Heavy Bleeding (Menorrhagia)

In some instances, the cause of heavy vaginal bleeding will remain unknown but most causes of abnormal or heavy bleeding can be identified.  These can be broadly separated into 

1. Hormonal or Non-Structural 
2. Structural  (Fibroids, adenomyosis, polyps, cancer, etc).  

Specific causes  include 

• Hormonal conditions   This may arise from obesity, insulin resistance, thyroid problems or polycystic ovary syndrome (PCOS)
• Anovulation – This is a dysfunction of the ovaries, namely when a woman fails to ovulate (i.e. her ovaries don’t release an egg) during her period. This means that her body doesn’t produce the progesterone hormone as it normally would during the menstrual cycle. This is typical among adolescent girls in the first year of ovulation;
• Fibroids   common benign (non-cancerous) tumours.
• Adenomyosis
• Endometrial polyps
• Cesarean section scars
• IUDs   a common side effect of using a non-hormonal intrauterine device for birth control;
• Medications – medicine for anti-inflammatory complaints, hormonal issues (e.g. oestrogen and progestin) as well as anticoagulants;
• Endometrial hyerplasia,  endometrial carcinoma, and cervical carcinoma
• Pregnancy Complications – A single, heavy, late period may be due to a miscarriage. Also, retained placental tissue can cause bleeding many months after delivery
• Inherited Bleeding Disorders – for example, Von Willebrand disease. This is a condition where an important blood-clotting regulator is deficient or impaired

Hormonal imbalance - too much, or too little- can affect the endometrium and cause abnormal bleeding.  Any condition that affects the endometrium can naturally cause abnormal bleeding.  

 
Low progesterone or unopposed estrogen

If your doctor says your heavy periods are the result of “hormone imbalance,”  it may mean you’re having anovulatory cycles and are not making the progesterone you need to thin the uterine lining and prevent heavy periods. In other words, you have estrogen that is “unopposed” by progesterone and so develop a thickened uterine lining.  

The only way to make progesterone is to ovulate, so, if you don’t have progesterone, it’s because you’re not ovulating. The next question is “why are you not ovulating?” Here are some possibilities.

• You have PCOS, in which case, your best treatment is to reverse PCOS so you can ovulate and make progesterone and prevent heavy periods.
• You have thyroid disease or high prolactin.
• You’re a teenager so too young to ovulate regularly. It’s a temporary situation that you will probably outgrow. In the meantime, you can lighten your flow with a dairy-free diet, turmeric, and iron (see below).
• You’re in perimenopause or which is when ovulation starts to wind down and you lose progesterone. This type of heavy bleeding is also called dysfunctional uterine bleeding

Your doctor might not be able to figure out if you’re ovulating or if you have enough progesterone. You can test yourself by tracking your basal body temperatures. 

Thyroid disease 

is a common and treatable cause of heavy menstrual bleeding. Experts say that thyroid function should be evaluated in all cases of heavy menstrual bleeding and doing so “would avoid unnecessary surgeries and exposure to hormones.”   Women are twenty times more likely to have a thyroid issue than men. As a major hormone-producing gland, an over or underactive thyroid can be detrimental to one’s health. There are various thyroid diseases and conditions, including Hashimoto’s Disease, where the immune system confuses the thyroid for a foreign structure and attacks it, thinking it’s defending the body.  

Ask your doctor to test your thyroid and then ask to see the results. If your TSH is higher than 3 mIU/L, it could be a sign of subclinical hypothyroidism (underactive thyroid).Also, if you have thyroid disease in your family, look at the test “thyroid antibodies” or “TPO antibodies,” which is the marker of autoimmune thyroid disease or Hashimoto’s disease. Autoimmune thyroid disease affects one in four women and can cause symptoms of underactive thyroid (including heavy periods) even when TSH is normal.