Heavy Menstruation

By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212

Heavy menstruation is called menorrhagia or hypermenorrhea. Menorrhagia is menstruation at a regular cyclical interval with excessive flow and duration; clinically, blood loss is in excess of 80 ml per cycle; or menses lasts longer than 7 days. Aside from the social distress of dealing with a prolonged and heavy period, over time the blood loss may prove to be greater than the body iron reserves or the rate of blood replenishment, leading to anemia.

There are many causes of menorrhagia. The condition should always be diagnosed by a doctor to rule out a variety of potentially serious underlying conditions such as cancer and uterine fibroids. The causes of heavy menstruation are regularly divided into two categories:

  • Functional uterine bleeding: A change in hormone levels is a common cause of abnormal menstrual bleeding.
  • Organic uterine bleeding (non-functional uterine bleeding): it is not caused by hormone imbalance but by underlying diseases. The following causes are quite common.
    • Endometrial hyperplasia
    • Cancer of the uterus
    • Uterine fibroids, uterine polyps or adenomyosis
    • Medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus
    • Pregnancy complications — such as miscarriage or ectopic pregnancy
    • Changes in birth control pills or estrogens that you take
    • Use of certain drugs such as steroids or blood thinners
    • Use of an intrauterine device (IUD) for birth control
    • Recent trauma, surgery, or other uterine procedure
    • Infection in the uterus (pelvic inflammatory disease)
    • Bleeding disorders such as Von Willebrand disease
    • Polycystic ovary syndrome

Conventional treatment
Where an underlying cause can be identified, treatment should be directed at underlying cause. For functional uterine bleeding, hormones are often treatment option, such as progestogen,or oral contraceptive. Non-steroidal anti-inflammatory drugs or tranexamic acid tablets are often used and some surgical procedures such as endometrial ablation, Uterine Artery Embolisation (UAE), or hysterectomy are sometime suggested for severe cases.

Chinese Medicine
Acupuncture and Chinese medicinal herbals offers a natural alternative to medical intervention in the treatment of menorrhagia. Various studies have been performed and the results show the effectiveness of Chinese medicine. The following are some studies from acupuncture. Study by Liu (1988) diagnosed 5 groups of patients who were treated with the appropriate points formulae and needle techniques. Patients received between 7 and 10 daily treatments, with a follow-up 3 months after treatment. The total effective rate was 90% with 80% of patients experiencing significant benefits. An interesting secondary feature of the study is the inclusion of blood tests. Post acupuncture tests revealed the blood cell counts had returned to normal levels.

Another study was performed by Zhang & Wang. They used one acupoint-formula for each along with the appropriate needle technique. Patients in this study received at least 10 treatments, with a follow-up 6 months after treatment. They report “complete cure” in 86% of cases, with 100% “total effective rate”.

In the third study (1994), patients received individualized treatment according to Chinese medical diagnosis. A course of treatment involved daily acupuncture for 4 to 5 days prior to and after menstruation. Patients received no more than 3 courses of treatment. This research found that acupuncture was effective in normalizing the menstrual cycle and regulating ovulation (as evidenced by mid-cycle luteinizing hormone and cervical mucus values) in patients who had previously used oral contraceptives. In 84.2% of cases significant benefits were achieved through treatment. There was no follow-up to gauge the long-term benefits. The authors also observed that those who had used oral contraceptive pill for more than 2-3 years, and those with a history of menstrual disorders before using oral contraception, required more treatments.

Clinical manifestations & treatment principles
There are various causes of heavy menstruation. The common causes of heavy menstruation are heat in the blood, blood stasis, qi deficiency, spleen deficiency, and kidney yin or yang deficiency. The following are the clinical manifestations and treatment principles.

Heat in the blood

  • Clinical Manifestations: excessive menstrual flow with bright red or dark red and viscous menses containing clots, restlessness, thirst, yellow urine, constipation, red tongue with yellow coating and smooth, rapid pulse. Sometimes, this category is accompanied with yin-deficiency such as hectic fever, feverish sensation over the palms, soles and the chest, flushed face and profuse bleeding.
  • Principle of treatment: clear away heat, cool the blood and stop bleeding.

Blood stasis

  • Clinical Manifestations: excessive or prolonged menstrual flow, dark purplish menses with clots, lower abdominal pain and tenderness, dark purplish tongue with petechiae and thready, or unsmooth pulse. Blood stasis may be co-existent with yin deficiency such as red tongue with little coating, dryness of mouth and throat, feverish sensation over palms, soles and the chest, night sweating.
  • Principle of treatment: activate blood circulation, eliminate blood stasis and stop bleeding.

qi deficiency

  • Clinical Manifestations: excessive menstrual flow with pink and thin menses, pale complexion, shortness of breath, weakness of limbs, empty and bearing-down sensation over the lower abdomen or palpitations, pale tongue and thready, weak pulse.
  • Principle of treatment: tonify qi, strengthen the Chong meridian and stop bleeding.

Spleen deficiency

  • Clinical Manifestations: Irregular menstrual cycle, manifested as metrorrhagia or metrostaxis, prolonged menstruation, accompanied with shortness of breath, spiritlessness, pale face, poor appetite.
  • Principle of treatment: tonify qi, strengthen the spleen, nourish blood and stop bleeding

Kidney yang deficiency

  • Clinical Manifestations: prolonged bleeding with a trickle for a long time after the period, late periods, cold feelings, sore back, cold limbs, pale complexion, weak knees and pale urine.
  • Principle of treatment: tonify and warm kidney yang, strengthen Chong meridian and stop bleeding.

Kidney yin deficiency

  • Clinical Manifestations: trickling of blood after the period. Late cycle, dizziness, tinnitus, weak knees, feelings of heat in the evening, night sweats, hot flashes, mental restlessness.
  • Principle of treatment: nourish kidney yin and stop bleeding.

Chinese medicine practitioners treat menorrhagia according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other modalities of Chinese medicine can be used alone, or combined, which depend on individual situation. Acupuncture, once or twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice. Individual patient’s response to acupuncture or herbal medicine is different, so treatment course and modalities chosen differ from person to person.