• Megan Gross

Heavy Menstrual Bleeding & Hormone Imbalance

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Heavy menstrual bleeding or menorrhagia is defined as bleeding that soaks one pad or tampon in an hour, bleeding that lasts for more than seven days, needing to change menstrual products in the night, or having blood clots with bleeding that are the size of a quarter or larger. Though this is a very common occurrence in women, it does not mean it is normal. Heavy bleeding is caused by a multitude of factors and I will be discussing them in a series of posts. Today’s post will cover heavy bleeding caused by a hormone imbalance.

Hormone Imbalance

There are four main hormones that control the menstrual cycle. Estradiol (estrogen), Progesterone, Follicular Stimulating Hormone (FSH), and Luteinizing Hormone (LH).

The menstrual cycle begins on the first day of your period when you experience bright red bleeding (spotting doesn’t count). A normal cycle can be anywhere from 24 days to 38 days in length. Usually you ovulate about 12-16 days before your next period is due. Most sources will say that you ovulate on day 14, but that is usually only for those with 28-day cycles.

On day one when your menstrual cycle begins, you enter the follicular stage of your cycle. During the follicular phase, your estrogen and progesterone levels are rather low as your uterine lining sheds and FSH rises slightly to aid in the support and maturation of an egg preparing for ovulation. Immediately prior to ovulation you should experience a spike in both estradiol, as well as FSH and LH. Ovulation will usually occur between 16-32 hours after the LH surge begins and can sometimes be felt. The feeling that you have when you experience ovulation pain (mittelschmertz) is the follicle rupturing as the egg is released.

After ovulation you enter the luteal phase where your estrogen stays relatively elevated, and the progesterone rises. FSH and LH are now decreased. The function of estrogen is to build up the uterine lining should a fertilized egg implant, and progesterone helps by inhibiting the smooth muscle contraction of the uterus and preventing the lining from being shed. Progesterone is released by the corpus luteum or the follicle from which the egg was released. Once the corpus luteum breaks down and progesterone levels drop, the next menstrual cycle starts.

Oftentimes, an imbalance of estrogen and progesterone can cause heavy menstrual bleeding. If there is an excess of estrogen and not enough progesterone, heavy cycles are more common. This happens frequently in adolescence and during because these are the times when women are more likely to experience anovulatory cycles, or a menstrual cycle when you don’t release an egg. Because of this, you don’t have a corpus luteum to aid in providing progesterone, which leads to an overproduction of the uterine lining.

How do I know if I have a hormone imbalance?

This is a great question and there are several schools of thought on this. The best way to test hormone imbalance would be to use a salivary or urine hormone test as it measures more than one hormone level throughout the day. The problem with blood tests for hormones is that you are only testing the hormones at one time on one day and hormones are constantly changing and shifting.

If you have questions about hormone imbalance causing heavy menstrual bleeding or any other symptoms, feel free to email me contact@megangrosscnm.com


Megan Gross, CNM 

805 Century Dr.

Suite 5

Dubuque, IA 52002

(563) 293 6225

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