Alternative Treatments for Menorrhagia

Menorrhagia is the medical term for menstrual bleeding that is abnormally heavy or prolonged. The amount of blood loss needed to be diagnosed with menorrhagia is extreme, and the prolonged bleeding often times multiple weeks in length. Menorrhagia affects approximately 10 million American women, mostly in their 40's and 50's, and accounts for 20% of gynecological visits.

The goals of alternative treatments for menorrhagia are the same as the goals of conventional treatment: control the bleeding, prevent and treat anemia, and restore an acceptable menstrual pattern. Through my functional medicine approach to treatment, I look at etiology, nutritional deficiencies, and how these two factors create a pattern of dysfunction. With correct identification of the pattern of dysfunction, treatment of menorrhagia can be more precise and effective.

What Causes Menorrhagia?

This is the million dollar question in menorrhagia treatment, because there is no one etiology. There are multiple underlying factors that contribute to heavy or prolonged menstrual bleeding. Finding the correct etiology defines how it should be treated. 

Understanding normal menstrual function is the foundation of determining specific causes of abnormal menstrual function. the buildup and mechanisms of regular menstrual bleeding occurs weeks before bleeding actually occurs. It begins when the pituitary releases follicle stimulating hormone (FSH) to stimulate the growth of a follicle into an egg, and estrogen begins to stimulate the thickening of the endometrial lining to make a soft home for this egg once it is ovulated and fertilized. Once ovulation occurs, the remaining corpus luteum produces progesterone. If there is no conception, the corpus luteum dies and no more progesterone is made, thus menses begin. Normal menstrual bleeding lasts 2-7 days with a blood volume loss of 80ml. Abnormal menstrual bleeding can be caused by any number of factors that can disrupt this normal pattern. 

• Hormonal Causes include: anovulation (no ovulation), or hypothyroidism
• Mechanical Causes include: abnormal uterine growths
• Genetic Causes include: blood clotting disorders such as vonWillebrand's Disease
• Nutritional Causes include: Vitamin A, Vitamin K, B Vitamins, and Iron deficiency

For some of these causes, traditional western treatment options are the most effective, thus proper etiology diagnosis is key to effects treatment. 

Herbal Therapy for Menorrhagia

The interest in herbs for alternative treatments is growing, as people develop fear in the use of traditional western medications. Although herbs are natural, coming from the plants primarily, they too can have side effects, you can over dose, and there could be negative implications if not used correctly. I always recommend speaking with a trained herbalist before making decisions on taking herbal medications, because they are just that...medications, albeit plant based. Some of these herbs are high specialized for specific presentations, and using the wrong herb at the wrong time may elicit no benefit, or worse cause other complications.

A variety of different herbal supplements have been used to treat menorrhagia. Some have research backing into their effectiveness. Chaste Tree/Chaste-berry (Vitex agnus castus) is probably the most well known. It is used for a variety of menstrual disorders, mostly related to progesterone production. It acts upon the hypothalamus and pituitary gland with its progesterone-like effect, increasing luteinizing hormone and inhibiting the release of FSH resulting in a shift of the ratio of estrogen and progesterone. Vitex doesn't work quickly, though, it can take 3+ months of taking it continuously before results are seen. 

Ginger is another herbs that has been shown to decrease symptomology in menorrhagia cases. It works, primarily, through the synthesis of prostaglandins. Those with menorrhagia, tend to have abnormal levels of arachidonic acid and increased series 2 prostaglandins (The same ones that increase cervical ripening and contractions during labor). Ginger's ability to decrease prostaglandin formation could be the mechanism of action behind it's ability to reduce menorrhagia symptoms.

Nutrition Therapy for Menorrhagia

Whether the underlying etiology is hormonal, mechanical, or genetic, nutrition plays a role in the biochemical mechanisms behind these actions and should also be used in combined treatment. Certain dietary patterns are more effective in reducing menorrhagia symptoms; lower red meat intake, higher fish intake, increase vegetable fat intakes (mostly Gamma Linolenic Acid intake). Individual vitamin deficiencies are also closely linked to increased menstrual dysfunction.

​Vitamin A deficiency has historically been associated with increased cases of menorrhagia. Vitamin A is a cofactor for the enzyme 3-beta-dehydrogenase enzyme, which is required for the synthesis of several steroid hormones, including progesterone from pregnenolone. Serum vitamin A levels are typically lower in women with menorrhagia. Studies using vitamin A therapy show upwards of 90% of patients seeing a reduction in symptomology within 30 days of treatment. 

B vitamin deficiencies have been seen to correlate with menorrhagic cases. B vitamins are needed for proper red blood cell formation, cellular energy metabolism, and estrogen metabolism in the liver. When B vitamin levels are functionally low, the body cannot clear estrogen. Estrogen elevations are seen in cases of heavy bleeding, especially cases with tissue growths, such as endometriosis, as a causative factor. 

Other nutritional deficiencies could also be present, such as iron, vitamin e, omega 3 fatty acids, vitamin K, etc... It is important to have an assessment done by a professional trained in nutritional therapies to determine the correct nutritional support needed for each individual case. 

Acupuncture for Menorrhagia

Acupuncture is a form of medicine that dates back thousands of years. In traditional Chinese Medicine, acupuncture is a central modality in treatment. It involves the insertion of small needles into specific anatomical points on the body. The elicited reaction is described, in TCM, using descriptive terms such as Qi, Yin, Yang, Blood, Fluids, Wind, Damp, etc... These were a way of describing biological reactions that occurred with needle placement. Today Acupuncture is scientific trials is increasing, and research is giving up medical descriptions to these traditional descriptive terms. 

The research available for Acupuncture in the treatment of menorrhagia is limited, but the research that is available is promising. 

In TCM, the pattern of menorrhagia has its own diagnosis, "Ben Lou Syndrome." In TCM Ben means "bursting through" and lou means "leaking," we generally call it "Flooding and Trickling Syndrome." Some of the first writings on the syndrome come for a text book written in the third century B.C.E., now that's old. TCM treatment typically looks at a number of factors including lifestyle, diet, and childbirth history to help diagnose the TCM pattern. Main treatment focus is put towards the blood (obviously), but also the organs in TCM that control the blood, the Spleen and Kidneys. 

If you are interested in trying Acupuncture for your symptoms, remember that treatments for menstrual irregularity is based on your menstrual cycles. Often successful treatment is not seen until months of treatment are administered a new menstrual pattern becomes apparent. I always recommend multiple cycles of treatment before assessing effectiveness, and I also recommend nutritional support in addition.

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My Sources

1. Livdans-Florret AB, Harvey PJ, Larkin-Thier SM. Menorrhagia: A synopsis of management focusing on herbal and nutritional supplements, and chiropractic. J Can Chiropr Assoc. 2007;51(4)
2. Pizzorno JE, Murray MT. Textbook of natural medicine. 3rd ed. St. Louis, Mo.: Churchill Livingstone Elsevier; 2006; 1901–1906
3. Kashefi F, Khajehei M, Alavinia, et al. Effect of ginger on heavy menstrual bleeding: a placebo-controlled randomized clinical trial. Phytotherapy Research. 2015;29:114-119.
4. Daily JW, Zhang X, Kim DS, Park S. Efficacy of ginger for alleviating the symptoms of primary dysmenorrhea: A systematic review and meta-analysis of randomized clinical trials. Pain Med. 2015;16(2):2243-55.
5. Lithgow DM, Politzer VM. Vitamin A in the treatment of menorrhagia. S Afr Med J. 1977 Feb 12;51(7):191-3. 
6. Morton S. Biskind, Nutritional Deficiency in the Etiology of Menorrhagia, Metrorrhagia, Cystic Mastitis and Premenstrual Tension; Treatment with Vitamin B Complex, The Journal of Clinical Endocrinology & Metabolism, Volume 3, Issue 4, 1 April 1943, Pages 227–234, https://doi.org/10.1210/jcem-3-4-227
7. White AR. A review of controlled trials of acupuncture for women’s reproductive health care. J Fam Plann Reprod Health Care. 2003; 29:233–236. 61
   
8. Nestler G, Dovey M. Traditional Chinese medicine. Clin Obstet Gynecol. 2001; 44:801–813. 62 Liu WC, Zhang J, Zhang YM, Pei TF. Acupuncture treatment of functional uterine bleeding – a clinical observation of 30 cases. J Tradit Chin Med. 1988; 8:31–33. 63
   
9. Zhang Y, Wang X. 50 cases of dysfunctional uterine bleeding treated by puncturing the effective points – a new system of acupuncture. J Tradit Chin Med. 1994; 14:287–291. 64