Heavy menstrual bleeding is one of the more common gynecological reasons why women come to their health care provider. The experience and results of heavy menstrual bleeding can greatly impact quality of life just due to frequency of needing to attend to bleeding protection in the bathroom, restricting her desire or ability to go out of the house for daily activities or social engagements and limiting her exercise. Other consequences are the blood loss leading to iron deficiency anemia. Not only can this result in mild to severe fatigue, but changes in cognition, exercise tolerance, dyspnea and heart palpitations. The bigger picture is determining what is causing 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 particular to each of the causes mentioned.
A wide variety of over the counter, prescription and herbal medicines can be used. 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 women’s herb, for dysmenorrhea, morning sickness, and now a randomized double-blind, placebo-controlled clinical trial.
In the current study, Iranian high school students had regular menstrual cycles and a recent history of at least one heavy menstrual cycle. These were girls who 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 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.
A scoring system for blood assessment was charted. 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 %. Three girls had adverse events in each group: ginger= 1 heart burn, 1 abdominal pain, 1 diarrhea; placebo= 1 abdominal pain, 2 flatulence.
Commentary: I have been using ginger for acute heavy menses for years, although mostly in combination formulas with other herbs, so I am not surprised by the very good results of this study. Serum levels of Prostaglandin E2 and Prostacyclin are higher in women with heavy menstrual bleeding, which results in the vasodilatation and local platelet accumulation in addition to lower amounts of prostaglandin F2alpha which is responsible for vasoconstriction. Women with heavy menstrual bleeding also have more PGE2 receptors. It would be logical then that herbs and/or 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. My most recent two favorite studies of ginger in women’s health has been for acute dysmenorrhea. Given that acute dysmenorrhea and heavy menses often come together, ginger becomes a leading candidate for this common combination of symptoms. However, don’t forget my earlier comments that it is always important to come to some determination as to the cause…. even if the conclusion is temporary anovulatory heavy bleeding.
Kashefi F, Khajehei M, Alavinia, et al. Effect of ginger on heavy menstrual bleeding: a placebo-controlled randomized clinical trial. Phytotherapy Research 2015;29:114-119.