In a busy integrative medical practice, menorrhagia is not uncommon. From teenage girls to menopausal women, this is a concerning issue seemingly more urgent than secondary amenorrhea. Anemias, iron loss, possibilities of cysts, tumors, and endometrial hyperplasia have to be ruled out quickly so that overreaction by the medical community can be avoided if possible. We love our gynecologists when needed for surgical emergencies but hope to have a few days or weeks to repair underlying hormonal and stress issues causing the heavy bleeding before more intensive intervention, such as endometrial ablation or hysterectomy, is sought.

Dysfunctional uterine bleeding (DUB) is a complex physiological event involving hormones and inflammatory enzymes such as MMPs (matrix metalloproteinases). Capillary breakdown of the endometrium has been associated with thrombocytopenia and fibrin abnormalities. Immune thrombocytopenia (ITP) can be caused by H. pylori and is worth checking on as it affects 50 percent of us. Scurvy and capillary weakness is, of course, rampant in humans. Generous vitamin C supplementation may also be important to reduce DUB.

Hypothyroidism

Hypothyroidism may be a primary cause of menorrhagia.^1,3 Thyroid replacement therapy based on the physical examination, basal temperatures, and symptomology has been very important for treatment of patients with heavy periods. Although is it important to do the full panoply of thyroid laboratory testing, they frequently don’t reveal which patients will benefit from thyroid supplementation. Gentle thyroid supplementation with Nature-Throid or Armour (porcine thyroid) is frequently well tolerated unless there is more of a picture of Hashimoto’s thyroiditis when [T.sub.3] and/or [T.sub.4] test better by EAV. Women after childbirth can become autoimmune to their own thyroid and the bioidentical but synthetic [T.sub.3] and/or [T.sub.4] is better for many of them. Porcine thyroid is similar to human thyroid. And (horror of horrors) Synthroid occasionally tests better for some even though it is not bioidentical. Thyroid supplementation turns on all the mitochondrial energy manufacturing enzymes, which increase the energy and ATP production everywhere to normalize our tissue metabolism.

Please remember my “cup of coffee” rule of thumb on thyroid dosing. Women who can drink two pots of coffee and go right to sleep can usually take thyroid more liberally than the person who smells coffee and is up for two days. Adrenal support and thyroid always go together so a little cortisol, 5 mg, two to four times per day or more, or our adrenal complex shots, weekly or more often, can smooth the gradual titration of thyroid in the adrenal-stressed woman.

Progesterone

Progesterone is a marvelous hormone. It is an adrenal intermediary hormone and has a myriad of uses, especially its anxiolytic effects. Michael Piatt, MD, has written a great book called The Miracle of Bioidentical Hormones. He believes that progesterone heals the uterus, relieving PMS and menstrual cramps by the second cycle. It can stop most anxiety in three to five minutes when 50 mg is rubbed into the forearms. It is not feminizing. I have watched it stop a two-week-old baby’s horrible, screaming colic and put her to sleep in two minutes after a pea-size progesterone cream dot was rubbed into one forearm.

When the pelvic ultrasound reveals a thickened endometrial stripe, the usual therapy is Provera (medroxyprogesterone acetate), a synthetic progestogen that may block bioidentical progesterone. By using natural progesterone, 50 mg four times per day rubbed into the forearms, or oral progesterone, 200 mg caps before bed, employed all the way through the menstrual cycle, periods frequently normalize. Sometimes, progesterone suppositories, 400 mg twice per day, may need to be employed to reduce bleeding. They are also beneficial for infertility problems.

Estrogen dominance causes heavier periods, PMS, fibrocystic breast disease, endometriosis, ovarian cysts, and fibroids. Fat makes estrogen and estrogen makes fat, so weight loss can help. Many environmental pollutants mimic estrogen. Bisphenol A (plastic water bottles) and other plastics, pesticides, and industrial waste such as PCBs activate estrogen receptors. Birth control pills, a popular treatment for menorrhagia, contain ethinyl estradiol, which is 12,000 to 60,000 times stronger than human estradiol, according to our friend William Clearfield, DO, in addition to the progestogens which block progesterone.

Herbs and Homeopathics

Herbs such as shepherd’s purse (Thlaspi bursa capsularis pastoris) have long been used for heavy periods. One capsule of herbal grade cayenne pepper opened in three ounces of warm water can slow down bleeding (any bleeding) quickly as it balances blood flow in the body. Homeopathic Crocus 6C or stronger is great for hemorrhage with clots. I depend on Trillium Combination from Marco Pharma for any acute hemorrhage (50 drops in water followed by 30 to 40 drops five times daily acutely). There are over 200 homeopathic remedies for menorrhagia.

This article first appeared in Townsend Letter,  April 2017.

References

1. Stoffer SS. Menstrua! disorders and mild thyroid insufficiency: Intriguing cases suggesting an association. Postgrad Med. 1982; 72(2): 75-82.

2. Wilansky DL, Greisman B. Early hypothyroidism in patients with menorrhagia. Am J Obstet Gynecol. 1989; 160(3): 673-677.

3. Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding. Human Reproduction Update. 2002; 8(1): 60-67.