NATUROPATHIC DOCTOR IN ONTARIO
How Bioidentical Progesterone Can Treat Menorrhagia (Heavy Periods) in Perimenopause
Heavy Menstrual Flow in Perimenopause
Heavy Periods in Perimenopause
One of the most disturbing symptoms of perimenopause can be menorrhagia (heavy, or even flooding periods). Not only does this deluge of menstrual bleeding cause a great concern for women as it can be severe enough to interrupt their work day with an overflow situation, but it also leads to nutrient deficiencies (including, but not limited to, iron deficient anemia).
Why do periods sometimes get heavier in perimenopause?
There are some women whose hormone levels, after the age of 40, gently and gradually lessen, and their periods therefore gradually lighten. This is the ideal situation. This occurs when a women’s estrogen and progesterone levels decline in tandem, with no relative imbalance.
For other women, progesterone production after ovulation begins to decrease, while estrogen levels remain more constant. This leads to a relative estrogen excess. And once ovulations start to be missed, closer to 50 years old, then a big disparity between estrogen and progesterone levels arises.
How does this impact the menstrual flow?
Estrogen is the stimulator hormone that builds up the endometrial lining. When estrogen is not perfectly opposed by progesterone, the endometrial lining is able to grow more unhindered. This thicker endometrial lining then of course has to be shed, and therefore leads to a heavier period.
How to stop heavy periods in perimenopause?
There are a few ways to lighten heavy menstrual flow in perimenopause:
- Improve liver and gut function to eliminate more estrogen.
- Use herbs to boost progesterone levels. This option includes supporting the adrenal axis to prevent progesterone from being converted to cortisol.
- Use progesterone to block estrogenic activity in the uterus. This can be as bioidentical progesterone, or can be using a progestogen-coated intrauterine device (Mirena or Kyleena for example).
Improve Liver and Gut Function to Eliminate More Estrogen
The liver is responsible for pulling estrogens out of the bloodstream, and integrating them into bile as a first step in the elimination process. The bile is then stored and concentrated in the gallbladder, and with the next meal, is squirted into the small intestine. Depending on the patient’s gut microbiome and dietary constituents, this estrogen will be excreted to a greater or lesser extent. For instance, diets high in indole-3-carbinol (found in cruciferous veggies like broccoli, kale, cauliflower, etc) more readily eliminate estrogen.
Use Herbs to Boost Progesterone Levels
There are certain herbs, like vitex, that are quite effective at boosting progesterone levels, especially if there is a concurrently elevated prolactin levels (which can occur in women with high stress levels).
The body can convert progesterone to cortisol when demands for a stress response are strong. This is why, even without touching the female sex hormones, regulating a woman’s stress levels and stress response can have a huge impact on their hormones symptoms, especially on perimenopausal symptoms.
Use Progesterone to Block Estrogenic Activity in the Uterus
A common intervention for heavy period, especially for heavy periods in perimenopause, is the use of a hormonal IUD. Hormonal IUDs, like Mirena or Kyleena in Canada, essentially block the hormonal feedback that leads to the growth of the endometrial lining. This can be absolutely life altering for some women.
Another option, especially if the woman is experiencing other symptoms that would benefit from increasing their progesterone levels (like anxiety or insomnia) would be to prescribe bioidentical progesterone. This not only regulates their menstrual symptoms, but very much manages any PMS symptoms as well.
What didn’t I do this earlier?
This is what we hear all the time. Women suffer needlessly for years, and then regret not having started seeing a naturopathic doctor and taking care of themselves sooner. Symptoms like heavy periods in perimenopause are usually easily managed.
Your Doctor: Meet Dr. Sarah
Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.
