Updated: Nov 20, 2020
It's pretty likely you've experienced at least one heavy period in your life time.
Heavy flow is most common in our teen years and during peri-menopause, when hormone levels are shifting. Your flow may also change in volume or consistency following child-birth.
But how do you know whether your flow is heavy, healthy or not quite right?
I want to kick things off by saying - your body is unique, and there is no 'one size fits all' for periods - or any other part of your health for that matter.
It's about determining your normal, observing consistency and knowing when things are out of balance.
That said, let's get to know the generally agreed upon guidelines for healthy flow.
Healthy menstrual bleeding generally looks like this:
Duration: 4-6 days (excluding spotting)
Colour range: dark brown – bright red
Consistency: fluid and may contain small clots
Blood loss: Usually around 35mL (one soaked standard tampon or pad holds 5mL. 35ml is around seven soaked tampons or pads.)
Symptoms: gentle fatigue, introversion, dull ache in womb/thighs, slightly increased bowel motion.
Signs of unhealthy bleeding include:
Duration: Less than 3 or more than 6 days of consistent bleeding.
Colour: Black, very dark purple, yellow, orange. These are likely signs of illness or infection.
Consistency: Very heavy bleeding with large clots that are painful to pass. Or very light, watery, scant bleeding.
Blood loss: Officially blood loss of 80ml or more - that's 16 soaked regular tampons or more per period. But in practice, a period that soaks from 9-12 tampons/pads per cycle is considered to be heavy.
Symptoms: Pain, cramping, bloating, indigestion, diarrhoea, nausea, fainting, complete exhaustion, emotional distress.
Menorrhagia is the medical term for 'very heavy flow' and is defined by blood flow of over 80ml and is often accompanied by iron-deficiency anemia as your body struggles to keep up the iron loss each cycle. Menorrhagia usually involves dark-red blood with clots that may be painful to release.
Metorrhagia is the term for irregular bleeding or break-through bleeding. Essentially bleeding that occurs outside your period. This kind of bleeding deserves it's own post, because there's alot to say about it, but the bottom line is, if you experience irregular bleeding it would be good to schedule an appointment with your reproductive healthcare provider to check it out.
A note on blood loss - please be mindful that tampons and pads need to be soaked for them to add up to 5ml. If you use a menstrual cup it's quite easy to monitor your flow as there are usually markings on the inside of the cup.
What causes heavy flow?
Hormones: in short estrogen is in charge of thickening your endometrial lining, whereas progesterone is required to thin it. Progesterone occurs in the second half of your cycle, and you need to ovulate in order to make it.
So in one scenario, no ovulation = no progesterone = high or unopposed estrogen = heavy bleeding.
High estrogen can also be exacerbated by poor liver and bowel clearance - more on this later.
Anovulation: if you're not ovulating, you've got to figure out why. Stress, illness and under-nutrition are among the top causes of a lack of ovulation. An easy way to tell if you've ovulated? Charting your basal body temperature daily.
Endometriosis - Endometriosis is a trickster - a complex condition involving multiple body systems and can feature inflammation, painful periods and high estrogen. There is a lot you can do to holistically support your body with the symptoms of endometriosis, and again, this deserves it's own post.
Hypothyroidism - low thyroid hormones can impact period flow making them heavier, a thyroid panel including TSH, T3 and T4 will show if your thyroid is under functioning - ask your doc.
Miscarriage, abortion and the morning after pill may cause you to have a heavy period, this should be relatively acute and not show up consistently in your cycles.
Other causes - these are some of the more common reasons for heavy flow, and this ain't an exhaustive list. To get to the root cause of your heavy flow I recommend working with a herbalist, naturopath or holistic reproductive practitioner.
What can you do for heavy flow?
Chart your cycle to see if you're ovulating take your basal body temp daily and look for cervical mucus changes, this gives you key insights about your hormones and can help you understand underlying causes of heavy flow.
Poop daily - regular bowel movements help eliminate excess estrogen from the body, a high fibre diet of with anti-inflammatory whole foods can help keep your bowel moving.
Avoid dairy - A1 protein in cow's milk dairy drive inflammation in the body leading to menstrual pain and heavy flow. Avoid dairy for 3cycles and see if it makes a difference.
Eat more soy, flax and Red clover - Trifolium pratense these plants help reduce excess estrogen through competitive inhibition at estrogen receptor sites. (Yes there is some controversy around soy - while I still use it - here's my caveat; please purchase non-gmo, organic, unsweetened and naturally fermented soy. For more info about soy and why as part of a balanced and nutritious diet I'm on board - see the excellent article in the reading list below. And of course, always trust your body - if soy isn't right for you, then steer clear).
Meet your heavy-flow allies.
1. Yarrow - Achillea millefolium.
Yarrow has a profound relationship with blood. It has been used throughout antiquity to staunch the battle wounds of fallen soldiers, internally Yarrow has the ability to slow the flow, so to speak.
Yarrow belongs to the Asteraceae and is a hemostatic, astringent, diaphoretic and tonic herb that contains many constituents including - flavonoids, tannins, bitters, alkaloids, camphor and cineole.
Yarrow works by "regulating blood flow to and from the surface, in and out out of capilliaries and venules" - Matthew Wood.
Yarrow is a bit magical because it's used in cases of both heavy menstrual flow, and scanty, slow-to-start bleeding too.
How? Yarrow works by regulating and bringing tone to the venous system.
For anyone who's worked with Yarrow, you'll know that this plant has many qualities and uses -in colds and fevers, for wounds and lacerations, to support digestive tone - which go beyond the scope of our discussion here. So in keeping to our point today, Yarrow's anti-haemorrhagic action is mainly used in uterine bleeding - in other words - Yarrow can be very helpful in supporting your heavy flow.
How to use:
Tea - add 2tsp per cup boiled water, allow to steep 5-10minutes and drink up to 3 cups per day. (Do not exceed 6-12g herbal tea daily).
Tincture - 1 dropperful (1:2) in a little water or tea at onset of period, every hour, for a maximum of 5 dropperfuls per day.
Please note Yarrow is contra-indicated in Pregnancy (it contains thujone) and cautioned in Breastfeeding (it contains thujone and can be very drying), please seek herbalist support.
2. Ladies Mantle - Alchemilla vulgaris
Ah, Ladies Mantle the little alchemist, who brings tone to your womb and reproductive organs.
Ladies Mantle is in the Rosaceae (relative of Rose and Hawthorn) and is an astringent, anti-haemorrhgaic and hemostatic containing glycosides, saponins and tannins.
This combination of constituents gives Ladies Mantle her unique ability to bring tone to the womb, and slow heavy bleeding - once upon a time, Ladies Mantle was also known for her ability to heal wounds.
I find Ladies Mantle especially useful in scenarios where heavy bleeding is associated with a lack of pelvic tone, like when cycles have been heavy or 'never well since' child-birth, miscarriage or abortion.
How to use:
Ladies Mantle leaves are used medicinally and harvested before flowering, while tender and green.
Tea: 2 tsp per cup boiled water, steep 10-15minutes and drink up to 3cups per day. Tea is quite pleasant and blends well with more flavourful herbs like mint or rose.
Tincture: (1:2) 1dropperful or 20drops in a little water or tea up to four times day.
Not recommended: Though not usually contra-indicated in pregnancy, I stray away from using reproductively-acting herbs during pregnancy unless there is a good reason and you're working with a herbalist who can support your process. So I would caution the use of Ladies Mantle in pregnancy.
3. Cinnamon - Cinnamomum Zeylandicum
Spicy, warming Cinnamon! It may seem like a strange period-ally but Cinnamon is a powerful herb, relatively common kitchen friend and tasty friend making it a great choice to add to blends and tea.
Cinnamon belongs to the Lauraceae and is a warming astringent, a carminative and an anti-microbial containing many constituents including volatile oils, tannins, sesquiterpenes, pro-anthocyanidins, mucilage, starch, and sugars.
I've used Cinnamon to help support diarrhoea, where it's astringent action helps to brings tone back to the bowel. It's this same warming-astringency action that helps to slow the flow of blood during your period.
Since Cinnamon is more of a general astringent and has such a wonderful affinity for digestion, I don't tend to use it by itself for heavy periods.
When combined with a uterine-tonic like Ladies Mantle it then has direction in the body and knows where to go.
When heavy blood flow is associated with coldness or a lack of tone in the uterus, Cinnamon's spicy-ness is a great addition to bring warmth to the womb.
How to use:
The inner-bark of the Cinnamon tree is used, so please be sure to source thoughtfully.
Add to herbal tincture blends or tea.
Contra-indications: Don't use in pregnancy, if you have stomach ulcers or are lactating. (The small amounts you would use in cooking - like when you make a cake or hot chocolate - during pregnancy are o.k. you just don't want to consume large amounts in tincture form.)
Slow flow - a tincture blend
Tincture blend: Yarrow 50%, Ladies Mantle 40% & Cinnamon 10%.
This is a powerful herbal blend that can be helpful in slowing heavy flow.
Take 1-2 dropperfuls in water or tea every hour on the first day of bleeding for up to six hours.
(Do not exceed 15mls aka 15 dropperfuls daily.)
Not for use in pregnancy or lactation.
A word about tinctures; I'm used to using stronger tinctures like 1:2 extractions in my clinical practice. Home-made herbal tinctures are generally closer to a 1:5 extraction, so there will be some variance in dose, depending on the strength of alcohol used and the quality of the herb you used to start with.
Also, as an Aussie living in the US, I still love the metric system! Oooh division - you're so easy! No weird fractions! (What the heck is 11/16ths anyway?)
I'm slowly getting my head around ounces and pints and such, but you'll have to bear with me as I navigate this brave new imperial world.
Tea blend: Ladies Mantle + Yarrow.
2tsp of Ladies mantle and 2tsp of Yarrow, per cup boiled water, allow to steep 10-15minutes. Drink up to 3 cups per day.
You could add some honey, rose petals or maple syrup to sweeten.
BTW, there are many herbal allies that can support and court your flow and help you nourish underlying causes. The best way to learn about herbs is to first do a little reading (to make sure what you're choosing is well aligned and suitable for use) and start bringing them into your life. An experienced herbalist can help you choose the right allies for your body. And finally, trust how the herbs feel in your body - if they don't feel good, stop using them and seek guidance.
Final thoughts on heavy flow
Pay attention to your body, everything is connected.
To gain some clarity on your heavy flow, ask yourself some key questions;
When did my heavy periods begin? What was happening in my life at that time?
How heavy are my periods? (use a menstrual cup or count your soaked pads or tampons).
What other symptoms are associated with my heavy flow? Pain, cramping, nausea, indigestion... etc. (Each symptom is a clue to your underlying causes)
How are my stress-levels? (Stress is a big disruptor of cycle health).
How have I been nourishing myself with food and exercise? (What you eat and how often you move impacts your period).
Occasionally you'll have a heavy period, and recognise that it was due to passing stress, or changes in your diet, these occasional heavy periods are likely nothing to be concerned about - just a reminder to take care of yourself.
If you have consistently heavy periods or notice your period shifting, getting heavier, more painful or erratic over say, three cycles or more, that indicates something is going on and is a call for deeper inquiry to find out the root cause of imbalance.
Your body is amazing and the right nourishing support can help you to heal and thrive.
Wishing you nothing less than a restorative, gentle, healthy flow,
Gabrielle Jansen BNat is an Australian herbalist and fertility educator with a professional background in natural health.
She lives, works and writes from her small cabin in rural Maine and wants nothing more than for you to have easy breezy periods.
Struggling with heavy flow? Want a little support?
1:1 sessions now available via Zoom. Find out more here.
References and extra reading;
Blankespoor (2011) Phytoestrogens, Chestnut School.
Briden (2020) What dairy does to periods. Period Revolutionary.
Prior (2017) Very heavy menstrual flow. Centre for Menstrual Cycle and Ovulation Research.
Trickey (2011) Women, Hormones and the menstrual cycle. Melbourne Holistic Health Group, VIC, Australia.
Taylor et al. (2017) Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein. J Adv Nutr. Sep; 8(5): 739–748.
Wood, M. (2009) Earthwise Herbal. North Atlantic Books, Berkeley California.
Chec, R. (2000) Making Plant Medicine. Horizon herbs, Oregon.
Thomsen & Gennat (2009) Phytotherapy Desk Reference. Global Natural Medicine, Tasmania.