Your Heavy Cycles Could be the Cause of your Infertility
For women struggling with heavy periods, the mainstay medical treatment is usually birth control pills or an IUD. That is obviously not an option for women wanting to conceive.
Heavy cycles, also called menorrhagia, can be treated effectively and naturally, however, finding the WHY behind your symptoms is an important determinant of therapy success, just as in any infertility case.
Menorrhagia is defined by:
loss of >80mL of blood loss per cycle over several months (14-16 soaked normal sized sanitary products in one flow usually accounts for >80mL of blood loss)
menstrual period lasting >7 days
leaking through 1 or more pads every hour for several hours (leaking at night)
passing of heavy clots during your bleed
Some causes of heavy menstrual cycles are thyroid disease, estrogen dominance (relative excess compared to progesterone), adenomyosis, endometriosis, pituitary malfunction, and nutrient deficiencies. Heavy cycles can be caused by fibroids and polyps but this is much more rare. Clotting disorders (von Willebrand disease) should be investigated if their is a strong family history and if other therapies have been ineffective.
Many of the women walking in to the clinic are rarely investigated for their heavy cycles. It can be a large factor into your fertility case since many of the conditions above can directly effect one’s ability to conceive.
A routine thyroid work-up should always be run for women struggling with heavy cycles. Optimal TSH range for fertility is typically below 2.5 mIU/L. Thyroid antibodies (TPO) should be included since it can show up as being abnormal despite TSH being within optimal range. Hashimoto’s disease (elevated TPO) can also be a cause of your heavy menstrual cycles.
Performing a comprehensive thyroid panel can save most patients from unnecessary surgeries or hormone replacement therapy.
Imaging (ultrasound) is another diagnostic tool that should be performed in patients being suspected of endometriosis, adenomyosis, or uterine fibroids and polyps. Based on other co-existing symptoms, it can be determined if this is necessary. Based on the size and location of the above disorders, medical treatment or surgery may be the best option based on patient’s health goals and timeline.
Measuring hormones, specifically estrogen and progesterone, can give some insight into if estrogen dominance is present. This is not your routine “Day 3” blood work, which provides minimal information regarding why cycles may be heavy. Specialized saliva hormone testing can be performed to determine the interplay of all your reproductive hormones and if there is a relative estrogen excess.
Estrogen excess could also mean you are likely not making enough progesterone to “counteract” estrogen production. This can result in an anovulatory (lack of ovulation) cycle. You want to target the cause of these anovulatory cycles. Common causes are PCOS, high prolactin, high stress (cortisol stealing from progesterone production), thyroid disease, or peri-menopause.
Having heavy cycles can be the only sign of peri-menopause due to the gradual decline in progesterone. Testing other hormones levels, such as FSH and LH could also determine if that is the case or if there is a pituitary issue.
Treatment is always catered to the cause of your heavy bleeding, for example if you are struggling with endometriosis, we implement more therapies that regulate the immune system and bring down inflammation. If your heavy bleeding is of primary nature (ruled out endometriosis, fibroids, adenomyosis, etc), we test for hormone balance and implement therapy to address any nutrient deficiencies.
No one should be enduring heavy cycles and this is not a “normal” part of having a menstrual period. Proper identification and treatment can not only improve your fertility, it can also reduce the need for any unnecessary procedures or surgeries and reduce any long term consequences (ie. iron deficiency).
In good health,
Dr. Kirti Deol