Saturday, January 20, 2018

Heavy Periods? Yeah, You Can Change That

I received a couple of questions in response to my post about Menstrual Cups for the Sensitive  relating to heavy menstrual flow and cup capacity. It is true that the heavier your flow, the more often you will need to empty your cup, and/or go with a larger sized cup - defeating the comfort of a smaller cup. While I myself have always had a four day period of light-to-medium flow, I completely understand the heavy flow problem. Let me explain.

I had always been accustomed to pretty regular periods, never lasting longer than four days, and fairly cramp-free. In fact, the only real symptoms I experienced were boob swelling and salty cravings. I always opted for OB Regular, or better yet, Slender Junior if I could find them, and a thin liner. I have never had any need for those crazy-absorbent super 'overnight' pads or tampons. Before menstrual cups became widely available, I used to use an old, small (size 65) diaphragm left over from the late-'80s when I suddenly became unable to tolerate the pill. When I moved to the UK and got the far better cervical cap, I ditched it immediately. But I hung onto it for years because it worked beautifully for use at night during periods. (Cervical caps don't work for that because they are so awesomely teeny.)

Just for fun, here's a cervical cap (hello, old friend!) & a diaphragm, pic courtesy of the awesome British National Health Service (NHS) where you can go to a Family Planning Centre and get free contraceptive care (at least you could c.1991):
Image result for small  ortho diaphragm

I remember this period fondly, before I found the Copper-T IUD, which lasts 12 years, is 99+% effective and is oddly unknown in the US. They were my BFF's for 20 years; I can't believe I ever put up with the Pill's side effects in my 20s. That was before I had met Iudia. (just like menstrual products, we are ridiculously far behind)
When the SoftCup came out, I thought: Great! Because that's basically all it is: a disposable diaphragm for period use. Yeah, not great. Not at all. The thing is basically shaped like a huge clunky diaphragm - much bigger than I would ever have been able to use - and worst of all, it has a thick, clunky square-edged(!) hard plastic rim. Not the soft, rounded spring of a diaphragm. Again: you might as well just put in your special order for a UTI. 

Here's an idea of different sizes; the SoftCup resembles that frisbee-sized option in the back:
Image result for small  ortho diaphragm

I digress. (Anyone who reads this blog will not be surprised by that.) Anyhoo. After 25 years of having easily predictable and manageable periods, a year ago my period didn't come. Since I'm 51, I thought: this is it! Menopause is here. Yeah, no. Perimenopause was here. When my period returned, after a 3-month hiatus, it did so with a vengeance. Lasting for 20 days, 10 of which were heavy bleeding. 

Yeah. That's what I thought: W....T....F?! Although my B.S. is in Women's Studies (now called Gender Studies, but whatevs) and my specific area of emphasis was women's reproductive health [irony alert] that means I knew a great deal about contraceptive options...and precious little about perimenopause. Because, I dunno, I figured I'd get to that later, you know, when it applied to me. So. I was shocked by the level of blood loss, which amounted to 7 times my usual amount. (I actually got a test for anemia afterward). Worst of all, I had to get up in the middle of the night because even the medium menstrual cup, normally enough for a full 8 hours, could not cope with the amount of flow. I instantly had So.Much.Empathy for my heavy flow friends. 

I very quickly did a huge amount of research into this whole issue of heavy flow. In my case, it's called 'flooding' and many women will have at least one episode of it when they reach perimenopause, and it tends to worsen. Or, it can just be a onetime thing. I was hoping it was that. I came across so many desperate women online who were at the point of surgical intervention. I tend to be a little crunchy, but also very pragmatic. I research naturopathic and conventional approaches, then take the best and leave the rest. While I hoped that 20 day apocalyptic adventure was a one-off, because I tend to be a pessimist, I immediately ordered two herbal supplements (in liquid extract form) on Amazon:
  • Lady's Mantle and Shepherd's Purse
These are time-honored plants for reducing blood flow, both menstruation and post-partum; they are usually used in tandem, with Shepherd's Purse being the stronger and faster-acting. There is lots of fascinating history. For example, Lady's Mantle is so-named for it's resemblance to the cloak worn by medieval women, which fell in graceful pleats; the leaves are fuzzy and hold dewdrops, which then catch refracted light and sparkle like jewels, hence its other name, Dewcup. I happen to have an English-style cottage garden and Lady's Mantle was used to edge the borders. So I made my own tincture by soaking the dried leaves in vodka, but while I waited the month for this to be ready, I bought some on Amazon. 
 Image result for Lady's Mantle

Shepherd's Purse is aimed more toward reducing blood loss quickly, and it tastes pretty astringent. So named because the shape is reminiscent of the bags traditionally carried by shepherds.

Image result for Shepherd's PurseImage result for traditional Shepherd's bag
Good thing too, because just 3 weeks later, the same thing happened. This time I used the Lady's Mantle and Shepherd's Purse, multiple doses a day, and after 5 days the bleeding reduced and slowed, finally ending after 10 days. OK, so they cut the flow by 1/3, and the duration in half - 10 days is better than 20 days - but still, not acceptable. 

Also, while I usually prefer liquid tinctures, in this case, the amount required is a lot, and the cost would become higher. So I found a capsule formula that worked even better and is more cost effective. I took 2 capsules, twice a day for the first couple of days. You can take much higher doses if you're really trying to get the bleeding under control. It has the uninspiring name of Menstrual Reg. The first two ingredients are Lady's Mantle and Shepherd's Purse. There's also Yarrow, Chasteberry, and False Unicorn, all herbs with a long, honorable history as remedies for women.
I did more research. And learned two very simple, and inexpensive, options:
  • Ibuprofen. For reals. Several studies have been done showing that this alone can reduce your flow by 30-50%. That's huge. It appears you're likely to get the best results if you start taking it right when your period begins, or better yet, a day or two before it starts. And if you take the Rx level dose of 600-800mg a couple times a day, which is 3 or 4 Advil, or 1 or 2 Aleve. The 2nd article describes just taking the low OTC dose of 200mg, and a resulting reduction of 25%. So, you can try either. (Usual disclaimers of "I'm not a health professional, do your own research, use common sense, & make your own decisions, yadda yadda" apply.) 
Specifics here
And here

Personally, I found this did work to reduce flow by about 25%, however I only used the low dose because I have one kidney and NSAIDs are one of the few things I need to use very conservatively; otherwise, I would have opted for the higher dose. But in the end, I decided to simply address the root reason that my flow was so heavy in the first place, with:
  • Progesterone cream. For me, this completely resolved the heavy flow, restoring my normal, light 4-day period, within just one cycle. 
Basically, when flow is heavy it very often means there is an imbalance in the hormone ratio, with estrogen being high, and progesterone low. Not that either of those hormone levels are too high/low in & of themselves, but rather that their ratio to one another is out of balance. 

In real (as opposed to highly scientific)  terms, here's how it plays out: estrogen is what encourages the uterine lining to grow rich and fluffy, but fragile. Progesterone is what turns off the switch and says 'OK, lining, you're fluffy enough: stop and stabilize'. But when estrogen steamrolls over progesterone, the lining gets pretty over-the-top (like a house of cards, the bigger it gets, the more unstable) and then there's no smoothing out, no gradual easing into the shedding process. Result: lining releases chaotically, and because it grew needlessly fluffy, its got a lot to release. Hello, heavy, long period. But if you can steady that teeter-totter between estrogen and progesterone....Yahtzee! You can restore moderate, efficient bleeding.

Other good indicators that your estrogen level is too high in relation to your progesterone? You're approaching perimenopause (ages 35-50) or you've had issues with PCOS, or you know you have a short post-luteal phase (often concurrent with PCOS). That means that the time between ovulation and menstruation is too short. So, if the average period is 28 days, then ovulation is usually around day 14. But if your post-luteal phase is short, that means ovulation is happening around day 18 or 20, with you period starting 8-10 days later, due to that shortage in progresterone. Restoring that balance does all kinds of other good things for PMS, fertility, mood swings, etc, but that's all beyond our scope, here. This post is already in danger of becoming a novel.

So how did I use the progesterone cream? I just applied around a 1/4 - 1/2 tsp alternating areas with thinner skin (insides of wrists, belly, tops of feet) every day for 10 days out of the month, specifically that post-luteal phase above, so day 15-25. It sounds complicated, but it really isn't. I was pretty lackadaisical about it; I didn't measure exactly, just glopped some out and eyeballed it. And I wasn't too exact about the days either, just aiming for 1/2way into my cycle. 

Didn't matter. The results were fast and everything I'd hoped for. The first cycle I did this, my period was normal. And has been every month since. I occasionally still use Lady's Mantle tincture or some Advil on the first day of my period, if it seems to be on heavy side, but most often, I don't even need that. It's pretty incredible that a $15 cream so effectively stopped the escalating pattern of heavy periods coming every 3 weeks and lasting 10-20 days.

The brand of cream isn't as important as that it contains actual progesterone (not just yams). I've used a few different brands I've had good results with, and they are not the most spendy, either.

NOW products have always been reliable for me, and very reasonably priced. 
Smoky Mountain Naturals is also a decent choice. LifeFlo, too. The best is probably Ona's Naturals. More spendy, but also 30% more concentrated. Plus I like supporting small, woman-owned companies.
(No, there are no affiliate links; this is just what I use myself.)  

So, this was the result of all my desperate research, and what worked for me.  The important thing is that you don't have to put up with needlessly heavy bleeding that disrupts your life. I've never minded my periods, and as I've grown older -without getting too feminist goddess-worshippy here- I've come to kind of, not exactly enjoy them, but to appreciate them. 

Bottom line: It always feels great to realize that you can gather knowledge, consider all of the choices, and then take control of your own health.