Heavy menstrual bleeding is one of the more common gynecological reasons why women see their healthcare provider. The experience and results of heavy menstrual bleeding can greatly impact quality of life. There can also be blood loss that leads to iron deficiency anemia, which can result in mild to severe fatigue as well as changes in cognition, exercise tolerance, dyspnea and heart palpitations.
In addition to effectively treating this condition, it’s important to determine the underlying cause of the heavy menstrual bleeding (defined as greater than 80 mL per menstrual cycle). Causes of heavy menstrual bleeding can include a simple anovulatory cycle due to stress or perimenopause, thyroid disorders, uterine polyps, uterine fibroids, adenomyosis, uterine pre-cancer, uterine cancer and von Willebrand syndrome. While some common herbs and medicines can be used to treat a particular episode of heavy menstrual flow, treating the underlying condition is the key clinical objective.
A wide variety of over-the-counter, prescription and herbal medicines can be used to treat heavy menstrual bleeding. Some of these address the acute episode and others address the desire to control the blood loss for the next cycle. Conventional treatments include non-steroidal anti-inflammatory medications (NSAIDS), oral progestins, oral progesterone, hormonal contraception (oral, transdermal, intravaginal, intra-uterine) and tranexamic acid.
Herbal therapies for acute intervention have included herbal anti-inflammatories, herbal astringents, and herbal coagulants. Ginger has proven to be an excellent herb for dysmenorrhea, morning sickness, and now a randomized double-blind, placebo-controlled clinical trial has shown it can help treat heavy menstrual bleeding as well.
In the most recent study, Iranian high school students had regular menstrual cycles but also had a recent history of at least one heavy menstrual cycle. These girls also had no gynecological disease, were not regularly taking hormonal medications or NSAIDS, did not have a vaginal or pelvic infection and were not overweight or obese. In the end, there were 46 girls in each group. Three consecutive menstrual cycles were monitored and scored for blood loss, before starting the ginger or placebo. Ginger capsules contained 250 mg of dried ginger, and the participants took 1 capsule three times daily or placebo capsule 3 times daily, starting from the day before menstrual bleeding until the third day of the menstrual period, for a total of four consecutive days for the three months of menstrual cycles.
Of the initial 92 participants, 71 completed the trial with 38 in the ginger group and 33 in the placebo group. The level of menstrual blood loss dramatically decreased during the three intervention cycles in the ginger group and was significantly better than in the placebo group. The average decrease in heavy menses in the ginger group started the very first month, and was even better the second month and then a little better the third month. There were no average hemorrhage changes in the placebo group. After the intervention, the ginger group decreased in mean hemorrhage by 46.6% and the placebo group by 2.1%.1 Three girls had adverse events in each group: Ginger: 1 heart burn, 1 abdominal pain, 1 diarrhea; Placebo: 1 abdominal pain, 2 flatulence.
I am not surprised by the positive results in this study. I have been using ginger for acute heavy menses for years, although usually in combination formulas with other herbs. Serum levels of Prostaglandin E2 and Prostacyclin are higher in women with heavy menstrual bleeding, which results in vasodilatation and local platelet accumulation, in addition to lower amounts of prostaglandin F2 alpha which is responsible for vasoconstriction. Women with heavy menstrual bleeding also have more PGE2 receptors. It would be logical then that herbs, foods and/or medications that inhibit prostaglandin synthesis and leukotriene formation may provide the needed anti-inflammatory effect to decrease heavy menstrual blood loss. Other research has documented the anti-inflammatory and prostaglandin inhibitory effects of ginger. Several studies, including a 2015 meta-analysis, have also demonstrated that ginger is effective for acute dysmenorrhea.2 Given that acute dysmenorrhea and heavy menses often occur simultaneously, ginger becomes a leading candidate for this common combination of symptoms. This most recent study combined with ginger’s solid safety profile makes it a first line treatment choice to alleviate pain in our female patients while we work to uncover the underlying cause(s) of this common condition.
Dr. Tori Hudson directs the curriculum for post-graduate training in women's health at the Institute of Women's Health and Integrative Medicine, and is the director of product research and education for VITANICA. For more information on Dr. Hudson visit http://drtorihudson.com/.
