3 Tests You Need If You Have Heavy Periods in Perimenopause

​It’s something many women have resigned themselves to tolerate and live with, or at least until periods do us part. The heavy periods, the “flooding”, the fatigue associated with it, and sometimes the monthly requirement for sick days. Many women don’t know what’s normal and are not given any many options to deal with them other than anti-inflammatories, the birth control pill, endometrial ablasion, or a hysterectomy. However, naturopathic medicine opens up a myriad of treatment options, which need to be targeted to you and the reason why you are getting heavy periods in the first place. I am a big fan of testing in the right context, since it allows us to then create a more targeted and more effective treatment plan for you.

Women can start getting heavy periods at different points in their reproductive lives, but what I will be covering today is the tendency towards heavier cycles which tends to occur as women start the transition towards menopause. If you’re nowhere near your 50’s, this could still apply to you: perimenopause can start up to 15 years before your periods actually stop! So, many women in their late 30’s start to experience symptoms.

Menstruation 101

Most women have only a very basic understanding of what goes on in their bodies during every menstrual cycle. So that you can breeze through the rest of this blog, let’s give you a rundown of the basics first, shall we? (Psst… Skip over this section if you’re all in the know!)

To begin, by convention, the first day of your menstrual cycle is the first day of your menstrual flow. If you have a day or two of spotting before your full flow starts, those spotting days are part of the previous cycle.

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The two main key players produced in your ovaries are estrogen and progesterone. Estrogen is the predominant hormone in the first half of your cycle until you ovulate, and then progesterone rises and becomes the predominant hormone (along with a second rise in estrogen). Your uterine lining, which prepares for the possibility of a pregnancy every month, goes from being very thin right after menstruation, to thickening up, maintaining after ovulation, and then shedding at menstruation. If you think of the lining of your uterus as a lawn, think of estrogen as the fertilizer which helps your uterine lining grow, and progesterone as the lawnmower which keeps the growth in check.

Estrogen = fertilizer
Progesterone = lawnmower

What happens in perimenopause?

The problem is that in perimenopause, progesterone levels start to dip, usually before estrogen starts to dip significantly. This progesterone dip has to do with irregular ovulation or the poor quality of the eggs that are released. Chronic stress can also decrease your progesterone production.

Fertilizer + no or little lawnmower = out of control lawn = heavy periods

What is an unusually heavy period?

Before we delve into testing, let’s clear up one thing: what defines heavy periods, or “menorrhagia”?
-Losing more than 80mL of blood during your period
-Soaking a pad or tampon every 2hrs or less
And/or
-Your period lasts more than 7 days

Test, don’t guess

If you find yourself in this situation, here are some of the top 3 tests that I would likely order to shed light into what is causing or contributing to your heavy periods.

1. Testing of estrogen and progesterone levels. This can be done either through the blood, saliva, or urine. My preferred method of testing is through urine using a DUTCH test (Dried Urine Test for Comprehensive Hormones) as it gives us so much more information, but each testing method has its place. Women with heavy periods tend to have either higher estrogen levels and normal progesterone, or normal estrogen but low progesterone (giving you a relative estrogen dominance). No matter which way you test, make sure that you’re testing during the right time in your cycle. Since hormones are always doing their dance during your menstrual cycle, you want to catch that time about 7 days after you ovulate, when your hormones are at their peak.
2. Test your iron stores and your hemoglobin levels. The main way that menstruating women lose iron is through their monthly menstrual flow. If your iron level is low, then your blood will be thinner, resulting in a heavier flow. Of course, if you have a heavier flow, then you will likely lose more blood, which then results in even lower iron levels! Low iron stores can make you feel tired, you can get short of breath walking upstairs, can cause anxiety/palpitations/panic attacks.
3. Test your thyroid function. Hypothyroidism tends to show up in women more typically in their 40’s and 50’s. This is partially because, in perimenopause, progesterone levels decrease, and adequate estrogen/progesterone balance is needed for the less active thyroid hormone (T4) to be converted into the more active thyroid hormone (T3) in your body. In terms of heavy periods, you need enough thyroid hormone to get the ovulation process going and produce Lutenizing Hormone (LH). As long as ovulation is delayed, you will be in an estrogen dominant state where the estrogen will build up the thickness of the uterine lining – you could either end up bleeding heavily in an ovulatory cycle because of the longer buildup of estrogen before ovulation, or if you don’t ovulate at all that cycle, the uterine lining could grow to the point that the blood vessels can’t keep up with the growing tissue, the tissue sloughs off, and you get what looks like a heavy period. If you experience the typical symptoms of hypothyroidism, then I would recommend testing a full thyroid panel (which includes TSH, free T3, free T4, anti-TPO antibodies, anti-TG, and reverse T3). Typical symptoms of hypothyroidism include: fatigue, difficulty losing weight, dry hair and skin, hair loss, constipation, and brain fog.

There are other causes of heavy periods, like clotting disorders, fibroids, polyps, or uterine cancer which can be more fully evaluated through a medical doctor due to their access to testing or imaging. If any of these are suspected, then I would refer you to your medical doctor.

Once we know what is going on, we can use our naturopathic tools to help lighten your period and make this transition in your life as manageable as possible! Herbs, nutritional supplements, dietary changes, bio-identical progesterone, and acupuncture can all be helpful to manage heavy perimenopausal periods.

If you’re currently navigating this perimenopausal period of your life and are looking for natural solutions, give us a call and I will be delighted to help you.

References:
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Image from 123rf.com
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Livdans-Forret AB, Harvey PJ, Larkin-Thier SM. Menorrhagia: a synopsis of management focusing on herbal and nutritional supplements, and chiropractic. J Can Chiropr Assoc. 2007 Dec;51(4):235-46.