Progesterone Therapy for Heavy Menstrual Bleeding

Many women experience very heavy menstrual cycles, frequently described as flooding. For them, the inability to reduce this heavy—and sometimes unpredictable—bleeding can be extremely stressful. Additionally, it can lead to dangerously low iron levels over time.

If your cycles are so heavy that you can’t go to work or leave the house, this is an issue that needs to and can be addressed! Progesterone therapy is one of the best and most effective treatment options. I use it frequently to provide these women with some relief.

What is Considered Heavy Bleeding?

A loss of 80ml or more of blood in a menstrual cycle is considered heavy bleeding. Most of us aren’t measuring blood loss this technically, however, you can estimate your blood loss with the following measurements:

1 Saturated light tampon = 3ml

1 Saturated regular tampon = 5ml

1 Saturated super tampon = 12 ml

1 full menstrual cup = 20-32ml (depending on the type used)

Most women will know if their cycle is heavier than normal without the need to calculate in this fashion. Heavy bleeding is also likely if you are changing your menstrual products every hour or every other hour. Additionally, if you experience any flooding or large clots, or if your bleeding lasts for longer than 7 days.

What Causes Heavy Bleeding?

There are many causes of heavy bleeding, but most commonly it’s associated with a hormonal imbalance. This can either be caused by excessive estrogen or insufficient progesterone. Estrogen causes the endometrial lining of the uterus to grow. Progesterone opposes this growth. In the presence of too much estrogen or not enough progesterone, we see excess growth and heavier and sometimes longer cycles.

Common reasons this imbalance between estrogen and progesterone is present include:

  • Perimenopause: This hormonal shift can occur up to 10 years before menopause. It’s associated with fluctuating estrogen and lowering progesterone levels. Other symptoms that can appear are hot flashes, vaginal dryness, migraines, and low libido.
  • PCOS: A metabolic condition that can be associated with missing cycles or very long cycle. Symptoms include weight gain, hair loss, acne, and hirsutism. Some women with PCOS have high estrogen levels. Without monthly ovulation, they have lowered progesterone, which contributes to heavy cycles.

Other causes of heavy bleeding can include:

  • Uterine fibroids
  • Blood clotting disorders
  • Infections
  • Thyroid disease
  • Endometrial polyps or endometrial cancer

It’s important to get any abnormal bleeding worked up thoroughly by your medical practitioner to determine what the cause is in your body before jumping into treatment.

Progesterone Therapy for Heavy Bleeding

Bio-identical progesterone can be very helpful in the treatment of heavy menstrual bleeding. As mentioned, progesterone is a natural opposer of estrogen. As a result, it can reduce excessive growth and fragility of the endometrial lining. This leads to lighter cycles.

Bio-identical progesterone can be administered in three forms: orally, topically, and as a suppository. Each progesterone format has its benefits and drawbacks so should always be discussed in-depth with your practitioner. This can determine what will be most effective for you.

Depending on the intensity of bleeding, progesterone can be dosed half of the menstrual cycle only. This won’t impair ovulation. In more extreme cases, the dose is every day of the cycle. The progesterone dose can also be increased as needed.

Progesterone can also be very helpful in women going through perimenopause and experiencing symptoms such as mood swings, hot flashes, and insomnia. Dr. Jerilynn Prior has done years of research on the importance of progesterone in female health. She discusses the other benefits of progesterone in her article here.

Other Treatment Options

Progesterone isn’t the only therapy for heavy cycles. Depending on the cause in your case, additional options can be supportive.

Additional naturopathic treatment options for heavy bleeding that can be discussed with your practitioner include:

  • Curcumin
  • Ginger
  • Dim/I3C (If estrogen excess is playing a role)
  • Botanical astringents such as Sheppard’s Purse and Yarrow

Conventional treatment options for heavy bleeding that can be discussed with your practitioner include:

  • Oral contraceptive pills
  • Hormonal IUD (Copper IUDs should be avoided since they can make cycles heavier!)
  • Tranexamic Acid
  • Ibuprofen
  • Endometrial Ablation
  • Hysterectomy

Get your iron checked!

On a final note, if you’re experiencing heavy menstrual bleeding, your iron stores must get assessed to monitor for anemia. It’s very common for women experiencing this monthly blood loss to have very low iron levels. This can make bleeding worse, as well as contribute to significant fatigue, shortness of breath, and in some cases worsening anxiety. I run a CBC and ferritin in all women experiencing heavy bleeding.

Next Steps

If you are experiencing heavy menstrual bleeding, you do not need to suffer. There are many conventional and naturopathic treatment options that can make a significant impact and improve your quality of life! Progesterone therapy is a proven and effective treatment option that can be discussed with your practitioner.

Dr. Jerilynn Prior has lots of information on using progesterone for heavy bleeding on her website here.

References

Bofill Rodriguez, M., Lethaby, A., & Farquhar, C. (2019). Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd000400.pub4

Kashefi, F., Khajehei, M., Alavinia, M., Golmakani, E., & Asili, J. (2014). Effect of Ginger (Zingiber officinale) on Heavy Menstrual Bleeding: A Placebo-Controlled, Randomized Clinical Trial. Phytotherapy Research29(1), 114-119. doi: 10.1002/ptr.5235

Prior, J. (2015). Perimenopause and menopause as oestrogen deficiency while ignoring progesterone. Nature Reviews Disease Primers1(1). doi: 10.1038/nrdp.2015.31