Everybody’s period is unique. Some last only a few days with a light flow, others last a week with a heavier flow, and they can be anything in between. If you have started to see changes in your menstrual flow, or you are wondering if the amount of blood you’re losing is normal, it is completely natural to feel worried.
Under normal conditions, menstrual blood loss should only be around 2 to 3 tablespoons of blood every month (about 30-45ml).(1) It is normal to have heavier and lighter flow days throughout your period. Having some small clots is also considered normal.
Menorrhagia
Menorrhagia, or heavy menstrual bleeding, is basically defined as excessive menstrual blood loss which interferes with a person’s physical, social, or emotional quality of life. Clinically speaking, it includes blood loss greater than 80ml, or around 1/3 of a cup, or a period that lasts longer than 7 days.(1)
Having heavy menstrual bleeding is really common, with around 1 in 5 Australian women being affected (2). This can sometimes go hand in hand with a lot of pelvic pain. That being said, menstrual bleeding that is so heavy that it interferes with your daily life is never normal.
You should be able to wear a standard pad or tampon for three to four hours without needing to change it. You should be able to wear a singular menstrual product without having to double up. You should be able to leave your home without having to pack extra menstrual products and a spare change of clothes. Most importantly, you should be able to go about your life as normal without having to miss out on work and activities that you enjoy.
Well, diet and exercise has been found to bring a range of health benefits as well as improving the experience of having a period.
Let’s look at 4 key nutrients that can specifically help you (manage your heavy periods).
But, Lovely lady, do know that while I am looking at four key nutrients, don't feel overwhelmed. This is how I can work with you, to bring all the food combinations together in an easy practical way (and without needing to cook like Jaime).
Iron
Iron is a key nutrient in blood, so when we bleed our iron stores are depleted. Your body needs iron to produce a protein in your red blood cells called haemoglobin. This protein carries oxygen to your body’s organs and tissues, and transports carbon dioxide from your organs and tissues back to your lungs.
When you have very heavy periods, it can be quite easy to develop a condition called iron deficiency anaemia, where your body lacks adequate healthy red blood cells
(3,4). Symptoms of this condition can be quite mild at first so you might not even notice them, such as fatigue, weakness, pale skin, dizziness, brittle nails, and strange cravings to eat items with no nutritional value such as ice cubes. The good news is that it can easily be diagnosed with a blood test.
Consuming more iron in your diet isn’t going to do a great deal to reduce your periods, but it is associated with increased general health and wellbeing and decreased fatigue. This boost in energy will help make dealing with your period easier as well as help you do everything you need to throughout the day.
Women, especially those with heavy periods, need around 18mg of iron per day (5). This is compared to men who only require 8mg per day. It has been found that many women are not consuming enough iron, which is possibly due to not knowing that the requirements are so high.
“Eat more meat” is probably one of the most common pieces of advice that you will hear when talking about how to increase your iron intake. Foods like meat, poultry and seafood are the richest sources of heme iron, which is better absorbed by the body when compared to non-heme iron.(6) You can find non-heme iron in foods like fortified grains, nuts, seeds, legumes, and vegetables.(6)
Let’s have a look at the iron content of some commonly consumed foods (6).
Kangaroo (100g cooked) – 4.4mg
Tofu (100g) – 5.2mg
Lean Beef (100g cooked) – 3.1mg
Milo (4 heaped tablespoons) – 6mg
Lean Lamb (100g cooked) – 2.7 mg
Iron fortified breakfast cereals (30g) – 3mg
Lean Pork (100g cooked) – 1.4mg
Oats (1 cup cooked) – 1.3mg
Chicken (100g cooked) – 0.9mg
Cooked spinach (1/2 cup) – 2.2mg
Chickpeas (100g) – 6.2mg
At first glance you might want to gravitate towards foods like milo and chickpeas as they seemingly have a higher iron content than the other foods listed. These kinds of foods are sources of non-heme iron, which are poorly absorbed by the body. Dependent on your iron store levels, your body is estimated to only absorb around 15-35% of heme iron and 2-20% of non heme iron (7,8). We tend to get most of our iron from non-heme sources (estimated to be about ~85-90% of intake), even though it does have a lower absorption rate (7,8).
So, what can you do to enhance absorption of non-heme iron?
Vitamin C has been shown to enhance iron absorption as it captures and stores it in a form that your body can absorb easily. Foods rich in vitamin C include citrus fruits, pineapple, strawberries, dark leafy greens, capsicums, and tomatoes (6).
A few studies have shown that the presence of vitamin A may also increase the amount of iron absorbed. In the next section, I’ll be going further in depth about rich sources of vitamin A (9).
Meat, fish, and poultry along with providing well-absorbed heme iron, have been found to stimulate the absorption of non-heme iron (10,11). Some studies found it comparable to vitamin C while others found absorption was around 2.5 times greater (10,11).
Vitamin A
Studies have found that adult women who experience heavy menstrual bleeding may have low levels of vitamin A and that supplementation may reduce the intensity of the period (3,7,8). It is important to note that this association has not been heavily researched, and most of the studies have only been done on small groups of people.
One of these studies where this association was found, used vitamin A to treat 40 women with heavy menstrual bleeding due to a variety of factors (8). The participants received a high dose of vitamin A for 35 days. An overall reduction in blood loss was shown with 92.5% of participants reporting relief (8).
Even though this study was quite small, it does demonstrate a potential of vitamin A to reduce the amount of blood loss during your period. So, if you have a heavy period it might be worth trying to increase the amount of vitamin A in your diet.
Before we look at rich sources of vitamin A, let’s have a look at its different forms. So, there are two main forms in the human diet: preformed vitamin A and pro-vitamin A carotenoids (9). Preformed vitamin A includes retinol and retinyl esters which comes from animal products, fortified foods, and vitamin supplements (9). The carotenoids on the other hand include beta-carotene, which is converted into retinol, can be found in plant foods (9).
A wide range of breakfast cereals, juices, dairy products, and other foods are fortified with retinol (9). You can find carotenoids in many different types of fruits and vegetables as well as some supplements (9). Rich sources of vitamin A include:
Leafy green vegetables such as kale, spinach, and broccoli
Orange and yellow vegetables such as carrots, sweet potato, and pumpkin
Tomatoes and red capsicum
Beef liver
Fish oils
Milk
Eggs
Fortified foods
Omega-3 Fatty Acids
So, what are fatty acids? Fatty acids are the building blocks of the fat that we store in our bodies and in the food that we eat. Many studies have identified a positive association between fatty acids and the reduction of cardiovascular disease and blood pressure, aiding infant development, diabetes prevention, as well as countless other benefits for other health conditions. Essential fatty acids include omega-3 and omega-6, which are necessary for optimal health and must be obtained through food.
Omega-3 has reported benefits in relieving menstrual pain and cramping and is believed to have a blood thinning effect when consumed in large quantities(3,7,10-14) This may prove useful if you have thick, heavy periods with lots of blood clots.
They are found naturally in some foods and are fortified into others. Eating a variety of foods will help you to meet your requirements.
Sources of omega 3 include:
Fish and other seafood, in particular cold water fatty fish such as salmon, mackerel, tuna, and sardines
Nuts and seeds, such as walnuts, flaxseeds, and peanuts
Plant oils, such as flaxseed oil, soybean oil, and canola oil
Fortified food like certain brands of eggs, milk, soy beverages and yoghurt
Supplements like fish oil, krill oil, cod liver oil and algal oil
It is important to speak to your dietitian or GP to work out what would work best for you.
Vitamin E
Vitamin E is a fat-soluble vitamin, that comes in several forms. Alpha-tocopherol is the only form that can be used by the body. There have been a few studies which have demonstrated that consuming high doses of vitamin E can ease menstrual cramps and reduce menstrual blood loss (15-19).
One of these studies was done in combination with a hormonal intrauterine device (IUD).15 This research showed that women who experienced heavy menstrual bleeding by using the IUD for birth control found relief from taking vitamin E at 100IU per day (~67mg of vitamin E) every second day for two weeks (15). It is important to note that the cause of IUD-induced menstrual blood loss is different to other types of menorrhagia. This means that it is possible that taking supplements of vitamin E or increasing your intake might not help with heavy bleeding that is not associated with using an IUD.
Other studies that focused more on menstrual pain, which is often associated with heavy periods, combined vitamin E with other supplements (17-19). One study found that combining omega-3 and vitamin E supplements effectively reduced menstrual pain when compared to the three other participant groups; those given a placebo, those only taking vitamin E, and those only taking omega-3 supplements (17). Other
studies found that combining vitamin C and vitamin E effectively reduced the severity of menstrual pain (18,19).
So where can I find vitamin E? It is found in plant-based oils, nuts, seeds, fruits, and vegetables. Rich sources include:
Wheat germ oil
Sunflower seeds and oil
Almonds
Peanuts and peanut butter
spinach
Pumpkin
Red capsicum
Mango
Avocado
What is the bottom line?
There is surprisingly very few studies out there about heavy periods in general, when you consider how common it is. These studies become even fewer when looking at how diet can play a role in the management of this condition. Even though the research is limited, a positive association had been shown between including rich sources of vitamin A, vitamin E and omega-3 in your diet and reducing menstrual blood loss.
In general, a diet rich in calcium and vitamin D, and low in animal fats, salt and caffeine may also help ease troublesome PMS symptoms. Avoiding salt can help ease common PMS symptoms like fluid retention, abdominal bloating, breast swelling and pain. It has been found that consuming large amount of caffeine can increase the severity of menstrual cramps.
A balanced diet that is high in fruits and vegetables, nuts, seeds, fish, low fat dairy products, protein and a variety of whole grains is almost always recommended. Lean meat is an important source of iron and protein especially for women with heavy periods.
When working with me 1:1, I can analyze your current intake to assess if you are meeting key nutrient requirements that can help you manage your heavy periods. If blood loss each month is worrisome for you and you are interested in managing it through change to your diet, the consider my 8 week coaching program RESTORE. This is where I work along side you each and every day; supporting, educating and guiding your food choices to optimise your health and wellbeing.
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