Menorrhagia

Menorrhagia refers to excessive menstrual bleeding, and can be of two types: functional, which is heavy bleeding during an otherwise normal menstrual cycle; and secondary, with heavy bleeding during menstruation, usually the result of uterine fibroids. Any kind of irregular bleeding however should be investigated by analyzing the case history, and performing pulse, tongue, and iris examination. If no cause is ascertained a laparoscopy, D&C (dilatation and curettage), or hysteroscopy may be required to determine the nature of the bleeding.

Functional menorrhagia is in some way related to a prostaglandin imbalance, usually PGI₂, leading to reduced clotting and dilated blood vessels during menstruation. It is often related to a relative estrogen excess and/or a diet high in saturated fat (which facilitates the growth of bacteria in the lumen of the intestine that deconjugates conjugated estrogens in the bile). The diagnosis of functional menorrhagia requires that hormonal causes are weeded out, best assessed by using a symptothermal chart to assess for ovulation, or any other method, such salivary testing. Using such a chart a woman records her basal body temperature first thing in the morning, before she gets out of bed. When ovulation occurs during mid-cycle there should be a noticeable rise in body temperature, and if there isn’t, this may indicate that ovulation has not occurred, suggesting a progesterone deficiency. (Trickey 1998, 174-79; Berkow 1805-06)

Using botanicals, the treatment of menorrhagia involves the use of astringents to check hemorrhaging and uterine tonics to promote the tone of the uterus. Useful hemostatics include Beth root (Trillium erectum), Yarrow (Achillea millefolium), Tienchi Ginseng (Panax notoginseng), Shepherd’s Purse (Capsella bursa pastoris), Lady’s Mantle (Alchemilla vulgaris), and Cranesbill (Geranium maculatum). Important uterine tonics include Dang gui (Angelica sinensis), False Unicorn root (Chamaelirium luteum), Raspberry leaf (Rubus spp.), Blue Cohosh (Caulophyllum thalictroides), Squaw Vine (Mitchella repens), and True Unicorn root (Aletris farinosa). Hepatics, or ‘liver’ herbs are also an important adjunct, helping to relieving the pelvic congestion that often underlies this condition, as well the conjugation and elimination of excess estrogen. Hepatics include Oregon Grape root (Mahonia aquifolium), Barberry (Berberis vulgaris), Yellowdock root (Rumex crispus), Dandelion root (Taraxacum officinalis), and Stoneroot (Collinsonia canadensis).

Important nutritional supplements include iron (20 mg/day), vitamin A (30,000 IU/daily), oils rich in GLA or EPA (3-5 g daily), vitamin C (to bowel tolerance), and bioflavonoids such as quercitin. Useful foods to emphasize in the diet are fermented legumes, leafy green vegetables, increasing fiber (to improve estrogen clearance), and organic, free-range animal products. If bowel function appears to be impaired the addition of Lactobaccilus and Bifido bacteria to the regimen may be of benefit, as are herbs that contain long-chain polysaccharides that are fermented by beneficial bacteria, such as Burdock root (Arctium lappa), Elecampane root (Inula helenium), and Slippery Elm bark (Ulmus fulva). To this end a diet rich in live culture foods is highly recommended.