Heavy Periods: Common, but NOT Normal

Heavy periods are extremely common.

Soaked pads. Missed work. Canceled plans.

Clots. Fatigue. Pain.

But just because something is common does not mean it is normal.

We are Natalie and Jenn (@naturalmamanurse & @holisticwithjenn on instagram), both ER nurses, and we see heavy bleeding come through the emergency room every single week. Some cases are true emergencies. Others are rooted in hormone imbalance, stress, nutrient depletion, or overlooked medical causes. Our goal is to help you know when an ER visit is necessary and how to start to identify root causes to help manage your periods. 

This is educational/informational only. 

Not medical advice.

What is a Period? - A Quick Review

A period is the natural shedding of the uterine lining, guided by shifts in a woman’s hormones throughout her monthly cycle. Each cycle, estrogen and progesterone work together to prepare the uterus for the possibility of pregnancy by developing a nutrient rich lining. When fertilization does not happen, hormone levels fall and that lining is released through bleeding. A healthy menstrual cycle usually reflects healthy communication between the brain, ovaries, thyroid, adrenal glands, and detoxification pathways. It is not just a reproductive event, but a vital sign of whole body health, influenced by nutrition, stress, mineral status, toxins, sleep, and metabolic balance.

When Is Bleeding Too Much: When to Consider It an Emergency

Not all heavy periods are emergency-level, but there are clear red flags when bleeding becomes dangerous. In the ER, we worry when bleeding is heavy enough to cause instability or anemia which would mean that you are losing blood faster than your body can compensate.

You should consider seeking immediate medical care if:

1. You’re soaking through a pad or tampon every hour for two or more consecutive hours.

2. You pass clots larger than a quarter repeatedly.

3. You experience dizziness, lightheadedness, rapid heartbeat, shortness of breath, or fainting.

4. You have severe pelvic pain, or the bleeding starts after sex, trauma, or pregnancy.

5. Your period lasts longer than 10 days and you feel weak, pale, or fatigued.

When bleeding is heavy enough to cause dizziness, weakness, fainting or to require hourly pad or tampon changes, it is considered abnormal menstrual bleeding (also called heavy menstrual bleeding or in medical terms sometimes “menorrhagia”) that requires prompt evaluation.

Common ER-Level Causes of Sudden Heavy Vaginal Bleeding

In my experience working in emergency care, several causes tend to show up most frequently when someone arrives with heavy vaginal bleeding. Among them:

1. Early or incomplete miscarriage

   • In women of reproductive age, miscarriage (especially in the early weeks) is one of the most frequent causes of sudden heavy bleeding. It can present as sudden, heavy, crampy bleeding often with tissue or clots.

2. Uterine fibroids (benign growths)

   • Uterine Leiomyomas (fibroids) are non-cancerous growths in the uterus that can enlarge the surface area of the uterine lining and lead to prolonged, heavy bleeding with clots and pelvic pressure.

3. Hormonal imbalances

   • If ovulation doesn’t occur, progesterone remains low and estrogen continues to stimulate the buildup of the uterine lining. That lining can then shed all at once, causing heavy bleeding. This is called anovulatory bleeding.

   • This pattern often shows up in teens, postpartum, perimenopause, or after stopping hormonal birth control.

4. IUD-related complications

   • A copper IUD can cause heavier, longer periods, especially in the first 6 months after insertion. Mispositioning, infection, or other complications can also trigger heavy bleeding.

5. Postpartum hemorrhage or delayed postpartum bleeding

   • Very heavy bleeding that occurs days to weeks after delivery may indicate retained tissue, infection, or poor uterine tone (uterine atony). These situations often require urgent medical evaluation. Oftentimes, you would ideally be evaluated at the L&D unit that you delivered rather than the ER.

6. Perimenopause (or periods approaching menopause)

   • As cycles become erratic, hormone fluctuations can cause irregular and unpredictable bleeding. Estrogen surges without enough progesterone balance leads to heavy, sometimes unexpected bleeding.

From a Hormonal Perspective: Which Hormones Are Often Disrupted in Very Heavy Periods

When we look at things from a functional or holistic lens, heavy periods are often a sign that hormone balance is off. While not comprehensive, these are some of the most common hormonal contributors:

1. Estrogen dominance (or relatively high estrogen compared to progesterone)

   • Estrogen stimulates the uterine lining to thicken. If progesterone is insufficient, which can happen when ovulation doesn’t occur, that lining can overbuild (get really thick). When it sheds, the bleeding may be heavier and include large clots.

   • Contributors to estrogen dominance can include poor liver detoxification, exposure to xenoestrogens (from plastics, fragrances, etc.), gut dysbiosis, low fiber intake (which impairs estrogen clearance), and diet/lifestyle factors.

2. Low progesterone

   • Progesterone stabilizes the uterine lining and helps regulate proper shedding. When progesterone is low, common in stress, perimenopause, after hormonal birth control, or during anovulatory cycles, the lining becomes unstable and shedding can be irregular or heavy.

   • Low progesterone may also go hand in hand with PMS, mood swings, sleep disturbances, shorter cycles, and other hormonal symptoms.

3. Thyroid hormone imbalances

   • Suboptimal thyroid function (especially hypothyroidism) can slow metabolism and impair the clearance of estrogen. That means estrogen may linger longer, promoting excess endometrial growth and dysregulated bleeding.

   • Studies show thyroid disorders are common in people with abnormal uterine bleeding.

4. Chronically elevated stress / chronically high cortisol

   • Chronic stress can suppress ovulation, lower progesterone production, and increase systemic inflammation. Over time, this can lead to estrogen dominance and dysfunctional uterine bleeding.

   • From a functional-medicine viewpoint, stress regulation is often one of the first “levers” to address in women struggling with heavy or irregular cycles.

Holistic / Functional Ways to Support More Balanced Cycles and Healthier Bleeding Patterns

Heavy, irregular, or painful periods don’t always mean you need medication or hormone replacement. Often your body is simply communicating imbalance. The goal is to support the body so hormones, nutrients, detox pathways, and stress regulation can restore harmony:

• Nourish with real, balanced food that supports stable blood sugar. Eat balanced meals and include adequate protein, healthy fats, and fiber. Focus on whole foods like grass-fed meats, wild fish, eggs, avocado, olive oil, root vegetables, and slow carbs. Avoid skipping meals, and limit caffeine and ultra-processed foods that spike estrogen or cortisol.

• Replenish key minerals / nutrients. Heavy bleeding depletes iron, magnesium, zinc, and sometimes copper. Iron helps rebuild red blood cells. Magnesium supports progesterone production and helps with cramps. Zinc and vitamin B6 support ovulation and a stable luteal phase. Food sources might include leafy greens, shellfish, pumpkin seeds, grass-fed red meat, and sea-salt based electrolyte mixes.

• Support stress reduction and regulate the nervous system. Incorporate gentle movement (like walking, stretching, or yoga), breathing exercises, grounding, or other calming practices. Adequate sleep, rest, and boundaries around stress are important. For some people, adaptogenic herbs (if tolerated and appropriate) may support stress resilience.

• Support liver and detox pathways. The liver is key to clearing excess estrogen. Encouraging healthy liver function can help prevent estrogen buildup: eat cruciferous veggies like broccoli, cauliflower, and brussels sprouts; do liver castor oil packs; maintain good hydration; eat fiber-rich foods to support regular elimination; and avoid excessive exposure to endocrine-disrupting chemicals (e.g., certain plastics, harsh cleaning products, synthetic fragrances).

• Choose non-toxic menstrual care when possible. Conventional pads and tampons may contain bleach, fragrance, or even PFAS. These may irritate delicate tissue or burden your body’s detox pathways. Look for 100% organic cotton pads or tampons, menstrual cups, or period underwear. I love the brands Rael and Cora!

• Use lifestyle practices to support hormone balance. Some people find “seed cycling” helpful: flax + pumpkin seeds during the follicular phase (to support estrogen balance), sesame + sunflower seeds during the luteal phase (to support progesterone). Gentle movement during menstruation or luteal phase; more energetic activity during follicular/ovulatory phase. Prioritize 7-9 hours of sleep per night.

Underlying or Often Overlooked Root Causes of Unusually Heavy Menstrual Bleeding

If heavy bleeding recurs month after month, it’s worth investigating underlying issues. Some often-overlooked contributors include:

• Thyroid dysfunction, especially hypothyroidism: as already mentioned, this can impair hormone clearance and destabilize cycles.

• Iron deficiency / anemia: heavy bleeding can deplete iron stores, which may worsen bleeding and fatigue, creating a vicious cycle.

• Non-hormonal structural issues: fibroids, adenomyosis (when uterine lining tissue grows into the uterine muscle wall), polyps, or even endometriosis. Adenomyosis, for example, often causes heavy flow and painful, clot-filled periods.

• Use of a copper IUD: inflammation or irritation of the uterine lining can lead to heavier, longer, more painful bleeds.

• Ovulatory dysfunction such as Polycystic Ovary Syndrome (PCOS): irregular ovulation or anovulation often means low progesterone, unstable lining build-up, and eventual heavy bleeding when shedding occurs.

• Clotting or bleeding disorders (rare but sometimes missed): some individuals may have platelet function problems or coagulation disorders that prevent proper clotting once the uterine lining sheds, leading to excessive bleeding.

• Nutrient deficiencies beyond iron: low magnesium, zinc, vitamin C, vitamin K2, or other minerals can impair proper uterine function, hormone synthesis, or clotting mechanisms.

• Chronic inflammation, poor gut health, or impaired liver detox: these can impair estrogen clearance, promote hormonal imbalance, and worsen menstrual flow.

What Red-Flag Symptoms Should Never Be Ignored — Know When to Seek Care

These are red-flag signs that are not “normal period discomfort” and needs prompt evaluation:

1. Soaking through pads or tampons every hour (for two or more hours) or needing to double-up frequently.

2. Passing large clots (size of a quarter or larger) repeatedly.

3. Dizziness, fainting, weakness, rapid heartbeat, or shortness of breath are signs of heavy blood loss or early anemia.

4. Severe or sudden pelvic pain, especially new or intensifying pain, which might indicate miscarriage, ectopic pregnancy, ruptured cyst, or other acute pelvic pathology.

5. Fever, foul-smelling discharge, or abnormal discharge accompanying bleeding: possible infection, especially postpartum, post-miscarriage, or following IUD insertion.

6. Heavy, persistent bleeding after birth (postpartum hemorrhage or delayed bleeding). Any heavy bleeding, clots, or foul odor after delivery, especially beyond two weeks, should be evaluated for retained tissue or infection.

7. Any vaginal bleeding after menopause: this is never considered “normal” and always warrants evaluation for possible uterine or endometrial pathology.

If Heavy Bleeding Happens Month After Month — What First Steps I Recommend

If you’re consistently experiencing heavy periods, here are my first-line recommendations to begin to address the root imbalances and better understand what’s happening behind the scenes:

1. Begin detailed cycle tracking

   • Record bleeding days, flow, clot size, pelvic pain, mood, sleep, energy, and even cervical fluid. Over a few cycles, patterns may emerge: irregular cycles, shortened luteal phase, signs of anovulation, or predictable symptom clusters. There are lots of apps that you can download to help track your cycle. A popular one is "Flo".

2. Switch to organic cotton period products

   • This was huge is my life. I had painful periods with severe pelvic cramping and lower back pain until I switched to "clean" period products. This swap is necessary for every woman.

3. Review your environment for endocrine disruptors

   • Everyday exposures like plastics, certain cleaning products, fragrances, and receipts can contribute to chemical “xenoestrogen” load, which may influence estrogen dominance and heavier bleeding. Consider swapping to non-toxic, fragrance-free, non-plastic products.

4. Request foundational labs from your provider

   • Useful labs: full thyroid panel (TSH, free T3, free T4, ideally including antibodies), mid-luteal progesterone (if applicable), estradiol, iron studies (ferritin, iron, TIBC), inflammatory markers (CRP, ESR), and metabolic markers (glucose, insulin, HbA1c) to assess insulin resistance or metabolic stress. These can reveal thyroid dysfunction, anemia, hormonal imbalance, or inflammation. If you are financially able, the DUTCH test is another amazing tool for a deeper look on hormone levels and imbalances.

5. Assess and reduce stress load

   • Ask yourself: am I resting, nourishing, and feeling safe? Or am I in a chronic fight-or-flight state? Supporting the nervous system with gentle movement, breathing, grounding, rest, and nourishing meals matters. Over time, reducing chronic stress can help normalize cortisol, improve ovulation, and support hormonal balance.

6. Focus on nutrition and blood sugar balance

   • Eat protein, healthy fats, and fiber every meal. Avoid long fasting windows or skipping breakfast, especially if you struggle with heavy periods. If you enjoy intermittent fasting, I highly recommend the book, "Fasting Like a Girl" which teaches how to fast around hormone cycles. Prioritize mineral-rich, whole foods to rebuild what’s lost through heavy bleeding.

Holistic Period Products I Personally Recommend

Supporting heavy periods is not only about hormones, nutrition, and stress. The products you put on your body and the remedies you use during your cycle matter too.

Organic Cotton Period Care

Many conventional menstrual products contain synthetic fragrance, chlorine bleach, and plastics that can irritate sensitive tissue and add to the overall endocrine load on the body. Choosing cleaner options is one simple but powerful way to reduce that burden. I personally recommend Rael and Cora for pads and tampons. Both brands use organic cotton and avoid synthetic fragrance, chlorine bleaching, and unnecessary chemicals. These products tend to be gentler on the vaginal tissue, especially for women who already struggle with inflammation, irritation, or heavy bleeding. Many women also notice less odor and irritation when switching to organic cotton options.

• Cora Pads: https://amzn.to/3Mn6euN

• Cora Overnight Pads: https://amzn.to/3MnddUy

• Cora Tampons: https://amzn.to/48rD5Y0

• Rael Pads: https://amzn.to/44cckEu

• Rael Tampons: https://amzn.to/48r61zf

Herbal Support for Cramping and Pain

For cycle related pain and uterine tension, I often recommend Earthley Ease the Ache. This herbal formula is designed to support the body with plant based pain relief rather than masking symptoms with harsh medications. It is commonly used for menstrual cramps, muscle aches, and general discomfort during the cycle.

• Earthley Ease the Ache: Natalie10off for 10% off

Hormone Support with Herbal Cyclical Support

Another favorite is LunaMore. LunaMore is often used to gently support hormonal balance, especially for women dealing with estrogen dominance patterns, heavy flow, or irregular cycles. It works best alongside foundational lifestyle support like adequate nutrition, mineral intake, stress regulation, and proper sleep.

• LunaMore: Natalie10off for 10% off

Your Heavy Bleeding Is Your Body Speaking

If your periods are heavy, irregular, painful, or debilitating month after month, your body is speaking up. We need to not simply suppress the symptoms, but try to uncover imbalances in hormones, nutrients, detox pathways, stress load, or structural health.

For many women, supporting the body holistically through nutrition, stress regulation, detox-safe choices, and mindful cycle tracking, can go a long way toward restoring balance. At the same time, heavy bleeding should never be dismissed lightly. If you’re hitting those red-flag markers (soaking hourly, passing big clots, feeling dizzy or weak, bleeding beyond a week, etc.), it’s important to get evaluated medically to rule out structural issues, anemia, or other serious concerns.

You deserve to have periods that feel manageable, that don’t steal your energy or disrupt your life. With awareness, good support, and gentle care, many of those heavy-cycle stories can lead to balance and easier management.