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After discussing ‘What does heavy mean and why does it matter?’ The natural next question is ‘So what do I do, if I have heavy menstrual bleeding?’

The first thing to do is to assess that there is no underlying cause that might need other treatment:

An ultrasound can be helpful to rule out fibroids or polyps.

Bloodwork to look at thyroid function and bleeding disorders; as well as bloodwork to assess and treat for anemia and iron deficiency is important.

Cycle history and other health symptoms can give us more insight as to if ovulation is happening, and if ovulation is not happening; and whether PCOS, perimenopause or hypothalamic amenorrhea may be contributing.

We don’t want to miss an underlying reason.

That said, some women will have heavy cycles without underlying reasons, and even while knowing the underlying reason (that reason might just be perimenopause!), may need to have their heavy cycles treated if iron is not being well managed. If iron IS being managed well, we may not need to slow the flow down at all. But if it’s NOT being managed well, this is important as iron deficiency can cause many concerns.

There are many options for treatment and it’s essential to talk to your healthcare provider about the right option for you. These are not all going to be safe and indicated for every person. It’s important to evaluate the pros/cons and risks/benefits of these options at different phases on your journey.

The options that I often discuss with patients include:

Ginger during menstrual bleeding. It can decrease bloodflow by about 20% for many women and is often well-tolerated.
Mirena/hormonal IUD - this is the best studied option and works for 85% of women to decrease blood flow. It is DIFFERENT than the oral contraceptive in that it THINS the uterine lining and does not block your natural hormonal production for most women
Oral contraceptive - blocks ovulation and as such the uterine lining doesn’t build up as much
Tranexamic acid - a medication used DURING menstrual bleeding to slow the flow down as it. Used as first line therapy in other countries. It promotes clotting so can’t be used in someone that has other clotting risk factors
NSAIDs - medication used DURING during menstrual bleeding to slow the flow down. Not as effective as IUD or tranexamic acid, but works well for some people. Need to be careful about digestive risk factors and side effects.
Surgery - ablation or hysterectomy. There are other risks that come with these procedures, so these are not first-line treatment options, but they can be reasonable options for some women with a thorough discussion about what to monitor overtime.

There are other options that exist as well. It’s worth a thorough conversation about what makes the most sense for you at this phase in your life, which might change in another phase of your life. The most IMPORTANT piece to prioritize is to manage iron levels; and to ensure there’s nothing else playing a role.

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Disclaimer:

This content is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, naturopathic doctor, or other qualified healthcare provider with any questions you may have regarding a medical condition or health concern. Never disregard professional medical advice or delay seeking it because of something you have read here.

Hi, I’m Dr. Janine, ND

I’m a Naturopathic Doctor currently practicing in Guelph, Ontario, Canada.
I truly believe that our enjoyment of life is closely tied to how we feel physically. When we’re healthy, we can take on anything. But when we feel off, even the simplest tasks become overwhelming. I’ve been through hormonal shifts, sleepless nights as a parent, and the stress of balancing everything. But I also know that with the right strategy, we can go from surviving to thriving—and create a healthy, thriving family in the process.
I look forward to meeting you soon.
***- Dr. Janine, ND***

Follow me on social media, @dr.janine.nd