Heavy period problems? Natural medicine can help! Heavy period problems can have a variety of causes or contributing factors but a common underlying issue is that of estrogen dominance. This refers to the relative excess of estrogen to progesterone during the menstrual cycle. As estrogen causes proliferation of the endometrial lining and progesterone “stabilises” the endometrial lining, a relative excess of estrogen or relative lack of progesterone results in the lining coming away in a less than coordinated fashion. This results in heavy periods, often associated with clots and pain. In younger women this is often a true excess of estrogen – either via excess production of or failure to metabolise/clear estrogens efficiently. In older women it is more likely a relative lack of progesterone as ovulation becomes less “robust” and more irregular but can also be due to or failure to clear estrogens well. In either case the periods can be heavy. In younger women the periods tend to come more closely together (eg short cycles) less than 28 days but fairly regularly. In older women with more erractic or no ovulation the cycle length can be erratic with the tendency towards “flooding” periods. Additional “estrogen dominant” conditions such as endometriosis, adenomyosis and fibroids may further complicate the matter. In both younger and older women excess body fat can contribute to the pool of estrogens as we make one form, called estrone, in our fat cells. So what to do? The first thing to look at is how effectively you are clearing the estrogens from your system. Remember we not only have to clear our endogenous estrogens that we produce but also the xenoestrogens we absorb from our environment (from a variety of chemicals, pesticides, plastics etc). Our liver is the main metaboliser of estrogen and our is also involved in both estrogen production and clearance therefore both these organ systems need to be addressed for optimal function. I generally recommend starting with a gut “detox” which means optimising our normal flora or “good bugs” with the use of probiotics and prebiotics as well as herbal treatment of “dysbiosis” or “bad bugs” if needed. It is not unusal for women who are estrogen dominant to have an overgrowth of yeast (candida) in the gut and other noxious bugs. These lead to gut and liver toxicity and put more stress on the estrogen detoxification systems. If the gut is sluggish it is important to correct this as bacteria in the gut will break down conjugated estrogens waiting in the faeces for excretion. These freed estrogens get reabsorbed increasing estrogen load. The liver has two main detoxification pathways for estrogen and the efficiency of these pathways can be tested with a urinary estrogen metabolites test. If less than optimal they can be easily corrected by the use of indole 3 carbinol (extracts from Brussels sprouts, cabbages, broccoli) which is why I generally recommend a good dose of these in the diet anyway! We also have several medicinal herbs that support liver detoxification including St Mary’s Thistle and Rosemary. It is extremely important to watch the diet and eliminate all processed foods, minimise sugars (including fruit, no more than 2 pieces daily), take out all caffeine (interferes with optimal metabolism of estrogen) and minimise hard to digest things like red meat, daily and wheat. Also avoid consuming high doses of phytoestrogens such as soy as they will add to the estrogen load. In addition to improving your estrogen metabolism and elimination, herbal medicines can be used to balance the hormonal milieu. Which herbs would depend on many factors but the various classes we have include herbs that raise progesterone (such as Chaste Tree, Wild Yam, Pulsatilla); herbs that act as uterine astringents and tonics (such as Shepherd’s Purse, Beth Root, Tienchi Ginseng) and herbs that help with cramping and spasm (Cramp Bark, Corydalis) to name only a few. Additional measures may include anti-prostaglandins such as Evening Primrose oil to help with cramping and spasm as well as herbs for anemia if present. Magnesium supplementation can also be useful for painful periods and spasm and Vitamin E, Zinc and B Vits can be useful for hormone balance. As every case is different it is important to seek professional herbalist advise so you can be prescribed herbal and nutritional medicine appropriate to your needs.