Heavy menstrual bleeding can affect up to 1 in 4 women (1). It’s defined as blood loss of greater than 80 mL or lasting longer than eight days (2). To visualize this, 80 mL equates to 16 fully soaked regular tampons, or eight fully soaked super-tampons over all the days of your period, or repeatedly soaking through a pad or tampon every two hours.
If you experience heavy menstrual bleeding, please see your healthcare provider. They will likely conduct investigations to determine the cause of your heavy bleeding. Possible causes include adenomyosis, fibroids, coagulation disorders, and “unopposed estrogen,” which means a hormone imbalance of too much estrogen and not enough progesterone (3).
Tip: Progesterone thins the uterine lining and prevents heavy menstrual flow (3).
Another possible cause of heavy periods is hypothyroidism, or underactive thyroid (4, 5).
Tip: The thyroid gland is located in the front of the throat and makes thyroid hormone, which regulates metabolism. When the thyroid is underactive, it cannot make sufficient thyroid hormone.
How can underactive thyroid cause heavy periods?
There are several mechanisms by which underactive thyroid can make periods heavier.
- Without sufficient thyroid hormone, your ovaries may not be able to make enough of the flow-decreasing hormone progesterone (6).
- Without sufficient thyroid hormone, you may not make enough of the coagulation factors you need to prevent heavy bleeding (7, 8).
- Without sufficient thyroid hormone, you make less of the estrogen-binding protein SHBG and so are exposed to more estrogen (3, 7).
If your healthcare provider discovers that you have an underactive thyroid, then your best treatment for heavy periods may be to take thyroid hormone (9).
Lara Briden is a naturopathic doctor with 20 years of experience in women’s health. Her book is Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. Follow her on Twitter and Instagram.
References
1. Fraser IS, Mansour D, Breymann C, Hoffman C, Mezzacasa A, Petraglia F. Prevalence of heavy menstrual bleeding and experiences of affected women in a European patient survey. Int J Gynaecol Obstet. 2015 Mar;128(3):196–200.
2. Fraser IS, Critchley HO, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med. 2011 Sep;29(5):383–90.
3. Melmed, S., & Williams, R. H. (2011). Williams textbook of endocrinology (12th ed.). Philadelphia: Elsevier/Saunders. Page 68.
4. Kakuno Y, Amino N, Kanoh M, Kawai M, Fujiwara M, Kimura M, Kamitani A, Saya K, Shakuta R, Nitta S, Hayashida Y, Kudo T, Kubota S, Miyauchi A. Menstrual disturbances in various thyroid diseases. Endocr J. 2010;57(12):1017–22.
5. Weeks AD. Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia. BMJ. 2000 Mar 4;320(7235):649.
6. Datta M, Roy P, Banerjee J, Bhattacharya S.Thyroid hormone stimulates progesterone release from human luteal cells by generating a proteinaceous factor. J Endocrinol. 1998 Sep;158(3):319–25.
7. Poppe K, Velkeniers B, Glinoer D. Thyroid disease and female reproduction. Clin Endocrinol (Oxf). 2007 Mar;66(3):309–21.
8. Squizzato A, Romualdi E, Büller HR, Gerdes VE. Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: a systematic review. J Clin Endocrinol Metab. 2007 Jul;92(7):2415–20.
9. Stoffer SS. Menstrual disorders and mild thyroid insufficiency: intriguing cases suggesting an association. Postgrad Med. 1982 Aug;72(2):75–7, 80–2.
