleeves and try natural approaches, an integrative approach to heavy periods is a reasonable next step.
Take an Integrative Medicine Approach
Integrative medicine takes into account the many ‘root causes’ or common conditions, including our diets, lifestyles, environmental exposures, and the ability of our natural physiologic processes to restore balance when given the right nurturing. It also includes herbal therapies – I’ll share those that are rooted in traditional use and grounded in science.
Commonly, several ‘root causes' are occurring together – for example, it's common to simultaneously have high estrogen and not be ovulating, especially with PCOS but more generally, too. So a combined holistic approach is usually the most effective. But have a look to see which approaches seem most relevant to you.
You’ll also find a complete guided protocol and plan for easing heavy periods – along with how to optimize your hormonal and total health – in my new book Hormone Intelligence.
Reclaim your power. Feel at home in your body. And be the force of nature you really are! Join my Summer Book Club
Reduce Excess Estrogen
The following steps help create healthy estrogen levels by removing environmental exposures and optimizing nutrients that support its breakdown and elimination..
Reduce Your Exposure to Endocrine Disruptors
Eliminating exposures to endocrine disruptors that make estrogen levels sky-rocket in the body is an absolute must for reducing excess estrogen. You can find a full list of ways to avoid endocrine disruptors here, but some that are especially important to address for heavy periods include the following:
- Avoid plastic. Avoid food and beverages that are in plastic containers or packaged in plastic, including water bottles, and choose glass or stainless steel food containers, water bottles, and glasses instead.
- Go clean and green with your cosmetics. Cosmetics are particularly high in endocrine disruptors and are a major problem because they are directly absorbed into your circulation. I know it can feel like a lot to swap everything, but start by paying attention to the products that cover the most surface area and that you use daily – think body lotion, soap, and shampoo.
- Swap your period products. Many women find that they experience much more painful and heavy periods when using conventionally produced tampons – or tampons in general. Try switching from tampons to another form of period product like menstrual pads or washable absorbent ‘period panties’. If you prefer tampons, consider switching to an organic cotton product – they're better for you and better for the planet. Ditto that on menstrual pads. You can even purchase cotton reusable ones you wash at home. Don't grimace- they're a great option that's economical and ecological. I know – I used them for decades, swapping in disposable ones when I had to be out and about.
Optimize Your Diet
Optimizing the nutrients in your diet serves two major purposes: it provides the powerhouse nutrients that support eliminating excess estrogen and it nourishes your estrobolome so it can better regulate estrogen. And what’s really cool – the bacteria in your estrobolome are actually able to manufacture estrogen from plants in our diet by converting a plant compound known as lignans to phytoestrogens (plant-estrogens.) Opposite to xenoestrogens, phytoestrogens are actually incredibly beneficial. When estrogen levels are high, they can block the receptors and protect you from the risks of excess estrogen exposure.
- Include plant sources of lignans. Sources include flax seeds, vegetables, and legumes. Adding 2 tablespoons of ground flaxseed in your diet daily – added to smoothies, non-dairy yogurt, oatmeal – is a great way to maximize dietary fiber.
- Reduce food sources of estrogen. Reduce exposure by eliminating dairy and reducing excess meat consumption. Limit red meat to no more than once a week and chicken to no more than twice a week. Emphasize fish and plant sources of protein like beans and lentils.
- Increase green vegetable and fruit intake to 8 to 10 servings daily. Pay special attention to including broccoli, cabbages, kale, Brussels sprouts, cauliflower, and collards—all especially important allies if you’re dealing with excess estrogen. Leafy greens are rich in antioxidants and plant chemicals needed for detoxification of hormones and environmental chemicals and contain the best type of fiber to feed your estrobolome to eliminate estrogen properly. Many studies have shown that a diet high in plant foods like leafy greens can increase estrogen excretion and decrease concentrations of bioavailable estrogen in the body.
- Add fermented foods like sauerkraut, kimchi, and coconut yogurt or kefir to further support a healthy balance of gut flora.
If your heavy periods are due to skipped ovulation (which commonly occurs along with excess estrogen!), it’s important to support your body in reestablishing regular ovulation. Signs that you're ovulating include having regular menstrual cycles, 26-34 day apart, and the presence of copious clear, stretchy mid-cycle discharge. There are other more subtle signs that you’re ovulating that are really fun to learn about.
If the symptoms described earlier under ‘not ovulating’ point to problems in this direction, here are some strategies to kick-start ovulation:
- Include nutrients and herbs that support ovulation:
- Flax seeds, in addition to helping keep your estrogen levels in balance, have been shown to improve ovulation – yet another reason to include 2 tablespoons of ground flax daily!
- Vitamin C has been shown to improve ovarian function, increase progesterone levels, and improve ovulation. Our ovaries are actually one of the highest Vitamin C concentrated areas in the body! Food sources aren’t just limited to orange-colored fruit; rich sources include all citrus (not just oranges), kiwi, berries, pineapple, peppers, broccoli, and Brussels sprouts. Supplementing with a dose of 750 mg/day has been specifically shown to support ovarian health.
- Maitake Mushroom is an adaptogen with the specific ability to induce ovulation in people with PCOS, so it’s a fantastic one to include for ovulation support. Dose: 50 mg/day of extract.
- Get good quality sleep. You need between 7 and 9 hours of good sleep every night to reset your natural clock. Get on a regular sleep cycle that has you waking and going to bed at roughly the same time each day, preferably waking by about 7 am and getting to bed between 10 and 11 pm.
- Add relaxation practices. Reducing stress in your life is easier said than done, but getting the body out of cortisol-producing fight-or-flight mode and into a more relaxed state is essential for improving progesterone levels. Be proactive about incorporating stress-reducing relaxation practices, whether it be meditation, yoga, journaling, being in nature, or dancing it out!
- Connect with your girlfriends: Studies show that when we connect with our friends, our progesterone levels increase, improving cycle regularity and ovulation. Many of us let it fall to the wayside when life gets busy, but I’d like you to reconsider it as vital to your health! So set aside that time – even if you’re a busy mom or work feels like all you have time for. Phone calls and virtual hangs count too!
Use Herbs that Reduce Heavy Bleeding
Herbs can be an amazing addition for reducing heavy bleeding and providing symptom relief as you work towards hormone balance. Here are my go-to’s for heavy periods:
- Ginger root is one of the best for periods. Ginger acts as an anti-inflammatory and reduces heavy bleeding, not unlike NSAIDS, but it does it without the risks and side-effects. Not only can it help with painful periods and reducing heavy menstrual flow, it helps with other period symptoms like nausea, bloating, and headaches. Dose: Ginger capsules 500 to 1000 mg up to three times daily.
- Vitex (Chasteberry) is an herb classically used for a variety of menstrual symptoms and has been shown to induce ovulation. It may reduce heavy flow over a few months of regular intake of 180 to 220 mg daily in capsule, once or twice daily, or 5mL (about 1 measured tsp.) daily of liquid extract.
- Yarrow tea is a traditional herb used at the start of your period for heavy menstrual bleeding. Dose: 1 to 2 cups daily during your heavy flow days. To prepare one cup, place 2 tsp. of dried yarrow flowers in a French press or covered teapot. Cover with 1 cup of boiling water. Steep for 20 minutes, strain, and drink warm. Not safe for use during pregnancy.
Try These Lifestyle Tips
You’ve already done the ‘heavy-lifting’ with the first four steps, but for added support, here are some tips that go a long way for both the physical symptoms and mental worries of heavy periods:
- Find the period products that are best for your flow level. While it may not be pointing to a root cause, period accidents are definitely one of the most stress-inducing aspects of heavy periods. Options that can give you some peace of mind include heavy duty maxi-pads, a heavier flow tampon with a pad for overflow, or absorbent period underwear (not the same as your old ‘period panties!”). Don’t leave home without supplies.
- Try period sex. I know that sounds weird and really messy, but if you’re open to it, sex – especially orgasms – during your period can reduce the amount and number of days of heavy flow and cramps. Thinking it might not be your partner’s thing? Think again. Most partners actually say they don’t mind. Too embarrassed, not into it, or don’t have a partner – self-pleasure works just as well.
How Long Does It Take?
Assuming there’s no further underlying cause such as uterine fibroids, PCOS, or endometriosis, you should can to see results in 2 to 4 cycles with a combination of the above approaches. If you know already that you have a hormonal condition such as PCOS or endometriosis, it may take closer to 6-12 months to see improvements as you work towards healing more complex root causes. If you’re still experiencing heavy bleeding beyond this time or have worsened symptoms, it’s important that you see a medical provider for further evaluation.
What About Conventional Treatments?
Heavy periods, especially when combined with severe menstrual cramps as they often are, can be debilitating. Sometimes your symptoms are so severe, especially when dealing with a complex hormonal condition, that you need to turn to conventional treatments to help provide some relief, and I support you in that. But also know that it doesn’t have to be one or the other – natural approaches can be used along with conventional methods to support healing in an integrated, holistic way.
NSAIDs like ibuprofen carry some risks with chronic use, but can be used to reduce a heavy flow (and cramps, too!) in a pinch or on an as needed basis.. Hormonal contraceptives like the Pill or the progestin-containing IUD, can help, but keep in mind, the Pill is not addressing the root causes of why you’re experiencing heavy bleeding, helping only to suppress it, and does have side-effects and risks. Know that when you stop the hormonal therapy, heavy periods may return and can be even worse.
While surgical options can be effective for endometriosis, uterine fibroids, and uterine polyps, I reserve them as a last resort due to the risks they carry, and of course, a hysterectomy carries significant risks and precludes pregnancy, if that’s something you’re hoping to experience.
Heavy periods can be debilitating and disruptive, and despite what many women have been told to believe, it’s not something normal you should have to suffer through. I hope this article helps start you on a path toward restoring hormone balance and finding the period ease you may have not believed possible.
Want more on how to turn the tide on heavy periods and feel like you're in harmony with your hormones, not a battle? Be sure to check out my book Hormone Intelligence – available for pre-order now! You’ll also get my FREE 7-Day Hormone Intelligence Quick Start Guide & 7-day meal plan when you order.
Berga SL and, Loucks TL. The diagnosis and treatment of stress-induced anovulation. Minerva Ginecol. 2005 Feb;57(1):45-54.
Bullivant SB, et al. Women's sexual experience during the menstrual cycle: identification of the sexual phase by noninvasive measurement of luteinizing hormone. J Sex Res. 2004 Feb;41(1):82-93.
Cohen J. and Rubin H. Functional Menorrhagia: treatment with bioflavonoids and vitamin C. Currently Therap Res 1960:2(11):539.
Cerqueira RO, et al. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017 Dec;20(6):713-719.
James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia. 2005 Jul;11(4):295-307.
James AH. Women and bleeding disorders. Haemophilia. 2010 Jul;16 Suppl 5:160-7.
Javan R, et al. Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review. Phytother Res. 2016 Oct;30(10):1584-1591.
Kashefi F, et al. Effect of ginger on heavy menstrual bleeding: a placeb controlled randomized clinical trial. Phytotherapy Research 2015; 29:114-119.
Rae C, et al. Bleeding disorders, menorrhagia and iron deficiency: impacts on health-related quality of life. Haemophilia. 2013 May;19(3):385-91.