In a normal period, you should not lose more than about 80 mL of menstrual fluid over all the days of the bleed. That’s equivalent to about five tablespoons spread over all the days of the bleed.
In episode two of my podcast/YouTube video, I discuss heavy periods including the role of hormone imbalance, mast cell activation, and insulin resistance; simple period-lightening strategies such as iron, zinc, and a dairy-free diet; and using body-identical progesterone to lighten periods.
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Transcript
Did you know that in a normal period, you should not lose more than about 80 mL of menstrual fluid over all the days of the bleed? That’s equivalent to about five tablespoons spread over all the days of the bleed. Of course, some women lose way more than five tablespoons, and today, we’re going to look at that very common problem of heavy periods and, more importantly, at what you can do about it.
Welcome back to my podcast. I’m your host Lara Briden—a naturopathic doctor and author of the books Period Repair Manual and Hormone Repair Manual. I’m Canadian but live in Christchurch, New Zealand and I’m an avid walker. In fact, I just came out from my first solo overnight hike on the beautiful Routeburn mountain track. Solo hiking is a bit easier in New Zealand compared to Canada because there are no bears here. And I’ve encountered bears a few times in Canada, and it’s always a mix of thrilling and a little bit of fear.
Okay. Let’s move on to heavy periods, which can occur at any age but are more common during the teen years and then again in our forties—both times when progesterone is low compared to estrogen. And that brings us to the fact that progesterone makes periods lighter, while estrogen makes periods heavier. And we’ll come back to that.
Keeping in mind that the balance between progesterone and estrogen is only one factor in heavy periods. Other factors include underlying problems such as fibroids, endometriosis, adenomyosis, thyroid disease, and coagulation disorders. All of which I’ve written about in my books, all of which—if present—need to be addressed in addition to the general period-lightening strategies that we’ll discuss today.
Yet one more underlying factor in heavy periods is mast cells, which you probably know is the part of the immune system that releases histamine and causes allergies, hives, anxiety, and arguably premenstrual mood symptoms. But mast cell activation can also contribute to heavy periods because there are lots of mast cells in the uterine lining and, when activated, mast cells release not just histamine but also heparin which is a natural blood thinner and can make periods heavier. And to complicate matters, there’s a curious relationship between estrogen and mast cells. In one direction, estrogen activates mast cells, and in the other direction, mast cell activation and histamine stimulate the ovaries to make more estrogen.
So, there’s a close connection between the “high estrogen” cause of heavy periods and the “mast cell” cause of heavy periods. And knowing all of that brings us to step one of natural treatment which is to calm mast cells. There are plenty of ways to do that, including conventional antihistamine medication. As well as quercetin, turmeric, probiotics, and the strategy of avoiding or quitting alcohol.
But one of the best ways to calm mast cells is to reduce or avoid normal A1 cow’s dairy, at least for a few months. Why? Because the protein A1 casein, which is found in normal cow’s milk, can in some people metabolize to an inflammatory peptide called BCM7, which can—among other things—activate mast cells.
Fortunately, A1 casein doesn’t do that in everyone, only in about one in three of us. And you’ll know if you’re one of the unlucky dairy-sensitive people if, when you were a child, you had recurring infections such as tonsillitis or ear infections. Because BCM7 or A1 casein or normal cow’s milk can have a negative effect on the immune system. Back when you were a child, that negative effect made you more vulnerable to recurrent infections, but you likely outgrew that. Now, that same negative effect of A1 casein on the immune system could be contributing to your period problems.
Dairy that does not contain A1 casein is usually fine for periods, and that includes goat or sheep dairy as well as A2 or Jersey cow dairy. Butter is also fine because it has almost no casein, and obviously, any plant-based milk like coconut, soy, or almond milk is fine. Twenty-five years ago, when I first started asking patients to avoid dairy, it was hard because there were so few options. But now, of course, you can take your pick of yummy goat cheeses
and coconut milk ice creams and other treats.
And if a dairy-free diet is going to lighten your flow, it should start to work within about three cycles. And it might be only one of several things you need to do. For example, if you’re 40-something and dealing with the crazy heavy periods of perimenopause, you’re almost certainly going to also need progesterone which we’ll discuss in a few minutes.
But if you’re young and having the temporary heavy periods of the teenage years, the change to dairy-free might be all you need to do. And if you need more help, you can think about the very simple strategies of iron, ibuprofen, and zinc.
Let’s look at those now. Starting with iron. You probably know that heavy periods can cause iron deficiency but did you know that iron deficiency can make periods heavier? That’s why it’s important to get your iron checked with a blood test called “iron studies” or serum ferritin. And then—if you’re deficient—supplement iron as a way to lighten your periods. Preferably as a gentle chelated iron that won’t cause digestive problems.
Next, ibuprofen—also called Advil or Nurofen brand names—is another way to reduce menstrual flow. Ibuprofen and other NSAID medications work by lowering prostaglandins and according to endocrinology professor Jerilynn Prior, who helped me with both books, ibuprofen taken during the flow can reduce menstrual flow by about half.
Finally, zinc can also help to lighten periods and works by lowering prostaglandins and calming mast cells. Zinc can be helpful when there’s period pain because zinc also improves period pain. And the therapeutic dose is 30 mg throughout all the days of the month—not just during the flow. And please always take zinc with food because zinc on an empty stomach can make you feel sick.
Now. if you’re 40-something, dairy-free plus iron plus ibuprofen plus zinc is a good place to start. But you’ll likely need more because the heavy periods of perimenopause can be very heavy indeed. In fact, about one in three women in their forties develop flooding periods losing up to 250 mL of menstrual fluid in one period, which is obviously far more than the acceptable upper limit of 80 mL.
If you’re in that situation, you’ll need some of the strategies I discuss in Hormone Repair Manual, including antihistamines, calcium-d-glucarate, iodine, and turmeric. Remembering to always take turmeric or curcumin at a different meal than your iron supplement because curcumin can impair the absorption of iron. The other tip around iron absorption is it actually absorbs better if you take it every second day with your largest meal.
In your forties, you’ll also need to identify if you have insulin resistance, also called metabolic syndrome or pre-diabetes. Which is the state of chronically high insulin that causes fatty liver and weight gain around the middle. Insulin resistance can also make periods heavier by thickening the uterine lining and by suppressing progesterone, which, remember, is the hormone that makes periods lighter. If you’re thinking that insulin resistance sounds a bit complicated and like maybe it doesn’t apply to you, I’ll just point out that insulin resistance affects at least one in two women over forty, so there’s a good chance that it does apply to you—even if you have a normal blood glucose. The way to test for insulin resistance is not to test glucose but actually to test the hormone insulin, which I discuss in my books and in a blog post that I’ll link to in the show notes.
Let’s now move on to the final strategy of using natural progesterone to lighten periods.
And when I say progesterone, I mean real progesterone or natural progesterone, which is different from the progestin drugs used in hormonal birth control.
Of course, progestins also lighten periods which is why they are the most common medical prescription for heavy periods and are given as pills, implants, or hormonal IUDs.
All of which have their place. But, as I explained in episode 1 of the podcast, progestins are not real progesterone. And can therefore have side effects including negative effects on the brain and breasts. Fortunately, real progesterone, which is safer, can also be used to lighten periods. Real progesterone goes by the name oral micronized progesterone capsules or the brand names Prometrium, Utrogestan, Teva, or others, depending on your country. There’s a list on my blog of brand names, and I will also link to that in the show notes.
The great thing about progesterone—rather than a progestin—is that progesterone can also be beneficial for mood, sleep, and migraine prevention. And real progesterone is safer for the breasts than estrogen or any progestin.
There’s more information about all of this in my books as well as my blog posts and some resources that I’ll put in the show notes. In particular, in that resources list, please take note of Professor Prior’s document called “Managing menorrhagia without surgery.” It’s an information sheet for doctors about using natural progesterone to lighten periods. So you could print that as a PDF and show it to your doctor.
Thanks so much for listening. Please share and leave a review. And if you want to discuss this topic or ask a question for a future episode, or comment on the Routeburn Track, you can do so on my forum at larabriden.com.
I’ll see you next time when I’ll discuss why polycystic ovary syndrome or PCOS cannot be diagnosed—or ruled out—by ultrasound.