Menstrual cycles are one of the most powerful ways the body communicates. If your periods have become heavier than usual, it may be tempting to dismiss the change as a stressful month or a normal part of getting older. But a shift in your menstrual flow, especially when it becomes consistently heavy, deserves a closer look.
5 Key Areas to Look At
As a naturopathic doctor with a focus in women’s health, I view the menstrual cycle as a vital sign—our monthly report card, if you will. When bleeding becomes excessive or prolonged, it can be your body’s way of waving a red flag. Instead of simply masking the symptoms, naturopathic medicine aims to understand the why. Here are five key areas I recommend investigating if your period has become heavier than normal.
1. Understand What “Heavy” Actually Means
Before we dive into causes and treatment, it's important to define what qualifies as a heavy period, also known medically as menorrhagia.
Signs that your period may be clinically heavy include:
- Soaking through a pad or tampon every hour for several hours in a row
- Needing to use double protection (pad and tampon) consistently
- Having to change your pad or tampon during the night
- Passing blood clots larger than a quarter
- Bleeding that lasts longer than 7 days
- Fatigue, shortness of breath, heart palpitations or other signs of iron deficiency
Tracking your cycle using an app or menstrual journal can provide valuable data. Record not just the number of days, but the heaviness of flow, presence of clots, associated symptoms, and whether the flow is interfering with your daily life.
Use a menstrual cup or period underwear to estimate blood loss volume. On average, a normal cycle involves losing around 30–40 mL of blood. More than 80 mL is considered heavy.
2. Are We Perimenopausal?
Perimenopause is the transitional phase leading up to menopause, often beginning in a person’s 40s, though it can start earlier. One of the most common (and frustrating) symptoms during this time is heavy menstrual bleeding. If you're finding that your periods are longer, heavier, or more unpredictable than usual, you’re not alone.
Why does perimenopause trigger heavier periods?
The root cause lies in hormonal fluctuations, particularly estrogen and progesterone. During perimenopause, estrogen levels may spike while progesterone declines, especially in cycles where ovulation doesn't occur. This relatively higher estrogen can cause the uterine lining (endometrium) to thicken more than usual. When your body finally sheds this lining, the result is a heavier, longer period. You might also notice shorter cycles (e.g., every 21 days) or unpredictable bleeding patterns, which are hallmark signs of the perimenopausal transition.
3. Check For Structural Causes—It’s Not All Hormonal
Sometimes, heavy periods are the result of a physical change in the uterus. Conditions to rule out include:
Uterine Fibroids
These are benign muscular growths that can distort the uterus and increase bleeding. Especially common in women in their 30s and 40s.
Endometrial Polyps
Small, usually non-cancerous growths on the uterine lining that can cause spotting and heavy flow.
Adenomyosis
A condition where the endometrial lining grows into the muscular wall of the uterus, leading to heavy, painful, and prolonged periods.
Endometriosis
Although more commonly associated with pain, it can also lead to irregular and heavy bleeding. Referral to a gynecologist may be needed for further investigation or management options like endometrial ablation, or surgical intervention if conservative measures aren’t enough.
4. Nutrient Deficiencies—Cause & Effect
Heavier bleeding puts you at risk of iron deficiency anemia, which can make your periods worse over time. But it can also work the other way, where nutrient deficiencies may be contributing to your heavy periods in the first place.
Key nutrients to evaluate:
- Iron: Loss of iron through heavy bleeding can cause fatigue, brain fog, hair loss, and cold intolerance.
- Vitamin B12 & Folate: Essential for red blood cell production and methylation. Low levels can worsen hormonal imbalances.
- Vitamin D: Plays a role in hormone regulation and inflammation. Low vitamin D is linked to endometriosis and fibroids.
- Magnesium & B6: Supports progesterone levels, reduces uterine muscle spasms, and helps regulate estrogen metabolism.
Naturopathic Strategy:
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Run a complete iron panel (ferritin, serum iron, TIBC)
- Test vitamin D, B12, and homocysteine to catch hidden deficiencies
- Incorporate iron-rich foods (grass-fed red meat, pumpkin seeds, lentils) and pair with vitamin C for absorption
- Consider working with a professional to curate an appropriate supplement plan for you and track your labs over time
5. Thyroid Dysfunction & Metabolic Health
Your thyroid plays a direct role in your menstrual health. Both hypothyroidism (low thyroid function) and hyperthyroidism (overactive thyroid) can cause changes to your period.
Hypothyroidism
This condition more commonly causes heavy or prolonged bleeding due to poor clearance of estrogen and delayed ovulation. Some signs include fatigue, constipation, cold hands and feet, thinning hair, and low mood.
Hyperthyroidism
Hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone, can significantly affect the menstrual cycle. The excess hormones can disrupt the balance of reproductive hormones, often leading to lighter, less frequent, or even absent periods (amenorrhea). Some individuals may also experience shorter cycles or increased menstrual flow, though this is less common.
PCOS & insulin resistance
Women with polycystic ovary syndrome (PCOS) often have irregular cycles, but when periods do come, they can be heavier due to a thickened endometrial lining from skipped ovulation. For a full thyroid picture, you should have a battery of tests done by your healthcare provider to determine next steps.
LISTEN TO YOUR FLOW
A heavy period isn’t just an inconvenience; it’s information. In naturopathic medicine, we aim to treat the root cause by viewing symptoms like heavy menstrual bleeding as the body's way of asking for help.
By exploring hormonal health, structural causes, nutrient deficiencies, and metabolic health, we can create a comprehensive treatment plan that goes beyond symptom suppression. You don’t need to “just deal with it” or normalise suffering. There are tools, testing, and treatment options that can restore balance and reduce heavy bleeding naturally and effectively.
WHEN TO SEE A DOCTOR
You should seek medical evaluation if:
- Your period is interfering with daily life
- You are experiencing signs of anemia (fatigue, dizziness, paleness)
- Bleeding lasts more than 10 days
- You are passing clots larger than a quarter
- You are over 40 and have a sudden change in your menstrual pattern. Also, if you are post-menopausal (you have gone 12 consecutive months without a period) and you suddenly have uterine bleeding, you must see a doctor immediately.
Working with a naturopathic doctor can help you explore holistic and integrative options alongside your primary care provider or gynecologist.
