Heavy Periods: It’s Time We Stopped Calling This Normal

7 July

Let’s get one thing straight: bleeding through your clothes, waking in the night to change pads, planning your life around your period, or sitting at your desk pretending you’re not completely depleted… that’s not just “bad luck.”

It’s a sign your body is trying to tell you something.

Heavy menstrual bleeding (HMB) is incredibly common — but that doesn’t make it normal. And it certainly doesn’t mean you have to accept it as your default. There’s always a reason for it. You just need someone willing to look deeper than the surface.

So that’s exactly what we’re going to do in this article — unpack the real drivers of heavy periods, explain what’s often missed in conventional care, and give you a clear roadmap for what to explore next if this is your experience.

What Is Considered Heavy Bleeding — and Why It Matters

If you’ve ever been told your period is “normal” because your blood tests came back fine, or because your iron is low but not low enough, let’s start with the basics.

Heavy menstrual bleeding is defined as:

Losing more than 80 mL of blood per cycle
Bleeding for longer than 7 days
Needing to change pads or tampons every 1–2 hours
Waking at night to change protection
Passing large clots or experiencing flooding
Developing iron deficiency or outright anemia as a result

This might sound clinical, but it has very real impacts. I’m talking about:

Exhaustion, foggy thinking, and that bone-deep tiredness that sleep doesn’t fix
Avoiding intimacy, exercise, social events, or even leaving the house
Anxiety about leaking or embarrassment at work
Repeated iron infusions or supplement cycles that don’t seem to hold

It’s not just a “heavy period.” It’s something that affects your quality of life. And you deserve to know what’s going on underneath.

Why It’s Happening: The Key Drivers I See in Clinic

There is rarely one single cause of HMB — it’s usually a combination of hormonal, metabolic, inflammatory, structural, and sometimes genetic factors. Let’s walk through the main culprits I assess for with my clients.

1. Oestrogen Dominance or Unopposed Oestrogen

Oestrogen’s job is to build up the uterine lining in the first half of your cycle. After ovulation, progesterone steps in to stabilise that lining and help it shed in an orderly way.

If ovulation doesn’t happen (very common in perimenopause, PCOS, post-pill recovery, high-stress states, or thyroid dysfunction), you’re left with unopposed oestrogen. The result?

A thicker, more vascular endometrial lining
Fragile blood vessels that break easily
Bleeding that lasts longer, with more clotting or flooding

This is why it’s not enough to just check if your hormones are “in range.” We need to look at ratios, especially progesterone to estradiol in the luteal phase. Ideally, we’re aiming for around 10:1 (e.g. 50 nmol/L progesterone to 500 pmol/L estradiol).

If that ratio is off — even when everything looks “normal” — you may still be dealing with functional oestrogen dominance.

2. Poor Oestrogen Metabolism (You Don’t Just Make Hormones, You Have to Clear Them)

Making oestrogen is one thing. Getting rid of it is another.

If your liver is sluggish, your gut microbiome is out of balance, or your detox pathways are clogged up (hello, low fibre, stress, poor methylation), then oestrogen metabolites can recirculate and compound the issue.

This is especially relevant if you:

Have a family history of oestrogen-related cancers
Are sensitive to synthetic hormones (e.g. the Pill)
Feel puffy, irritable, or get breast tenderness in the lead-up to your period
Have noticed that supplements or hormone treatments make you feel worse

Key supports here include:

Fibre (especially flax)
Brassica vegetables (broccoli, cabbage, kale)
Liver-supportive herbs (dandelion, St Mary’s thistle)
Targeted supplements like Calcium D-glucarate and sulforaphane (if indicated)…..but remember, we don’t just willy nilly supplement, we get guidance on this with a degree qualified practitioner.

3. Low Progesterone (and the Reasons You Might Not Be Making Enough)

No ovulation = no progesterone. But even if you’re ovulating, you might still have a luteal phase defect or suboptimal progesterone production (I know, it feels confusing and complex sometimes).

We often see this in:

Perimenopause (where cycles become more erratic)
Post-pill recovery (especially after long-term hormonal contraception)
High stress or poor sleep
Under-eating, over-training, or unstable blood sugar
Hypothyroidism

Supporting ovulation and progesterone naturally can look like:

Repleting magnesium, vitamin B6, zinc
Using Vitex (Chaste Tree) in the morning (at the right dose, with the right timing and again, don’t guess with this as it can make things worse)
Eating enough across the day — especially protein and healthy fats
Addressing blood sugar regulation and HPA axis function

And sometimes, when indicated, oral micronised progesterone is a helpful tool — particularly during perimenopause or when fertility is a focus.

4. Prostaglandin Imbalance — The Inflammatory Piece

This one gets missed a lot.

Prostaglandins are hormone-like compounds made from fatty acids that control how much your uterus contracts, how tightly blood vessels constrict, and how much inflammation and pain you feel during your period.

With HMB, what we often see is:

Too much PGE2 (vasodilatory and inflammatory)
Not enough PGF2α (vasoconstrictive and helps stop bleeding)

This can lead to poor uterine tone, flooding, pain, and periods that just won’t quit.

What drives this?

A diet high in omega-6 fats (seed oils, processed food)
Low omega-3s
Gut dysbiosis
Magnesium or vitamin B6 deficiency
Poor liver clearance (again…..this one is to blame for a lot)

Supportive strategies include:

Increasing omega-3s (fatty fish, flax, walnuts, algae oil)
Anti-inflammatory nutrients: curcumin, ginger, zinc, magnesium
Liver and microbiome support
Herbal medicine tailored to your pattern

5. Structural Causes: Fibroids, Adenomyosis, Polyps, or Hyperplasia

Sometimes HMB isn’t purely hormonal — there’s a physical reason.

Key things I screen for:

Fibroids (especially submucosal types that distort the uterine cavity)
Adenomyosis (endometrial tissue embedded in the uterine muscle wall)
Polyps or hyperplasia of the endometrium

These can often be picked up on a transvaginal ultrasound, though sometimes MRI or hysteroscopy is needed for a full picture (especially for adenomyosis, which is notoriously underdiagnosed).

A few signs that make me suspect this:

You’ve tried everything and still flood through pads
Pain isn’t relieved by magnesium or NSAIDs
There’s spotting between cycles or sex is painful
Bleeding is getting progressively worse with age

Treatment here needs to be personalised — but anti-inflammatory support, hormone regulation, and sometimes NAC or glutathione can be incredibly helpful alongside medical imaging and specialist referrals if needed.

6. Bleeding Disorders (Yes, Really — and It’s Often Missed)

This won’t apply to everyone, but it’s important.

Up to 20% of women with unexplained HMB may have an undiagnosed bleeding disorder, like von Willebrand Disease (VWD).

Clues that this might be you:

Heavy periods since your teens
Easy bruising
Nosebleeds
Prolonged bleeding after dental work or childbirth
Family history of bleeding issues

It’s not something to fear — but if your periods are extreme and nothing’s helping, it’s worth ruling out. A basic clotting panel and VWD screen can be organised through your GP or specialist.

Natural Relief While You Get to the Root Cause

Yes, we want to understand and treat the underlying reason for your bleeding — but sometimes, you need something now to help manage symptoms.

Some favourites from clinic include:

Shepherd’s Purse: Astringent, helps reduce flow in real-time
Tienchi Ginseng: Supports clotting and reduces vascular fragility
Vitex: Regulates cycles, supports ovulation, reduces estrogen-driven bleeding
Magnesium citrate or glycinate: Calms cramps and improves uterine tone
Iron bisglycinate: Rebuilds stores gently without constipation
NAC: Particularly helpful if adenomyosis or endo is suspected

Again, do this with someone who understands herbal medicine and supplementation. It is complex and guessing can often make things a lot worse.

Where to From Here?

If you’ve read this far, you’ve probably tried the “take iron and deal with it” approach. Maybe you’ve been offered the Pill, or an ablation, or even told to wait it out until menopause.

But you’re not here for a bandaid.

You want answers. You want to feel like yourself again. And you want a plan that works with your body, not against it.

I might be biased but this is where naturopathy shines — looking at your whole story, running the right tests (not just the basic ones), and putting the pieces together in a way that actually makes sense.

If you take anything out of this article let it be this. You are not broken. Your body is just asking for support. And that starts with listening.

If you would like to have a chat to about seeing a naturopath, having your own 4 month personalised protocol , yoga, reiki or EFT you are very welcome to book in a free discovery call with me. I know it can feel very confusing working out what the right thing to do is and I am here to support you. You can book a free call HERE or if you know its right for you, book an Initial Naturopathic Consultation and we can jump right into getting your health on track and have you feeling amazing in no time.

Carolyn Allen