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DESCRIPTION
Dysfunctional uterine bleeding (DUB) is bleeding that is not related to a woman's normal menstrual pattern and is not associated with tumor, inflammation, or pregnancy. Most often occurs in women age 40 years and over or in adolescents.
Abnormal premenopausal bleeding (AUB) refers to any bleeding that deviates from the normal menstrual cycle before menopause. These deviations include menstrual bleeding that is abnormally infrequent (oligomenorrhea), abnormally frequent (polymenorrhea), excessive (menorrhagia or hypermenorrhea), deficient (hypomenorrhea), or irregular (metrorrhagia [uterine bleeding between menses]). Rarely, menstrual symptoms are not accompanied by external bleeding (cryptomenorrhea). Premenopausal bleeding may merely be troublesome or can result in severe hemorrhage; the prognosis depends on the underlying cause. Abnormal bleeding patterns often respond to hormonal or other therapy.
- Oliogmenorrhea: Cycle length greater than 35 days.
- Polymenorrhea: Cycle length less than 21 days.
- Amenorrhea: Absence of menses for 6 months, or absence of menstrual periods for 3 normal months.
- Menorrhagia: Heavier and increased flow occurring at regular intervals or loss of more than 80 ml of blood.
- Metrorrhagia: Irregular episodes of bleeding.
- Menometrorrhagia: Longer duration of flow occurring at unpredictable intervals.
- Postmenopausal Bleeding: Bleeding that occurs more than 12 months after the last menstrual cycle.
- Dysfunctional Uterine Bleeding: Excessive, erratic, or irregular bleeding not associated with intrauterine pathology.
INCIDENCE
Abnormal uterine bleeding is a common presentation in primary care, but is often complex and difficult to diagnose. One national study found that menstrual disorders were the reason for 19.1 percent of 20.1 million visits to clinicians for gynecologic conditions over a 2-year period. Furthermore, a reported 25 percent of gynecologic surgeries involve abnormal uterine bleeding. Between 30 to 50 percent of all hysterectomies are due to abnormal bleeding and fibroids, yet 20 percent of hysterectomies are associated with normal uterine pathology. Many conditions may be associated with abnormal uterine bleeding, including anovulatory cycles, chronic medical conditions, and systemic illness. Conditions may also be associated with intrauterine pathology. Dysfunctional uterine bleeding is defined as abnormal bleeding in the absence of intracavitary or uterine pathology.
MENSTRUAL BLOOD LOSS
Most women prior to menopause will establish a menstrual cycle that occurs every 21 to 35 days. Normal menstrual flow lasts 3 to 7 days, with the majority of blood loss occurring within the first 3 days. Normal menstrual flow amounts to 35 ml and consists of effluent debris and blood. Patients with menorrhagia lose more than 80 ml of blood with each menstrual cycle and often develop anemia. Practically speaking, women count the number of pads, tampons, or other menstrual products to gauge the amount of bleeding. A pictorial blood analysis count greater than 100 ml generally indicates blood loss of more than 80 ml per cycle. The sensitivity is 81 percent and specificity is 87 percent accurate in predicting blood loss. In general, most normal menstruating women use five to six pads or tampons per day and do not complain of social embarrassment or inconvenience. Approximately 16 mg of iron is lost with each menstrual cycle, but this rarely results in anemia in women with adequate intake of dietary iron. If a woman complains that she is inconvenienced, socially embarrassed, or alters her lifestyle due to menstruation, a workup should be promptly instituted.
FREQUENT SIGNS & SYMPTOMS
ABNORMAL BLEEDING
Bleeding between menstrual cycles. Blood flow may be irregular, prolonged, sometimes very heavy (flooding) and may contain clots.
Bleeding not associated with abnormal pregnancy is usually painless, but it may be severely painful. When bleeding is associated with abnormal pregnancy, other symptoms include nausea, breast tenderness, bloating, and fluid retention. Severe or prolonged bleeding causes anemia, especially in patients with underlying disease such as blood dyscrasia and in patients receiving anticoagulants.
Abnormal bleeding is associated with an array of symptoms. Frequent complaints include:
- Heavier or prolonged menstrual flow.
- Social embarrassment.
- Diminished quality of life.
- Sexual compromise.
- Alteration in lifestyle.
PAIN
Pain is not a common presenting symptom unless associated with passage of large blood clots.
ANEMIA
Incessant menstrual blood loss can be associated with anemia. Typical complaints of anemia include:
- Fatigue.
- Unusual food cravings for ice, starch, or dirt (pica).
- Headaches.
Severe anemia may cause:
- Fainting.
- Congestive heart failure.
- Exercise-induced fatigue.
- Shortness of breath.
- The inability to perform routine activities.
Dysfunctional uterine bleeding is rarely associated with the need for a blood transfusion unless it is a chronic condition. Hemorrhagic shock and death are rare.
CAUSES
Usually caused by an overgrowth of the endometrium (lining of the uterus) due to estrogen stimulation. With dysfunctional uterine bleeding ovulation (the development and release of an egg from the ovary) occurs periodically.
Causes of abnormal premenopausal bleeding vary with the type of bleeding:
- Oligomenorrhea and polymenorrhea usually result from anovulation due to an endocrine or systemic disorder.
- Menorrhagia usually results from local lesions, such as uterine leiomyomas, endometrial polyps, and endometrial hyperplasia. It may also result from endometritis, salpingitis, and anovulation.
- Hypomenorrhea results from local, endocrine, or systemic disorders, or from blockage due to partial obstruction by the hymen or to cervical obstruction.
- Cryptomenorrhea may result from an imperforate hymen or cervical stenosis.
- Metrorrhagia usually results from slight physiologic bleeding from the endometrium during ovulation but may also result from local disorders, such as uterine malignancy, cervical erosions, polyps (which tend to bleed after intercourse), or inappropriate estrogen therapy. Complications of pregnancy can also cause premenopausal bleeding. Such bleeding may be as mild as spotting or as severe as menorrhagia.
PATHOPHYSIOLOGY
The hallmark of normal menstrual bleeding is the final result of fluctuations in the hypothalamic-pituitary-adrenal-ovarian axis leading to predictable denudation and sloughing of the endometrium. Hemorrhage followed by prompt hemostasis and repair causes stabilization and regrowth of the endometrium. Physiologically, constant low levels of estrogen prime the endometrium. Normal secretion of progesterone from the corpus luteum stabilizes the endometrium, decreases vascular fragility, and supports the endometrial stroma. Patients with menorrhagia typically have an imbalance of prostaglandin levels and increased fibrinolytic activity. Specifically, women with heavy bleeding often have elevated levels of plasminogen activators compared to those with normal menstruation.
An intact coagulation pathway is important in regulating menstruation. Menstruation disrupts blood vessels and in the face of normal hemostasis, the injured blood vessels are rapidly repaired. Restoration of the blood vessel requires successful interaction of platelets and clotting factors. Deficiency of platelets, abnormal platelet function, and an intact coagulation pathway may be associated with profound changes in the menstrual cycle.
Abnormal uterine bleeding can usually be classified as either anovulatory bleeding or ovulatory dysfunctional bleeding. Anovulatory dysfunctional uterine bleeding is usually due to failure of the corpus luteum to sustain the developing endometrium. Anovulatory bleeding can be episodic or continuous. Patients with anovulatory cycles typically do not experience constitutional premenstrual symptoms. Cycles that vary in length by more than 10 days from one cycle to another are likely anovulatory.
Puberty and the perimenopausal years are typically associated with anovulatory menstrual cycles. The immature hypothalamic-pituitary axis does not develop the necessary hormonal feedback to sustain the endometrium. Likewise, the decline of inhibin levels and rise in follicle-stimulating hormone (FSH) levels reflect the loss of follicular activity and competence as the perimenopausal transition occurs.
Ovulatory dysfunctional bleeding occurs when ovulatory cycles coexist with intracavitary lesions including polyps, hyperplasia, endometrial cancer, or fibroids, which cause erratic bleeding. Patients who ovulate typically have the following symptoms: breast discomfort, increased mucoid vaginal discharge midcycle, premenstrual cramping and bloating, mood, and appetite changes.
RISK INCREASES WITH
Polycystic ovary syndrome.
Obesity.
Use of synthetic estrogen without added progestin.
PREVENTIVE MEASURES
Maintain proper weight.
Follow medical advice regarding any hormone therapy (do research about this treatment before using it).
EXPECTED OUTCOME
Usually curable with treatment.
POSSIBLE COMPLICATIONS
Anemia.
Cancer (considered rare, but risk may be higher if disorder is untreated).
TREATMENT
GENERAL MEASURES
DIAGNOSIS Diagnosis requires a detailed history and review of systems, a thorough physical examination, and appropriate laboratory testing. A detailed clinical history will reveal systemic and medical conditions that cause menstrual dysfunction. Inherited and acquired disorders of coagulation, liver, and renal diseases frequently present with symptoms of abnormal uterine bleeding.
PHYSICAL EXAMINATION
The physical examination must be detailed and complete, even in the presence of heavy bleeding. Initially, a thorough inspection of the skin is important, particularly to establish the presence of acanthosis nigricans (seen in women with insulin resistance and anovulation), ecchymosis, or hyperandrogenism (hirsutism, acne, clitoromegaly, or male pattern baldness). Thyromegaly should be ruled out. A thorough gynecologic examination should be performed with a systematic evaluation of the vulva, vagina, cervix, uterus, adnexa, bladder, and rectum. Special attention to the cervix is important to exclude cervicitis, ectropion, sexually transmitted ulcerations, and cervical polyps. The speculum should be rotated to fully visualize the vaginal fornices and to establish the absence of ulcerations or foreign bodies. The patient should be instructed to empty her bladder to facilitate the evaluation of the adnexa as well as the uterine contour, size, and the presence of uterine tenderness.
DIAGNOSTIC TESTS
Numerous diagnostic tests may have been done previously to rule out any benign or malignant disease that could cause the bleeding. Dysfunctional uterine bleeding is the usual diagnosis for women without discernible causes (a catch-all diagnosis).
The history and physical examination should be used to guide the choice of laboratory studies. The typical clinical picture confirms abnormal premenopausal bleeding. Special tests identify the underlying cause:
Pregnancy testing should always be performed in sexually active women (even those who have had a tubal ligation) and in adolescents (even those who deny sexual activity).
In those who have persistent vaginal bleeding after pregnancy, a beta-human chorionic gonadotropin should be checked to exclude trophoblastic disease.
In addition, prolactin levels should be checked if the patient complains of galactorrhea, oligomenorrhea, or decreased libido.
Serum hormone levels reflect adrenal, pituitary, or thyroid dysfunction. Thyroid-stimulating hormone should be evaluated to exclude hypothyroidism or hyperthyroidism.
Liver and renal function tests should be checked in women with signs or symptoms of systemic disease.
Urinary 17-ketosteroids reveal adrenal hyperplasia, hypopituitarism, or polycystic ovarian disease.
Complete blood count rules out anemia.
Endometrial sampling (biopsy) rules out malignant tumors and should be performed in all patients with pre-menopausal bleeding who are older than age 35 or younger if risk factors for endometrial hyperplasia or malignancy are present. This procedure involves insertion of a thin tube into the uterus to obtain a sample of the lining to determine if bleeding is associated with ovulation.
MoonDragon's ObGyn Procedures: Endometrial Biopsy
Ultrasound is increasingly used to evaluate the thickness of the uterine lining and to exclude other causes of the bleeding. Transvaginal ultrasound (TVUS), saline infusion sonography (SIS), hysteroscopy, or magnetic resonance imaging (MRI) may be used in selected cases.
Pelvic examination, Papanicolaou (Pap) test, and patient history rule out local or malignant causes. A Pap smear should be performed to rule out cervical causes of bleeding, with biopsy of any visible lesions, even if cytology is negative.
If testing rules out pelvic and hormonal causes of abnormal bleeding, a complete hematologic survey (including platelet count and bleeding time) is appropriate to determine clotting abnormalities.
SPECIAL CONSIDERATION: VON WILLEBRAND DISEASE
Von Willebrand factor (VWF) causes platelets to adhere to sites of blood vessel injury; the lack of this protein causes abnormal bleeding. Von Willebrand disease results from low levels of VWF (Type 1), abnormal VWF (Type 2), or total absence of VWF (Type 3). Von Willebrand disease (VWD) is the most common bleeding disorder in women, affecting 1 to 2 percent of the population, and 10 to 35 percent of women with menorrhagia. A survey of women with VWD revealed that 95 percent experienced menorrhagia compared with 61 percent of controls, and 59 percent of women with VWD experienced postpartum hemorrhage versus 21 percent of controls. Other gynecologic aberrations experienced by women with VWF include pain with ovulation, hemorrhagic ovarian cysts, intraoperative bleeding, antepartum bleeding, postpartum hemorrhage, wound complications, and miscarriage. Women with profuse menorrhagia and normal uterine size should be screened for VWD; 13 to 20 percent of women offered surgical intervention may have the subtle form of Type 1 disease.
The American College of Obstetrics and Gynecology (ACOG) recommends testing for VWD in adolescents with severe menorrhagia, adult women with significant menorrhagia without another apparent cause, and in women undergoing hysterectomy for menorrhagia. The College suggests that the single best screening test for VWD is von Willebrand ristocetin cofactor activity (platelet function screen). More recently, the platelet function analyzer PFA-100 has been shown to be both sensitive (90 to 100 percent) and specific (88 to 95 percent) in the detection of VWD and platelet function disorders.
Referral to a hemophilia treatment center or hematologist with an interest in hemostasis and thrombosis is imperative in women with abnormal test results or normal test results but a persuasive bleeding history.
SPECIAL CATEGORIES OF ABNORMAL UTERINE BLEEDING
PRE-PUBERTY
Vaginal bleeding in girls younger than 9 years of age deserves special mention. In these patients, sexual abuse should always be considered. Foreign bodies, vulvovaginitis, urologic (urethral prolapse), precocious menstruation, and neoplasm should also be considered in the differential diagnosis.
ADOLESCENTS
Anovulatory bleeding contributes to most abnormal vaginal bleeding in adolescents. However, adolescents who require hospitalization, present with a Hgb less than 10 g/dL, or require blood transfusion, have a risk for coagulopathies approaching 20 to 30 percent. Specifically, adolescents need evaluation for VWD with ristocetin cofactor assay or platelet function screen before initiating hormonal therapy. A rare cause of menorrhagia in this group occurs from congenital or acquired arteriovenous (AV) malformation. When traditional surgical approaches aggravate the condition, AV malformation should be suspected and diagnosed by pelvic arteriography.
PERIMENOPAUSE
Perimenopause begins with the first clinical signs of approaching menopause (usually cycle irregularity and vasomotor symptoms), and finishes 1 year after the last menstruation. Most women who present with abnormal uterine bleeding are between 30 to 49 years of age. Smokers experience menopause 1 to 3 years earlier than non-smokers and have greater rates of menstrual disturbance.
In North America, the average duration of menopausal transition is 4 years, and its hallmark is menstrual irregularity. Approximately one-half of women by age 45.5 years, three-quarters of women by age 47.8 years, and 95 percent by age 50.8 years will experience menstrual abnormalities. Intermittent anovulation during perimenopause causes recurrent bouts of dysfunctional uterine bleeding and associated physical complaints: bloating, cramping, water retention, fatigue, decreased mental clarity, diminished concentration, vaginal dryness, hot flashes, and night sweats. The hormonal milieu is characterized by decreased inhibin levels, variable estradiol levels, and normal FSH. Menstrual cycles may be episodically ovulatory and predictable, followed by episodes of erratic menses. This is often frustrating for the patient and clinician because the pattern of bleeding changes dramatically.
A retrospective review of 500 perimenopausal women categorized bleeding patterns as follows:
- Hypomenorrhea (70 percent)
- Menorrhagia, metrorrhagia, and/or hypermenorrhea (18 percent)
- Sudden cessation of menses (12 percent)
It is not necessary to obtain an FSH, luteinizing hormone, or estradiol level in these patients because the hormonal milieu fluctuates. The patient history most accurately determines perimenopausal status. When evaluating women with perimenopausal menstrual irregularities, pregnancy and cancer must be excluded. Most pregnancies in perimenopause are unplanned and associated with a high degree of miscarriage and therapeutic abortion. The incidence of uterine cancer ranges from 10 to 40 cases among 100,000 women 40 to 50 years of age and increases to 110 cases per 100,000 women aged 70 years. Among women under 50 years of age with endometrial cancer, identifiable risk factors include: obesity, nulliparity, irregular menstrual cycle, and polycystic ovarian pathology. Risk is increased threefold in women 9 to 23 kg more than ideal body weight and tenfold in women more than 23 kg above ideal body weight.
Hormonal contraceptive therapy (pills, patches, or vaginal rings) in perimenopause should be the first line of therapy rather than conventional hormone replacement therapy; traditional doses of postmenopausal hormone replacement therapy do not suppress ovulation or prevent pregnancy. In healthy, nonsmoking women greater than 35 years of age, oral contraceptive pills (OCPs) regulate menstrual cycles, decrease vasomotor symptoms, improve bone mineral density, and decrease the need for surgical intervention for dysfunctional uterine bleeding. Additionally, endometrial and ovarian cancer rates are reduced in women using oral contraceptive therapy. Generally, OCPs are well tolerated and enhance menstrual health and quality of life.
MENOPAUSE / POSTMENOPAUSE
Menopause is defined as the cessation of menstrual bleeding for 12 months. Approximately 10 percent of women by age 45, 80 percent of women by age 52, 95 percent of women by age 55, and 100 percent of women by age 58 have reached menopause. Because bleeding is the most common symptom of endometrial cancer, any bleeding after 12 months of amenorrhea warrants immediate evaluation, no matter how scant or episodic it is. One exception to this rule is in women using sequential hormone therapy, in whom predictable and scheduled bleeding is expected. Endometrial cancer occurs in up to 12.5 percent of women presenting with postmenopausal bleeding (range 1 to 25 percent) and must be excluded. Additionally, postmenopausal women with abnormal or heavier discharge should be evaluated for endometrial cancer. Non-cancerous intracavitary lesions including polyps, submucosal fibroids, and endometrial hyperplasia account for 20 to 40 percent of cases of abnormal uterine bleeding.
Basic laboratory testing in postmenopausal bleeding should include Pap smear, endometrial biopsy, and TVUS. Pap test should be performed because cervical cancer has a bimodal distribution, with the peak between 35 to 39 years of age and 60 to 64 years of age. Endometrial biopsy is highly accurate in detecting endometrial cancer when the cancer is global (not focal), involves a greater surface area of the endometrium, and is exophytic. Endometrial biopsy is less invasive and more cost effective than dilation and curettage. However, endometrial biopsy does miss focal lesions such as polyps or fibroids, and focal disease occurring near the cornua or fundus. The sensitivity of Pipelle endometrial biopsy is 67 to 100 percent depending on size, surface area involved, and location.
ENDOMETRIAL HYPERPLASIA & ENDOMETRIAL CANCER
Endometrial carcinoma most frequently occurs in the sixth and seventh decades of life, with three-quarters occurring in women older than 50 years of age. Bruchim et al 12 found that length of time since menopause and endometrial thickness together are predictive of endometrial cancer risk. Specifically, among 95 women with postmenopausal bleeding, the incidence of endometrial cancer increased with the number of years since menopause. No patient had endometrial cancer when the endometrium was less than 5 mm thick, but 18.5 percent had cancer when the endometrium exceeded 9 mm. The incidence of cancer was 2.5 percent in women who had been menopausal for 5 years or less, but was 21.4 percent in those who had been menopausal more than 15 years. Evidence suggests that measurement of endometrial thickness via transvaginal ultrasound (TVUS) can accurately discriminate between women at high and low risk of endometrial cancer if a 5 mm endometrial thickness cut-off is used. In a metaanalysis of more than 6,000 women with postmenopausal bleeding, the use of a 5 mm cut-off to define abnormal endometrium identified 96 percent of women with endometrial cancer and 92 percent of women with any endometrial pathology with a false-positive rate of 39 and 10 percent, respectively. The likelihood of endometrial cancer increases with increasing thickness of the endometrium.
The ACOG guidelines recommend endometrial biopsy in women older than 35 years of age with anovulatory uterine bleeding to rule out endometrial hyperplasia or cancer. 4 Younger patients with bleeding that does not respond to medical therapy or a history of prolonged unopposed estrogen stimulation secondary to chronic anovulation are also candidates for endometrial sampling.
CLINICAL TOOLS TO EVALUATE THE ENDOMETRIUM
Historically, medical therapy is instituted for 3 months and if it fails, additional evaluation is warranted. This guideline is appropriate for hemodynamically stable patients with normal laboratory evaluation. Evaluation with TVUS, saline infusion sonography (SIS), and power/color Doppler is being used more frequently with the initial workup and minimizes unnecessary trials of medical therapy when intracavitary lesions are evident.
Endometrial biopsy is generally performed in the office with a Pipelle instrument. The biopsy can be performed quickly with few complications and is generally well tolerated. It has a high sensitivity for detecting endometrial cancer and hyperplasia, but a low sensitivity for detecting other intracavitary lesions including polyps and submucosal fibroids. A metaanalysis of 39 studies reviewing 7,914 premenopausal and postmenopausal women with endometrial Pipelle biopsy noted that the detection rate of endometrial cancer in postmenopausal women was 99.6 and 91 percent in premenopausal women. The detection rate for atypical hyperplasia was 88 percent, and the specificity was 98 to 100 percent.
Lesions encompassing a small surface area may be missed. Some studies suggest that the biopsy instrument samples 10 to 25 percent of the endometrial cavity. Patients with persistent symptoms despite a normal biopsy and TVUS require further evaluation with SIS or hysteroscopy.
Transvaginal ultrasound is helpful in evaluating women with abnormal uterine bleeding who have a negative endometrial biopsy or continue to experience abnormal bleeding despite medical therapy. Transvaginal ultrasound is most sensitive in detecting disease in patients with postmenopausal bleeding, since a cutoff of 5 mm or less reliably excludes endometrial cancer. In premenopausal women, endometrial thickness varies between the proliferative phase (4 to 8 mm) and the secretory phase (8 to 14 mm), and TVUS should be scheduled between days 4 to 6 of the menstrual cycle, when the endometrium is the thinnest. Transvaginal ultrasound permits rapid assessment of size, position, and presence of uterine fibroids. The texture of the endometrium can be evaluated for homogeneity or heterogeneity. Adnexal pathology and pelvic tenderness can be assessed. If the uterine size is greater than 12 gestational weeks, then transabdominal scanning is preferred.
Measurement of the endometrial echo in postmenopausal women is helpful in determining whether endometrial biopsy or further imaging studies are necessary. Normally, the endometrial echo measures less than 5 mm. Increased endometrial thickness is associated with intrauterine synechiae, endometrial hyperplasia, endometrial polyps, fibroids, and endometrial cancer. When the endometrium is greater than 5 mm, cannot be visualized completely, is indistinct or indeterminate, an enhanced view is required with SIS or hysteroscopy. An endometrial echo of less than 5 mm is associated with malignancy in less than 0.5 percent of cases.
Saline infusion sonography infuses saline into the endometrial cavity during TVUS to enhance the image. Saline infusion sonography allows the clinician to evaluate the uterus for intracavitary lesions more accurately than TVUS.
The more streamlined concept of "one-stop evaluation" for menstrual disorders combines physical examination, basic laboratory studies, and endometrial imaging (TVUS or SIS) with endometrial biopsy as indicated. Surgical intervention can be more directly implemented when this evaluation suggests surgical instead of medical therapy.
Hysteroscopy permits full visualization of the endometrial cavity and endocervix and is helpful in diagnosing focal lesions that are missed with endometrial sampling. Thin operative hysteroscopes with outer diameter sizes ranging from 3 to 5 mm can easily and comfortably be performed in the office. Rapid visual inspection permits accurate diagnosis of atrophy, endometrial hyperplasia, polyps, fibroids, retained products of conception, and endometrial cancer. Directed endometrial biopsies are possible with some hysteroscopes. Office hysteroscopy can accurately diagnose many conditions associated with abnormal bleeding. The likelihood of endometrial cancer diagnosis after a negative hysteroscopy is 0.4 to 0.5 percent.
If conservative medical management of menorrhagia or dysmenorrhea fails to improve a patient's symptoms after evaluation reveals a normal endometrial cavity, MRI may be useful in diagnosing adenomyosis. This is also useful in evaluating uterine anomalies, although the increased cost of MRI over ultrasound rarely justifies its use.
CONVENTIONAL MEDICAL TREATMENT
Treatment depends on the type of bleeding abnormality and its cause. Menstrual irregularity alone may not require therapy unless it interferes with the patient's attempt to achieve or avoid conception or leads to anemia.
Treatment is directed to stopping the excessive bleeding, to correcting anemia if it exists, and to following up response to the therapy. If bleeding is severe, hospitalization may be necessary to bring it under control.
When it requires treatment, clomiphene induces ovulation. Electrocautery, chemical cautery, or cryosurgery can remove cervical polyps; dilatation and curettage, uterine polyps. Organic disorders (such as cervical or uterine malignancy) may necessitate hysterectomy, radium or X-ray therapy, or both of these treatments, depending on the disease's site and extent. Of course, anemia and infections require appropriate treatment.
SPECIAL CONSIDERATIONS
Use heat to relieve pain. Place a heating pad or hot water bottle on the abdomen or back. Take a hot bath for 10 to 15 minutes as often as needed.
If the patient complains of abnormal bleeding, tell her to record the dates of the bleeding and the number of tampons or pads used per day. This helps to assess the cyclic pattern and the amount of bleeding.
Instruct the patient to report abnormal bleeding immediately to help rule out major hemorrhagic disorders, such as occur in abnormal pregnancy.
To prevent abnormal bleeding due to organic causes, and for early detection of malignancy, encourage the patient to have a Pap smear and a pelvic examination annually.
Offer reassurance and support. The patient may be particularly anxious about excessive or frequent blood loss and passage of clots. Suggest that she minimize blood flow by avoiding strenuous activity and occasionally lying down with her feet elevated.
BIRTH CONTROL PILL THERAPY
Birth control pills are often used to treat uterine bleeding that is due to hormonal changes or hormonal irregularities. Birth control pills may be used in women who do not ovulate regularly to establish regular bleeding cycles and prevent excessive growth of the endometrium. In women who do ovulate, they may be used to treat excessive menstrual bleeding. Non-steroidal anti-inflammatory drugs (NSAIDS, e.g., ibuprofen, naproxen sodium) may also be helpful in reducing blood loss and cramping in these women.
During perimenopause, birth control pills or other hormonal therapy may be used to regulate the menstrual cycle and prevent excessive growth of the endometrium.
PROGESTERONE THERAPY
Progesterone is a hormone made by the ovary that is effective in preventing excessive bleeding in women who do not ovulate regularly. A synthetic form of progesterone, called progestin, may be recommended to treat abnormal bleeding. Progestins are usually given as pills (e.g., medroxyprogesterone acetate, norethindrone), and are taken one or more times daily for two to three weeks. When the progestin is stopped, the woman should expect to have uterine bleeding within 14 days. In some cases, the progestin is given on a regular basis (e.g., every few months) to prevent excessive growth of the uterine lining and heavy menstrual bleeding. Progestins may also be given in other ways, such as in an injection, an implant, or an intrauterine device.
An intrauterine contraceptive device (IUD) that secretes progestin (e.g., Mirena) may be recommended for women who do not ovulate regularly. IUDs are inserted by a healthcare provider through the vagina and cervix into the uterus. Most are made of molded plastic and include an attached plastic string that projects through the cervix, enabling the woman to check that the device remains in place. Progestin-releasing IUDs decrease menstrual blood loss by 40 to 50 percent and decrease pain associated with periods. Some women completely stop having menstrual bleeding as a result of the IUD, which is reversible when the IUD is removed.
MEDICATION
HORMONE THERAPY
Hormone medications to correct a hormone imbalance. For many women, oral contraceptive pills are used for treatment, even in cases where contraception is not required.
Medical therapy with oral contraceptive pills (OCPs) or cyclical progesterone therapy is the hallmark for the treatment of anovulatory menstrual cycles. Patients with ovulatory dysfunctional uterine bleeding must be evaluated for intracavitary uterine pathology since hormonal dysfunction is not the likely cause of bleeding and does not respond to luteal-phase progestogens. Patients with anatomic causes associated with abnormal bleeding can be treated surgically.
Dysfunctional uterine bleeding due to anovulatory cycles is best treated medically; surgery is suggested when medical therapy fails or is contraindicated. Generally, OCPs are the mainstay of therapy. Several medical strategies are also effective in treating this disabling condition, and therapy must be tailored to the individual patient. Medical therapy is very effective in managing most patients with dysfunctional uterine bleeding however, clinicians must be informative and reassure women about the safety / effectiveness. In a stable patient, it is advisable to have at least a 3-month trial of medical therapy.
- Oral contraceptive pills have many roles in the treatment of menorrhagia and dysfunctional uterine bleeding. Combined estrogen-progesterone therapy reduces menstrual blood flow, and estrogen raises levels of both factor VIII and VWF. In those with mild bleeding, OCPs are prescribed in a dose identical to that used for contraception (21 days of hormonally active pills followed by 7 days of placebo, during which time withdrawal bleeding occurs). Parents of adolescents with dysfunctional uterine bleeding should be reminded that the treatment is being used for its hormonal effects, not as a contraceptive modality.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease dysmenorrhea rates and menstrual blood loss. Mechanism of action includes the inhibition of cyclooxygenase system and prostaglandin synthesis. The most frequently used NSAIDs include: meclofenamate, naproxen, and mefenamic. Some studies have demonstrated a 30 to 50 reduction in blood loss with proper use. Patients are advised to begin therapy 1 to 2 days before expected menstruation and continue use throughout the menses. Nonsteroidal anti-inflammatory drugs can be combined with OCPs if needed. Nonsteroidal anti-inflammatory drugs are helpful in decreasing menstrual bleeding in patients with ovulatory abnormal bleeding and in those with adenomyosis, fibroids, and intrauterine devices. Patients with bleeding disorders and platelet abnormalities should avoid all NSAID medications.
- Progesterone therapy is effective in women with anovulatory menstrual cycles. It stabilizes the proliferative endometrium and creates a regular sloughing of the endometrium. Cyclical progesterone is useful in women with contraindications to estrogen therapy (i.e. women over 35 years of age who smoke, have a history of deep vein thrombosis, or higher cardiovascular risk factors). Generally, norethindrone acetate (Aygestin) 5 to 10 mg for 10 to 14 days each month will induce a regular withdrawal bleed in anovulatory women. This will not, however, provide contraception. Norethindrone, given from days 7 to 21 of the cycle, decreases menstrual blood loss, but may be associated with progestational side effects, including bloating, irritability, fatigue, and premenstrual dysphoria. Luteal-phase progestogens, such as norethisterone, are ineffective in women with regular ovulatory cycles. However progesterone (norethisterone 5 mg three times daily) from day 5 of the menstrual cycle for 21 days can reduce menstrual blood loss by 80 percent. The mechanism of action includes inhibition of ovulation and endometrial suppression.
- Long-acting progesterone therapy in the form of medroxyprogesterone acetate (Depo-Provera) induces amenorrhea in the majority of patients. Standard dosing involves medroxyprogesterone acetate 150 mg intramuscularly every 3 months. Approximately 80 to 90 percent of patients completing 12 months of medroxyprogesterone acetate will be amenorrheic. Side effects include weight gain, irregular breakthrough bleeding, depression, and bone loss. Newer subcutaneous dosing of medroxyprogesterone acetate is preferable to previous intramuscular injections.
- Profound menorrhagia rapidly responds to high-dose intravenous conjugated equine estrogen, promoting rapid regrowth of endometrial tissue, covering denuded endometrium, stabilizing lysosomal membranes, and stimulating proliferation of endometrial ground substance.
- Short-term, high-dose estrogen therapy is used when excessive bleeding occurs in an emergency situation. It successfully stops heavy menstrual bleeding in adolescent girls and perimenopausal women. Any low-dose 30 to 35 mcg ethinyl estradiol product can be used (every 6 hours) for 5 days, to rapidly stop heavy menstrual bleeding. This is followed by a tapering dose (every 8 hours for 2 days, then every 12 hours for 2 days, then daily during the next 1 to 2 weeks), which provides emotional relief from the heavy bleeding, knowledge that another menstrual withdrawal cycle will ensue, and stabilization of hemoglobin levels. Once bleeding has stabilized, a single daily maintenance dose will provide a regular menstrual cycle and contraception. Low-dose contraception is safe and effective and can be used in women over 35 years of age who do not smoke or have a history of thromboembolic disease.
- Danazol (Danocrine), a weak androgen, creates a hypoestrogenic state and decreases menstrual blood loss by 70 to 80 percent. A less traditional dosing schedule of 50 to 100 mg daily as well as the conventional 400 to 800 mg daily is helpful in inducing amenorrhea. If long-term use is desired for amenorrhea, then a hepatic panel should be done 3 months after therapy is initiated and yearly if asymptomatic.
- Gonadotropin-releasing hormone (GnRH) therapy creates a hypoestrogenic, menopausal-like condition. Cessation of menstruation usually occurs within 3 months of therapy. Menopausal symptoms including hot flashes, night sweats, and vaginal dryness may occur. Osteoporosis is the biggest risk of prolonged therapy, so treatment is limited to 6 months unless estrogen "add-back" is instituted. Gonadotropin-releasing hormone is a good option for the late perimenopausal woman with contraindications to other medical therapies; these women may spontaneously transition into menopause while amenorrheic from GnRH therapy.
- The levonorgestrel intrauterine system (LNG-IUS) provides another option for dysfunctional uterine bleeding therapy. Levonorgestrel produces a decline in menstrual blood loss by 65 to 98 percent within 12 months of use. It increases hemoglobin and serum ferritin levels with long-term use. The device, imbedded with 20 mcg of levonorgestrel, causes pseudo-decidual changes and amenorrhea with little systemic absorption of progesterone. A recent randomized trial noted that menstrual blood loss with LNG-IUS compared to endometrial ablation showed equivalent declines in blood loss. A recent 5-year follow-up of women using LNG-IUS reported that 42 percent subsequently underwent hysterectomy. The LNG-IUS may have a role for women who have menorrhagia with a normal uterine size and wish to avoid surgery.
ANTIFIBRINOLYTIC AGENTS
- Successful medical options for women with anovulatory bleeding and VWD include oral contraceptive therapy (88 percent success), desmopressin acetate, antifibrinolytic agents, and plasma-derived concentrates rich in the high molecular weight multimers of VWF. Hysterectomy or surgical therapy are not the first options; rather, medical therapy is paramount for these women. Desmopressin acetate, which is available in concentrated form (Stimate, 1.5 mg/mL) can be administered intranasally (two sprays for the first 2 to 3 days) during menstruation or intravenously before procedures. Desmopressin acetate releases stored VWF from within the endothelium and reduces bleeding in patients with type 1 VWD, some forms of type 2 VWD, platelet function disorders, and hemophilia carriage.
- Tranexamic acid (Amicar), an alternative antifibrinolytic, significantly reduces menstrual bleeding. It functions as an inhibitor of plasminogen activation. Reports demonstrate that it effectively decreases menstrual bleeding in patients with a copper IUD and is more effective than NSAIDs in decreasing blood loss. Side effects occur in up to one-third of patients and include muscle cramps and nausea. This treatment is currently not available in the United States, but will soon be evaluated.
OTHER MEDICATIONS
Pain medications if needed.
Tranquilizers to reduce anxiety (rarely required).
Avoid aspirin, especially if you are anemic.
Iron supplements may be necessary for anemia.
SURGICAL MANAGEMENT / THERAPY
The surgical management of abnormal uterine bleeding is reserved for those in whom medical therapy fails or is contraindicated. Treatment modality depends on the etiology of abnormal bleeding as well as the preference of the patient and clinician.
Submucosal fibroids and endometrial polyps vary in number, location, and size. Altered endometrial surface area, increased fragility and endometrial vascularity, endometrial irregularities, and abnormal prostaglandin levels contribute to dysfunctional uterine bleeding when patients have submucosal fibroids and polyps. Likewise, intracavitary lesions can coexist with anovulatory and ovulatory cycles. Outpatient hysteroscopic myomectomy or polypectomy is quick, safe, and effectively treats symptoms; both are associated with high rates of patient satisfaction.
Intramural fibroids can also cause disturbances in menstrual flow. The risk of heavy bleeding increases as fibroid size increases. The mechanisms of abnormal uterine bleeding in the presence of intramural fibroids are unclear, but may be attributable to topographic endometrial abnormalities, endometrial glandular atrophy overlying the fibroid, venous congestion, increased endometrial surface area, and alteration of prostaglandin levels.
Treatment options are variable. The type of therapy offered is dependent on the patient's desire for pregnancy or personal wish to preserve the uterus. When fertility is desired, the patient should be counseled for abdominal, hysteroscopic, or laparoscopic myomectomy. The surgical route for myomectomy depends on the number, size, and location of fibroids.
Treatment options for intramural fibroids is dependent on the patient's desire for pregnancy or personal wish to preserve the uterus.
DILATION & CURETTAGE
If hormone therapy does not control the bleeding, a dilation and curettage (D & C) (which is the dilation of the cervix and scraping out of the uterus with a curette) or a hysteroscopic procedure may be performed to check for other problems. However, dilation and curettage (D&C) is no longer acceptable as the single surgical treatment for menorrhagia or dysfunctional uterine bleeding. It does not correct abnormal bleeding unless intracavitary lesions are totally removed. This procedure is inaccurate due to missed diagnosis, incomplete removal of intracavitary pathology, and a high false-negative rate.
ENDOMETRIAL ABLATION
Surgery may be necessary to remove abnormal uterine structures (eg, fibroids, polyps). Women who have completed childbearing and have heavy menstrual bleeding can consider a surgical procedure such as endometrial ablation. This procedure is done while the woman is under general or regional anesthesia, and uses heat, cold, or a laser to destroy the lining of the uterus. Women with fibroids can have surgical treatment of their fibroids, either by removing the fibroid(s) (eg, myomectomy) or by reducing the blood supply of the fibroids (e.g., uterine artery embolization).
The aim of endometrial ablation is a reduction in menstrual bleeding to normal levels or less. Endometrial ablation is an outpatient procedure associated with rapid recovery, minimal complications, and high patient satisfaction rates. Approximately 12 to 55 percent of patients who undergo endometrial ablation become amenorrheic; 65 to 70 percent become hypomenorrheic; and 5 to 19 percent fail. Approximately 30 percent of patients treated by endometrial ablation will require a subsequent surgical procedure. Outcomes of endometrial ablation are age-dependent. Women undergoing the procedure younger than 40 years of age have more surgical procedures performed than perimenopausal women. Preoperative patient counseling is critical, and it should be emphasized that the aim of endometrial ablation is a reduction in menstrual bleeding to normal levels or less. Amenorrhea should not be "promised" to the patient.
UTERINE ARTERY EMBOLIZATION
When pregnancy is not desired and fibroids contribute to heavy menstrual bleeding, the patient can be offered uterine artery embolization. Transcutaneous insertion of a catheter through the femoral artery, and subsequent occlusion of the uterine artery with Embospheres, polyvinyl alcohol particles, coils, or gel foam causes cessation of blood flow to the fibroid. Shortly thereafter, the fibroid necroses and shrinks. There is an 85 to 95 percent chance of resolution of menorrhagia-related symptoms.
HYSTERECTOMY
For some women where all of the conservative treatment measures have failed, a hysterectomy (removal of the uterus) may be necessary.
Hysterectomy offers definitive therapy for patients with fibroids who have completed childbearing and do not have a personal desire for uterine preservation. Hysterectomy may be performed vaginally, laparoscopically, or abdominally depending on the number, size, and location of fibroids, as well as the need for concomitant procedures.
Kuppermann et al 20 randomized 63 women 30 to 50 years of age to hysterectomy or oral medical therapy for abnormal uterine bleeding. After unsuccessful therapy with progesterone or OCPs, women who underwent hysterectomy experienced greater symptom improvement and expressed higher satisfaction with their overall health 6 months after treatment than women assigned to medical therapy. Specifically, women undergoing hysterectomy noted greater improvements in mental health, sexual desire and functioning, and sleep. It is important to note that recent research demonstrates that patients under 65 years of age who have their ovaries removed during hysterectomy may increase their risk of dying of heart disease.
ACUTE SEVERE UTERINE BLEEDING
Patients who present with profound menorrhagia and are hemodynamically unstable should be promptly evaluated in the hospital. Immediate intervention can be life-saving until all diagnostic, imaging, laboratory, or culture results are available. Once intravenous lines are placed and aggressive fluid resuscitation has been established, a Foley catheter with a 30 mL balloon can be inserted into the uterus to effectively tamponade the bleeding site until the workup is complete. The balloon is inflated until the bleeding decreases and can remain until the patient is hemodynamically stable (greater than 24 hours). Once the patient is stabilized, the balloon can be deflated slowly over 8 to 12 hours and removed. Some patients experience intense uterine contractions with the inflated balloon that may require intravenous narcotics or a patient-controlled analgesic pump.
Emergency hysteroscopy with a high-flow distention pump is effective in establishing and treating menorrhagia in critically ill or unstable patients. The incidence of intracavitary pathology increases as the amount of bleeding increases.
PROGNOSIS (OUTCOMES)
Abnormal uterine bleeding is usually well categorized after the initial history, physical examination, and laboratory evaluation. Regardless of the patient's age, AUB requires a thorough evaluation. Medical management is the hallmark of therapy unless uterine pathology is present. In the menopausal woman with an atrophic endometrium, the patient can be reassured; short-term, low-dose hormone replacement therapy is usually effective in treating symptoms. Most patients with anovulatory uterine bleeding respond favorably to hormonal manipulation with oral contraceptive therapy or progesterone treatment. For patients who cannot tolerate medical therapy, the levonorgestrel IUS is effective in the treatment of abnormal menstruation. Patients with intrauterine polyps and submucosal fibroids have excellent relief of symptoms following operative hysteroscopy. Women with symptomatic uterine fibroids have a wide array of therapeutic options including medical therapy, myomectomy (abdominal, laparoscopic, or hysteroscopic), hysterectomy, or uterine fibroid embolization. Finally, surgical therapy with endometrial ablation offers 90 percent success for the treatment of menorrhagia and dysfunctional bleeding in women with a normal uterine cavity and negative workup who do not desire future fertility.
RELATED LINKS
ACTIVITY
Stay as active as possible, depending on the underlying condition.
DIET
No special diet after treatment, but eat a well-balanced diet . Vitamin and mineral supplements are helpful to prevent anemia.
Eat an healthy all-food diet. The patients suffering from abnormal uterine bleeding should increase intake of whole grains, fresh ripe fruits, fresh green vegetables, legumes, seeds and fish of sardines, tuna, salmon varieties to endow body with adequate nutrition and minerals.
It is advisable for patients to avoid consumption of saturated meat products like beef, chicken, cheese etc. to stimulate the prostaglandin pathways which further assists in elimination of inflammation from body and also controls menstrual cramps and excessive flows.
The adequate consumption of iron rich food items is of utmost significance in the treatment of excessive bleeding. Inclusion of iron rich foods in major meals of day provides with a superior immune system together with prevents from iron deficient anemia. It is advisable for the patients to take half a cup of brewer's yeast or wheat germ daily once a day.
NUTRITIONAL SUPPLEMENTS & PRODUCTS
The main objective of natural treatment for abnormal uterine bleeding is to control bleeding, repair the menstrual pattern and avoid endometrial hyperplasia. Given below are a number of tried and tested natural cures that can be exercised by a patient to get almost instantaneous relief. You should consult with a qualified herbal practitioner before taking any supplement to make sure you are using the right supplement(s) for your situation and for correct dosages.
Agrimony (Agrimonia Pilosa). In Traditional Chinese Medicine Agrimony is used to stop excessive menstrual bleeding. Its natural astringency has been effective both internally and externally for thousands of years to stop bleeding and bruising by "tanning" skin cells, making them impermeable to bleeding. Further, its vitamin K content works by promoting blood clotting that also controls bleeding. When used externally, this action also prevents bacteria from entering the wound. Used for various kinds of bleeding, such as hematemesis, hemoptysis, epistaxis, hemafecia, metrorrhagia, etc. It is also used to clear away toxic material and kill parasites and for skin infection, hemorrhoids, diarrhea, dysentery and malaria. Recently, used for bacterial food poisoning, and trichomonas vaginitis. Its active component agrimonine is a hemostatic.
Shaman Shop: Agrimony Herb Powder (Agrimonia Pilosa; Agrimonia Eupatoria var. Japonica), 90 VCaps
Shaman Shop: Agrimony Herb Powder (Agrimonia Pilosa; Agrimonia Eupatoria var. Japonica), 1 lb.
Alfalfa alkalizes and detoxifies the body. Eases inflammation, lowers cholesterol, balances hormones. Rich in nutrients it is good for anemia, bleeding-related disorders, bone and joint disorders, colon and digestive disorders, skin disorders, and ulcers.
Herbal Remedies: Alfa Max, Alfalfa Extract, Nature's Way, 525 mg, 100 Caps
Herbal Remedies: Alfalfa Powder, Whole Food Supplement, NOW Foods, 1 lb.
Herbal Remedies: Alfalfa, NOW Foods, 650 mg, 500 Tabs
Herbal Remedies: Alfalfa Leaf Root Powder, Kosher, 4 oz. Bulk
Herbal Remedies: Alfalfa Leaves, Nature's Way, 405 mg, 100 Caps
Ashoka Bark Powder (Saraca Indica) is a tonic for the uterus believed to help maintain proper function of the female reproductive system. It has been known to be used in uterine and uterine related indications. Helpful in managing conditions involving menorrhagia (fibroids), bleeding hemorrhoids, hemorrhage, dysentery. The bark has a stimulating effect on the endometrial and ovarian tissues and is largely useful in menorrhagia due to uterine fibroids, in leucorrhea and in internal bleeding, where ergot is indicated. It is well established for its effectiveness in dysmenorrhea. Produces an estrogen-like effect that enhances the repair of the endometrial and stops bleeding. It is also useful in internal bleeding, hemorrhoids and also hemorrhagic dysentery. Oxytocic activity of the plant was seen in rat and human isolated uterine preparations. Estrogen-primed or gravid uterus was more sensitive to the action of the alcoholic extract. Pentolinium bitartrate completely blocked the oxytocic action. Seed extract is found effective against dermatophytic fungi. Its use in treatment of excessive uterine bleeding is extensive in India. The plant is used also in dysmenorrhea and for depression in women. Bleeding from piles is reduced with the plant. In the commonly used doses side effects are rare. Larger doses may cause constipation. Warnings: Do not take during pregnancy.
Herbal Remedies: Ashoka Bark Powder, Banyan Botanicals, Certified Organic, 1/2 lb. Bulk
Ashwagandha is well established for its effectiveness in dysmenorrhea. Produces an estrogen-like effect that enhances the repair of the endometrial and stops bleeding. It is also useful in internal bleeding, hemorrhoids and also hemorrhagic dysentery. Oxytocic activity of the plant was seen in rat and human isolated uterine preparations. Estrogen-primed or gravid uterus was more sensitive to the action of the alcoholic extract. Pentolinium bitartrate completely blocked the oxytocic action. Seed extract is found effective against dermatophytic fungi. Its use in treatment of excessive uterine bleeding is extensive in India. The plant is used also in dysmenorrheal and for depression in women. Bleeding from piles is reduced with the plant. In the commonly used doses side effects are rare. Usage: 3 to 6 VCaps Daily. Warnings: Do not take during pregnancy.
Herbal Remedies: Ashwagandha (Withania Somnifera), 450 mg, 120 VCaps
Herbal Remedies: Ashwagandha Root Powder, 4 oz. Bulk
Herbal Remedies: Menopause Support, TheraVedas Anita, 60 VCaps
Black Cohosh has a history as a folk medicine for relieving menstrual cramps. Black cohosh (derived from species of buttercup) is effective against hot flashes and night sweats and can also lower the blood pressure, acting to the hypothalamus and pituitary gland. Black cohosh can be taken in several forms, including crude plant, dried root, or rhizome (300-2,000 mg per day), or as a solid, dry powdered extract (250 mg three times per day). Standardized extracts of the herb are available, though they have primarily been researched for use with menopausal women suffering from hot flashes. The recommended amount is 20-40 mg twice per day. The best researched form provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can are also used (2-4 ml three times per day). The Commission E Monograph recommends black cohosh be taken for up to six months, and then discontinued. Black cohosh should not be used during pregnancy.
Herbal Remedies: Black Cohosh & Red Clover, NOW Foods, 40 mg / 225 mg, 60 VCaps
Herbal Remedies: Black Cohosh Extract, Standardized, Nature's Way, 40 mg, 60 Tabs
Herbal Remedies: Black Cohosh Root, Nature's Way, 540 mg, 180 Caps
Herbal Remedies: Black Cohosh Powder (Cimicifuga Racemosa), 4 oz. Bulk
Herbal Remedies: Black Cohosh Supplement Tincture, 2 fl. oz.
Bloodwort Root (Sanguisorba Officinalis), also known as Great Burnet, is a Traditional Chinese Medicine remedy employed mainly for its astringent action, being used to slow or arrest blood flow. It is said to cool the blood and stop bleeding and for bleeding due to blood-heat, mainly used for hematemesis, hematuria, hemorrhoids, also for hemoptysis, metrorrhagia, etc. It is used to clear away heat and toxic materials, for diarrhea and dysentery of dampness-heat type. Recently also used for typhoid fever. Topical application may be adopted for burn, skin infection, eczema, skin erosion. It is a hemostatic and inhibits the growth of various pathogenic bacteria.
Shaman Shop: Bloodwort Root Powder (Sanguisorba Officinalis), 500 grams
Cat Tail Pollen (Typha Angustata), is also known as Bulrush, is a Traditional Chinese Herbal Remedy used to stop bleeding and remove blood stasis. It is used for bleeding caused by trauma and blood-stasis, especially for metrorrhagia and menorrhagia; to promote blood circulation to remove blood stasis: For angina pectoria, postpartum abdominal pain, menalgia, abdominal pain and swelling and traumatic pain due to blood stasis. recently used for hyperlipemia, especially for hypertriglyceridemia and hypercholesterinemia. It promotes diuresis and reduce stranguria: For stranguria complicated by hematuria and that of heat type. In addition, external use for exudative eczema. It strengthens the tone and promotes rhythmical contraction of uterus in animals and human. Its decoction lowers blood pressure and shortens blood clotting time.
Shaman Shop: Cat Tail Pollen Granules (Typha Angustata), 100 grams
Shaman Shop: Cat Tail Pollen Extract Powder (Typha Angustata), 5:1, 100 grams
Shaman Shop: Cat Tail Pollen Whole (Typha Angustata), 500 grams
Chaste Tree (Vitex) is one of the most popular herbs in European nations for hormonal disorders related to females. Since medieval times, the chaste tree has been used to treat all kind of menstrual disorders. Chaste tree should be consumed for at least 2-3 months to get permanent solution of problem. Although, it cannot be trusted to deliver instantaneous relief but its positive results are well guaranteed by the past studies.
Chaste Tree may help relieve different menstrual abnormalities associated with pre-menstrual syndrome, including dysmenorrhea. 40 drops of a liquid preparation delivers the equivalent of 40 mg of the dried berries of the plant. Vitex and Black Cohosh can be combined at 30 drops each, twice daily, to reduce dysmenorrhea.
Herbal Remedies: Vitex Fruit (Chaste Tree), 400 mg, 100 Caps
Herbal Remedies: Chaste Tree Berry Powder (Vitex Agnus Castus), 4 oz. Bulk
Herbal Remedies: Chaste Tree Berry Supplement Tincture, 2 fl. oz.
Herbal Remedies: Femaprin Vitex Extract, Pharmaceutical Grade, Nature's Way, 425 mg, 60 Caps
Cimicifuga Rhizome (Cimicifuga heracleifolia Kom., C. dahurica ( Turcz.) Maxim. and C. foetida L.) is a Traditional Chinese Herb used to expel wind and heat, clear away toxic materials and let out skin eruptions. Used for common cold of wind-heat type, and measles with indistinct eruptions, lift up yang-energy, for visceroptosis, clear away heat and expel fire, inhibiting myocardium, slowing heart rate and lowering blood pressure. In traditional Chinese medicine, the Chinese variety of Black Cohosh is thought to relieve pain and was used for headaches, gingivitis, diarrhea and skin disorders (from hives to measles). It may be combined with hemostatic herbs for use in menstrual bleeding disorders.
Shaman Shop: Cimicifuga Rhizome Granules (Cimicifuga Foetida), 100 grams
Cinnamon Bark is warming to the body, an analgesic, carminative, antiseptic, and antibacterial. It is used to treat chronic diarrhea, cramps, heart and abdominal pains. Cinnamon Bark is also used to treat coughing, wheezing, and lower back pains. It is especially useful for stomach problems; colic, flatulence, indigestion, dysentery, and spasms. It is useful in treating uterine hemorrhaging. Cinnamon Bark can be used as a tincture every fifteen minutes to stop uterine bleeding. Suggested Dosage or Use: Use 6-12 drops in juice, water, under the tongue or as desired. May be taken 3 times daily.
Herbal Remedies: Cinnamon Bark Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Cinnamon Bark Extract Supplement, Vegetarian, Herbal Remedies USA, 250 mg, 60 Liquid VCaps
Shaman Shop: Cinnamon Bark (Rou Gui Pi), Powdered, 500 grams
Complete Tonic Uplifter (Shiquan Dabu) is made of extracts from Atractylodes, Poria, Licorice, Chinese angelica, Ligusticum, White peony, Prepared rehmania, Astragalus, Cinnamon bark, Panax ginseng, Chrysanthemum flower, Goji berry. Chinese medicine uses its overall blood and Qi tonifying, immune supporting, revitalizing, invigorating and natural healing promoting properties for lack of energy, withered complexion, weakness in legs and joints, poor appetite, night emissions, uterine bleeding, depression and hot flashes. Directions: As a dietary supplement, take 3 capsules 3 times daily 30 minutes before meal.
Herbal Remedies: Complete Tonic Uplifter, Shiquan Dabu, Balanceuticals, 60 Caps
Cyperus Rhizome (Cyperus Rotundus / Nutgrass Rhizome) is a Traditional Chinese Herb used to disperse the stagnation liver energy, activate vital energy circulation and alleviate pain, regulate menstruation and prevent miscarriage. It is indicated for stagnation of liver energy with distension and pain of the hypochondria and breast, convulsions, dysmenorrhea, amenorrhea, irregular menstruation and menstrual cramps. It is for headache due to stagnation of liver energy; for those complicated by stomach-cold with epigastric pain, vomiting and acid regurgitation and for stagnation of liver energy and stomach energy with morning sickness and threatened abortion. Its 5 percent extract inhibits the uterine contraction in guinea-pigs, rabbits, cats and dogs in vitro.
Shaman Shop: Cyperus Rhizome Granules (Cyperus Rotundus), 100 grams
Shaman Shop: Cyperus Rhizome Powder (Cyperus Rotundus), 500 grams
Shaman Shop: Cyperus Rhizome Whole (Cyperus Rotundus), 500 grams
Dong Quai (Angelica Sinensis) has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps or dysmenorrhea, menstrual concerns and menopausal symptoms. Indication for use includes enrich the blood for blood-deficiency syndrome. It promotes blood circulation, regulate menstruation and alleviate pain. If is used for blood-deficiency, blood stasis or blood-dryness manifested as menoxenia, amenorrhea, menorrhalgia; or as headache, chest pain, abdominal pain and rheumatism, or as the early stage of skin infection or unhealed skin lesions, urticaria, eczema, prurigo, leukoderma, apoplexy, prolapse of rectum, bronchial asthma, arrhythmia, cor pulmonale, etc.
Herbal Remedies: Moon Cycle Tea With Dong Quai, Woman's Tea, Certified Organic, 16 Tea Bags
Yogi Tea Woman's Moon Cycle tea with Dong Quai is an organic way to regulate mood swings, cramps, and other minor symptoms of premenstrual discomfort.
Herbal Remedies: Dong Quai Root, Nature's Way, 565 mg, 100 Caps
Herbal Remedies: Dong Quai Root Powder (Angelica Sinensis), 4 oz. Bulk
Herbal Remedies: Dong Quai Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Dong Quai (Tangui Ladys) Organic Herbal Tea, 20 Tea Bags
Eclipta Herb (Eclipta Prostata; E. Erecta) is used in Traditional Chinese Medicine and in Ayurveda. It is used to nourish the liver and kidney, for the deficiency of liver-yin and kidney-yin manifested as dizziness, tinnitus, alopecia, looseness of teeth and poliosis. It is used to cool the blood to stop bleeding and for blood-heat syndrome manifested as hemoptysis, hematemesis, hematuria, metrorrhagia, hemafecia or dysentery with bloody stools. Recently, used for acute hemorrhagic necrotizing enteritis, also for coronary heart disease; external use for rice-field dermatitis, allergic dermatitis and eczema. It promotes lymphocyte-blastogenesis and is an anticoagulative and promoting fibrinolysis.
Shaman Shop: Eclipta Herb Granules (E. Prostata, E. Erecta), 100 grams
Shaman Shop: Eclipta Herb Powder (E. Prostata, E. Erecta), 500 grams
Shaman Shop: Eclipta Herb Whole (E. Prostata, E. Erecta), 500 grams
Female Regularity TCM Formula. Chinese medicine uses this time-honored formula to tonify the Qi and blood, activate female hormone, maintain healthy uterus smooth muscle tension, promotes gynecological regularity and postpartum recovery. It is also an analgesic. Direction for Use: As a dietary supplement, take 3 to 5 capsules 3 times daily. Not recommended for use by pregnant woman. Clinically, this product was used in menstrual disorders, sterility, and post partal deficiency. For Menstrual disorders: Mainly manifesting irregular menstrual cycle, profuse menstrual bleeding, light color and loose texture, lumbago, scanty blood, pink and clear blood like water, or with coagulated clots, leukorrhea, rubrorrhea, phthisis, hectic fever, massive hemorrhage, leaking blood, bloody fainting, bloody collapse, delayed or prior menstruation, menolipsis prior to climacteric period, functional uterine bleeding, uterine bleeding during puberty, climacteric period. This product is indicated for the above disorders.
Herbal Remedies: Female Regularity, TCM Formula, Shenrong Dingkun, 60 Caps
Flax Seed is a good source of omega-3 essential fatty acids, important for health and wellness. Flaxseed is also used in herbal medicine for the premenstrual syndrome. Diets low in omega-3 fatty acids (EPA and DHA) found in cold water fish have been associated with menstrual pain. Supplementation with fish oil, a good source of omega-3 fatty acids, can lead to a drop in menstrual symptoms. Hot flashes, the most common menopause symptom, are handled with the flaxseed. Omega-3 fatty acids and lignans act as phytoestrogens. Fish oil that provided 1,080 mg of EPA and 720 mg of DHA per day for achieves this result. The same amount of EPA and DHA plus 7.5 mcg per day of vitamin B-12 can lead to a greater decrease in menstrual symptoms, but taking only fish oil does not obtain as much relief. Six grams of fish oil per day provides the approximate levels of EPA and DHA used in relieving menstrual symptoms. Essential fatty acids (Omega-3 and Omega-6 oils) can be found in flaxseed, evening primrose, or borage oil. These will reduce inflammation and/or support hormone production.
Herbal Remedies: Wild Salmon Oil Capsule, NOW Foods, 120 EPA/80 DHA, 2000 mg, 250 SoftGels
Herbal Remedies: Ultimate Oil, Essential Fatty Acids Supplement, Nature's Secret, 90 SoftGels
Herbal Remedies: Black Currant Oil, 500 mg, NOW Foods, 100 SoftGels
Herbal Remedies: Barlean's Primrose Oil, With Gamma Linolenic Acid (GLA), 1300 mg, 120 SoftGels
Herbal Remedies: Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.
Herbal Remedies: Barlean's Flax Oil, Highest Lignan, 1000 mg, 250 Caps
Herbal Remedies: Omega 3-6-9 Oil, Mega EFA Blend, Lime-Flavored, Nature's Way, 1350 mg, 90 Softgels
Herbal Remedies: Omega 3-6-9 Oil, Mega EFA Blend, Lime-Flavored, Nature's Way, 16 fl. oz.
Herbal Remedies: Borage Oil With Gamma-Linolenic Acid (GLA), Barlean's, 60 SoftGels
Ginger (Zingiber Officinale) is known for its exceptional healing properties. Ginger consists of prostaglandin synthetase and cyclooxygenase-2 enzymes which are identified to rectify the altered ratio of prostaglandin-2 in body. Excessive quantity of prostaglandin-2 in body triggers the pain and augments irritation. Ginger cleanses the colon, stimulates circulation. A strong antioxidant and effective antimicrobial agent. Useful for bowel disorders, circulatory problems, fever, hot flashes, indigestion, bleeding, morning sickness, motion sickness, nausea, and vomiting. Ginger is a strong antioxidant and an effective microbial.
Herbal Remedies: Ginger Tea, Organic Digestive Aid, Yogi Tea, 16 Tea Bags
Herbal Remedies: Ginger Tea, Caffeine Free, 20 Tea Bags
Herbal Remedies: Ginger Root Powder, 4 oz. Bulk
Herbal Remedies: Crystallized Ginger Slices, NOW Foods, 12 oz.
Herbal Remedies: Ginger Root, Nature's Way, 550 mg, 180 Caps
Herbal Remedies: Ginger Root Tincture, 100% Organic, 2 fl. oz.
Ginseng Root (Panax Ginseng) is taken by athletes to improve strength and performance. It strengthens the adrenal and reproductive glands. Useful for bronchitis, circulatory problems, diabetes, infertility, lack of energy, and stress. Enhances immune function, promotes lung functioning and stimulates the appetite. Siberian ginseng belongs to a different botanical family than American and Korean ginseng, but the properties and uses of all three are similar. Ginseng is a Traditional Chinese Herb used to promote blood circulation to remove blood stasis, stop bleeding, relieve swelling and alleviate pain. It is used for various kinds of bleeding due to trauma and blood-stasis syndrome, such as hematemesis, hemoptysis, metrorrhagia, hematuria, hemafecia and epistaxis, which manifested as dark petechia, localized pain, dull-colored tongue with petechiae, etc. For amenia, menalgia, and trauma with blood-stasis syndrome. Recently also used for coronary heart disease, angina pectoris, hyperlipemia, chronic infectious hepatitis, etc. Its pharmacological actions include flavonoid glycoside, one of its components, increases coronary flow, reduces myocardial oxygen consumption and lowers arterial pressure. Cardiotonic on frogs' hearts in vitro; low concentration of its extract exerts a vasoconstrictive effect on the vessels of frog's leg and high concentration, vasodilative. Its liquid extract shortens clotting time and exerts hemostatic effect in rabbit.
Shaman Shop: Ginseng Root Powder, Chinese Red (Panax Ginseng), 1 lb.
Shaman Shop: Ginseng Root Powder, Chinese White (Panax Ginseng), 1 lb.
Shaman Shop: Ginseng Root Powder, Korean White (Panax Ginseng), 1 lb.
Herbal Remedies: Red Panax Ginseng, Ultra Strength, 10 ml Vials, 30 Vials
Herbal Remedies: Red Ginseng & Royal Jelly, 10 ml Vials, 30 Vials
Herbal Remedies: Ginseng Royal Vitality Tea, Yogi Tea, 80% Organic, 16 Bags
Goldenseal (Hydrastis canadensis) acts as an antibiotic, cleanses the body, has anti-inflammatory and antibacterial properties; strengthens the immune system. Promotes functioning capacity of the colon, liver, pancreas, spleen, and lymphatic and respiratory systems. Decreases uterine bleeding, reduces blood pressure, and stimulates the central nervous system.
Herbal Remedies: Goldenseal Root Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Goldenseal Root, Nature's Way, 570 mg, 100 Caps
Herbal Remedies: Goldenseal Herb, Nature's Way, 400 mg, 100 Caps
Kava-Kava (Piper Methysticum) can be helpful with anxiety and sleeplessness. Because of its sedative qualities, it should not be mixed with prescription sedatives, sleeping pills, or alcohol. It should be standardized to 70 mg. of kava lactones per capsule, with the daily dose being in the 140-280 mg range of kava lactones. It can even be used on an "as needed" basis for occasional stress or sleeplessness.
Herbal Remedies: Kava Kava Root Extract, Standardized to 30% Kavalactones, NOW Foods, 250 mg, 120 Caps
Herbal Remedies: Kava Kava Root, Maximum Strength, Standardized to 90% Kavalactones, 175 mg, 60 Caps
Herbal Remedies: Kava Kava Root Powder, 4 oz. Bulk
Herbal Remedies: Kava Kava Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Lady's Mantle. The astringent properties in Lady's Mantle help reduce bleeding, particularly in cases of excessive menstrual bleeding and in menopause. It can also stimulate contractions during childbirth. This herb acts as a hormone balancer which means it can help regulate periods. Lady's Mantle has been used as a mild painkiller and is used in treating diarrhea and gastroenteritis. Externally, this herb is used as a douche for vaginal discharge, irritation, and infection. In lotions, Lady's Mantle works well for soothing rashes, eczema, cuts, wounds, sores, and insect bites. This herb is also used as a mouthwash or gargle for bleeding gums, mouth ulcers, and sore throats. Lady's Mantle comes in various forms and is an ingredient in many products. To regulate the menstrual cycle or reduce a heavy flow, take 200 ml (8 fl oz) as an infusion, 3 times a day. An infusion uses 1 ounce of the dried herb to 1 pint of boiling water in teacupful doses as required. In treating diarrhea, use 2 ml (40 drops) of a tincture, 3 times a day until symptoms subside. For other uses or formulations, read and follow product label directions.
Shaman Shop: Lady's Mantle Herb, Cut & Sifted, 1 lb.
Licorice (Glycyrrhiza glabra) cleanses the colon and promotes adrenal gland function. Has estrogen- and progesterone-like effects. Beneficial for allergic disorders, asthma, chronic fatigue, depression, emphysema, fever, herpesvirus infection, hypoglycemia, and inflammatory bowel disorders. Whole licorice root can cause aldosterone-like activities such as fluid retention, high blood pressure, and potassium loss when taken at dosages exceeding 3 g daily for more than 6 weeks. Licorice in the DGL form (deglycyrrhizinated licorice) does not cause aldosterone-like activities; however, it is not clear DGL provides the same benefits as whole licorice. One possible side effect for men is reduced testostorone levels. Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease is not known at this time. People taking Digitalis, Thiazide or loop diuretics, corticosteroid treatments could experience negative side effects. People using aspirin or other anti-inflammatory drugs while taking Licorice regularly might lower the risk of ulcers.
Herbal Remedies: Licorice Root, Nature's Way, 450 mg, 100 Caps
Herbal Remedies: DGL (Deglycyrrhizinated Licorice), NOW Foods, 400 mg, 100 Lozenges
Herbal Remedies: Licorice Root Powder, 4 oz. Bulk
Herbal Remedies: Licorice Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Egyptian Licorice Tea, Certified Organic, Yogi Tea, 16 Tea Bags
Nettle (Urtica Dioica / Stinging Nettle) acts as a diuretic (increases the production and elimination of urine), expectorant (stimulates the removal of mucous from the lungs), pain reliever, and tonic (nurtures and enlivens). Good for anemia, arthritis, hay fever, allergic disorders, kidney problems, malabsorption syndrome. Improves goiter, inflammatory conditions.
Herbal Remedies: Nettle Herb, Nature's Way, 435 mg, 100 Caps
Herbal Remedies: Nettle Leaf Powder, 4 oz. Bulk
Herbal Remedies: Nettle Tincture, 2 fl. oz.
Herbal Remedies: Nettles Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Herbal Remedies: Nettle Leaf Tea, Organic, NOW Foods, 30 Tea Bags
Red Clover. Plant estrogens, like those found in red clover isoflavone extract, although weaker than the estrogens given by prescription, are present in body storage 1000 times as abundant than the body's natural estrogens. Red clover extract has passed medical studies and shown to be helpful in menopausal symptoms, but strangely enough has not been shown to raise the body's natural estrogen supply (of estradiol). This is important when worrying about breast cancer patients who should not be taking estrogen. In fact, it has been shown that women with breast cancer excrete lower than normal amounts of isoflavone, so there is a logic to increasing the supply of isoflavone. This is being studied as possibly beneficial for these women, acting more like the selective estrogens (e.g., Tamoxifen) given women to decrease the risk of breast cancer.
Herbal Remedies: Red Clover & Black Cohosh, NOW Foods, 225 mg / 40 mg, 60 VCaps
Herbal Remedies: Red Clover Herb, Nature's Way, 500 mg, 100 Caps
Herbal Remedies: Red Clover Herb Powder, 4 oz. Bulk
Herbal Remedies: Red Clover Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Red Clover Tea, Caffeine Free, Alvita Tea, 30 Tea Bags
Red Raspberry (Rubus Idaeus) tea strengthens uterine tissue. Red Raspberry Leaf strengthens the uterine wall and regulates menstrual flow. It nourishes the reproductive organs, especially the uterine muscles, and helps strengthen and prepare the body for childbirth. It is also highly valued for soothing and astringent properties to the stomach and intestinal tract.
Herbal Remedies: Yogi Tea Raspberry Leaf, Woman's Female Support, 16 Tea Bags
Herbal Remedies: Red Raspberry Supplement Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Red Raspberry Leaves, Nature's Way, 480 mg, 100 Caps
Herbal Remedies: Red Raspberry Tea, NOW Foods, 30 Tea Bags
St. John's Wort (Hypericum Perforatum) has antidepressant and anti-anxiety properties. Do not use if you are taking antidepressants and can have serious side effects when taken with other medication like Prozac. The standardizations patients should seek are 0.3 percent hypericin or 0.5 percent hyperforin. 300 mg of the plant extract in tablet form should be taken three times a day, but may not show benefits for 8 to 12 weeks. It can be safely taken with prescribed estrogen replacement.
Herbal Remedies: St. John's Wort Herbal Tea, 20 Tea Bags
Herbal Remedies: St. John's Wort Tea, Caffeine Free, Yogi Tea, 16 Bags
Herbal Remedies: St. John's Tonic Depression Formula Tincture, 2 fl. oz.
Herbal Remedies: Mood Support, NOW Foods, 90 Caps
Teasel Root (Dipsacus Asper) is a Traditional Chinese Herb used to invigorate the liver and kidney, strengthen the bone and muscle, expel wind-dampness, for deficiency of the liver and kidney manifested as backache, knee aching and rheumatism, and trauma. It is used to regulate blood flow, stop vaginal bleeding and calm the fetus. It is used for metrorrhagia and threatened abortion due to deficiency of the liver and kidney. It counteracts the deficiency of vitamin E and inhibits the growth of Pneumococcus. Indication for use includes derangement of Chong and Ren meridians due to deficient liver and kidneys manifested as profuse menstrual flow, uterine bleeding and threatened abortion (restless fetus). Teasel root (Xuduan) is used with Eucommia bark (Duzhong), Donkey hide gelatin (Ejiao), Mugwort leaf (Aiye), Astragalus root (Huangqi) and Chinese angelica root (Danggui).
Shaman Shop: Teasel Root Whole (Dipsacus Asper), 500 grams
Shaman Shop: Teasel Root Powder (Dipsacus Asper), 500 grams
Shaman Shop: Teasel Root Granules (Dipsacus Asper), 100 grams
U O Clear (Ovarian Cyst & Fibroid Support). The herbs work synergistically to strengthen the body's natural capability of female systems self-cleaning functions, especially for uterus and ovary. When symptoms of bloating, pressure, cramps or pains occur in the pelvic area, with or without irregular periods or bleeding, periods with blood dots, or clots, or low fever, tiredness, for women, it may due to the growth of cysts or fibroids, or endometriosis problems. U O Clear is a natural treatment for ovarian cysts.
Herbal Remedies: U O Care, Ovarian Cyst & Fibroid Support, 500 mg, 60 Caps
Uterus Care TCM Formula is made of prepared rehmannia root, schizandra fruit, eucommia bark, dissacus, oyster shell, common yam, cuttlefish bone, garden burnet root, common peony root, typha pollen and red berried mistletoe. Chinese medicine uses this well-known formula to tonify the kidney and control the Yin, enhance excitability and tension of the uterus smooth muscles, promote regular contraction of the uterus, maintain normal blood flow and avoid excessive uterus bleeding. Direction for Use: As a dietary supplement, take 3 to 5 capsules 3 times daily. Not for use by pregnant woman. Store in a cool and dry place out of the reach of children.
Herbal Remedies: Uterus Care, Balanceuticals, TCM Formula, 100% Natural, 60 Caps
Valerian (Valeriana officinalis) improves circulation and acts as a sedative. Good for anxiety, fatigue, high blood pressure, insomnia, irritable bowel syndrome, menstrual cramps, muscle cramps, nervousness, pain, spasms, stress, and ulcers. It is especially effective if sleeplessness is related to hot flashes or other symptoms of menopause. Valerian is usually available in tea, tincture, and other mixtures. Patients should use only products that standardize the dosage and take between 300-600 mg. of standardized extracts, best taken an hour before retiring, and best started at the lower dosage.
Herbal Remedies: Valerian Root Powder, 4 oz. Bulk
Herbal Remedies: Valerian Nighttime With Lemon Balm Supplement, Nature's Way, 265 mg, 100 Tabs
Herbal Remedies: Valerian Root Extract, Standardized, 510 mg, 90 Caps
Herbal Remedies: Valerian Root, 530 mg, 100 VCaps
Herbal Remedies: Valerian Root Glycerite Tincture, 2 fl. oz.
Woundwort, also known as Selfheal or All Heal (Prunella Vulgaris) uses the leaves and young shoots of the plant to stop bleeding. It has been used as a styptic that has been used internally in Western medicine to stop hemorrhage, internal bleeding ulcers and excessive menstruation, and its gentle astringency also helps to control chronic and sudden diarrhea (although it is recommended that this application be used under the aegis of a health care provider). For external treatment, those astringent qualities may be applied to relieve hemorrhoids and decrease the bleeding of wounds and cuts. A poultice of fresh leaves and shoots can be used as emergency first aid on clean cuts. Woundwort tea helps heal internal wounds, and the tea can also be used in a poultice for external wounds, bruises, ulcers, and sores. The tea is used as a gargle for sore throat, mouthwash for bleeding gums, canker sores, and thrush. Woundwort tea can also be used to help treat hemorrhage, diarrhea, convulsions, seizures, epilepsy, hepatitis, jaundice, headache, high blood pressure, fluid retention, edema, and fevers. The Chinese believe the tea is useful in treating liver and kidney conditions, blood circulation, conjunctivitis, and boils. To use as an infusion, take 1 ounce of Woundwort in 1 pint of boiling water. Let it cool slightly. Drink 1 wineglassful several times a day. To use an extract, soak 1 teaspoon of this plant in 1 pint brandy or whiskey for a few days. Take 1 tablespoon a day, or as needed. For other formulations, or for other products that contain Woundwort, read and follow product label directions. It is best to consult your health care provider before using Woundwort if you have abnormal uterine bleeding, bleeding gums, or blood in the urine.
Shaman Shop: SelfHeal (Wound Wort / Prunella Vulgaris), 4:1, 90 VCaps
Shaman Shop: Selfheal (Wound Wort / Prunella Vulgaris), 4:1 Powder, 1/4 lb.
MENORRHAGIA SUPPLEMENTAL PRODUCTS
Information, supplements and products for menorrhagia.
Ashokarishta Female Tonic, 15 fl. oz.
Ashokarishta is useful in gynecological conditions like menorrhagia, leucorrhea and dysmenorrhea. Ashokarishta is also useful as a uterine tonic. Suggested Use: Dosage: 2 tablespoons mixed with 1/4 cup of water once daily before meals.
Ashokarishta is a very effective treatment for menopausal symptoms, regulating menstruation and menstrual pain and discomforts. Alterative ,stimulant and astringent. Used in leucorrhea, hematuria, and other female conditions.Dong Quai Root, Nature's Way, 565 mg, 100 Caps
Dong Quai root is native to China, this herb is used extensively throughout the Orient, particularly by women for menstrual concerns.Dong Quai Root Powder (Angelica Sinensis), 4 oz. Bulk
Dong Quai root (Angelica sinensis), referred to as the 'female ginseng', is rich in vitamins and minerals and is one of the most widely used herbs in traditional Chinese medicine. It is effective for female disorders such as menstrual disturbances, PMS and hot flashes due to its anti-inflammatory, analgesic, antiseptic, bactericidal and vasodilative effects. The herb is also used to regulate menstrual cycles, relieve menstrual cramps and alleviate symptoms related to PMS.Dong Quai (Tangui Ladys), Organic Herbal Tea, 20 Tea Bags
For maintaining normal gynecological functions, to regulate female hormone, cycles, alleviate cramps and mid-life hot flashes, and to prevent hair loss.FemPrin Vitex Extract, Pharmaceutical Grade, Nature's Way, 425 mg, 60 Caps
Femaprin's Vitex extract is unique formula combines clinically proven standardized Vitex Chaste Tree Berry extract with Vitamin B-6 to help alleviate the bloating, breast tenderness and mood changes associated with premenstrual syndrome (PMS). Femaprin is the most used supplement for balancing a woman's monthly cycle and for the avoidance of periodic discomforts. It has been trusted for over 40 years by European health practitioners.Manjistha (Rubia cordifolia), 100 VCaps
Ayurveda in the maintenance of general health and normal blood circulation. Recent studies revealed that the biologically active constituents of the extract facilitate the free circulation of blood by removing congestion and improving the quality of blood. An infusion of the root has also been prescribed in women after delivery to clear the uterine channels. It is used as an immune regulator. (its role in supporting heart health is evidenced by studies that show that it regulates blood pressure, blood vessel constriction and the tendency of blood to form Clots). Its evaluation as an anti cancer compound in the laboratory has been extensive, the extract showing weak activity in vitro and in vivo against standard tumour cell lines. The plant extract shows significant anti-inflammatory activity. The best herb for blood purification; blood circulation, controls bleeding, mends broken bones, amenorrhea, cancer, cleanses and regulates liver, spleen, pancreas, and kidneys; diarrhea, dysentery, dysmenorrhea, edema, destroys kidney and gall stones, heart disease, hepatitis, herpes, jaundice, menopause, menorrhagia, painful menstruation, post partum uterus stimulation, paralysis, skin problems, tissue healing, traumatic injuries, skeletal disease, joint pain, rheumatoid arthritis, improves complexion, helps destroy benign and malignant tumors.Manjistha Powder (Rubia cordifolia), 100% Organic, 8 oz. Bulk
Ayurveda in the maintenance of general health and normal blood circulation. Recent studies revealed that the biologically active constituents of the extract facilitate the free circulation of blood by removing congestion and improving the quality of blood. An infusion of the root has also been prescribed in women after delivery to clear the uterine channels. The best herb for blood purification; blood circulation, controls bleeding, mends broken bones, amenorrhea, cancer, cleanses and regulates liver, spleen, pancreas, and kidneys; diarrhea, dysentery, dysmenorrhea, edema, destroys kidney and gall stones, heart disease, hepatitis, herpes, jaundice, menopause, menorrhagia, painful menstruation, post partum uterus stimulation, paralysis, skin problems, tissue healing, traumatic injuries, skeletal disease, joint pain, rheumatoid arthritis, improves complexion and voice, helps destroy benign and malignant tumors.Menstruation Decrease Formula (For Heavy Menstruation), 2 fl. oz.
Use Menstruation Decrease Formula for heavy menstruation. Mistletoe helps strengthen nerves and improve circulation and Native Americans used it to stop bleeding after childbirth. Blessed Thistle is used for menopause and menstrual cramps. Witch Hazel is known to slow bleeding significantly. All of these helpful herbs and more can be found in Alternative Health and Herb's All Natural Menstruation Decrease Formula for Heavy Menstruation.Red Raspberry Tincture, 100% Organic, 2 fl. oz.
Red Raspberry supplement is said to be good for common female problems, but it's healing properties for other uses are sometimes overlooked. Red Raspberry Supplement is beneficial for pregnant women as it tones the uterine and pelvic muscles, preparing for an easier labor, as well as for the prevention of miscarriage. Red Raspberry Supplement relieves morning sickness. It also helps to increase the flow of the mother's milk, brings balance into the menstrual cycle, and will help alleviate excessive bleeding and cramps. Red Raspberry Supplement is safe and effective for children to use for diarrhea and stomach complaints.Shepherd's Purse Herb Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Shepherd's Purse is mainly used to stop bleeding of all kinds including postpartum bleeding, excessive menstrual flow, acute bleeding symptoms of endometriosis, bleeding hemorrhoids, bleeding of the lungs, stomach, kidneys, uterus and nosebleeds.Shepherd's Purse Tincture, 2 fl. oz.
Shepherd's Purse is mainly used to stop bleeding of all kinds. Shepherd's Purse may be used for postpartum bleeding, excessive menstrual flow, acute bleeding symptoms of endometriosis, bleeding hemorrhoids, bleeding of the lungs, stomach, kidneys, uterus and nosebleeds.Squaw Vine (Partridge Berry), 90 VCaps
Squaw Vine (Partridge Berry) Powder, 1/2 lb. Bulk
Squaw Vine (Partridge Berry) Extract Tincture, 2 fl. oz.
Squaw Vine is used as a preparation for childbirth. Squaw Vine is often used for both menstruating and pregnant women. Native Americans used Squaw Vine in the last few weeks of pregnancy to prepare for childbirth. Used for menstrual irregularities (amenorrhea, dysmenorrhea, and menorrhagia) and for vaginal discharge (antiseptic properties for vaginal infections). Suggested Dosage or Use: Take 6-12 drops in liquid or under the tongue, 1-3 times/day or 2 capsules one time each day with water at an early to mid-day mealtime.Stop Bleeding Menstrual Regulation Remedy, TCM Formula, Sanqi Zhixie, 100% Natural, 400 mg, 60 Caps
Made of extracts from notoginseng, baked fossilized bone, Frankincense, myrrh, purple gromwell root, dragonis blood, pearl, deer horn glue, mentha, catechu, astragalus and corydalis, this time-honored formula is used in Chinese medicine to stop bleeding and pain and promote natural menstrual cycle.U O Clear (Ovarian Cyst & Fibroid Support), 500 mg, 60 Caps
Major Symptoms of fibroids or cysts may include:
1. Heavy bleeding or abnormal menstrual cycles.
2. Bloating or pains in the pelvic area.
3. Tiredness, low fever, anemia, etc.
4. Uterine or ovarian lumps confirmed by exams.
When symptoms of bloating, pressure, cramps or pains occur in the pelvic area, with or without irregular periods or bleeding, periods with blood dots, or clots, or low fever, tiredness, for women, it may due to the growth of cysts or fibroids, or endometriosis problems. U O Clear is a natural treatment for ovarian cysts.
U-O-Clear is a 100% natural herbal formula well proven in China to be effective to relieve the said symptoms caused by clots or abnormal growth of Uterus or Ovary tissues. U-O-Clear relieves most symptoms of cysts/fibroids/endo with no known side effects. It works on the principle to supplement the body's cleaning function for the clots and sputum-fluids of female organs, especially for uterus and ovary, so that the growth of bad tissues could be stopped or reversed.Vidhari Kand Leaf (Ipomoea digitata), 100 VCaps
Relative to the sweet potato, it is commonly used as a general tonic and in hoarseness of voice, cough, enlarged liver and diminished lactation. Used as a powder, confection, decoction, milk decoction. It is recommended for emaciation in children. It enters into the composition of a compound decoction, which is nutritive, diuretic and expectorant, and useful in fevers and bronchitis. Powdered root is given for diseases of the spleen and liver, for menorrhagia, debility and fat accumulation.Vidhari Kand Leaf Powder (Ipomoea digitata), 100% Organic, 8 oz. Bulk
Relative to the sweet potato, it is commonly used as a general tonic and in hoarseness of voice, cough, enlarged liver and diminished lactation. Used as a powder, confection, decoction, milk decoction. It is recommended for emaciation in children. It enters into the composition of a compound decoction, which is nutritive, diuretic and expectorant, and useful in fevers and bronchitis. Powdered root is given for diseases of the spleen and liver, for menorrhagia, debility and fat accumulation.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of abnormal uterine bleeding.
The following occur during treatment:
- Bleeding becomes excessive (saturating a pad or tampon more often than once an hour).
- Signs of infection, such as increasing pain, muscle aches, fever, headache and dizziness.
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
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-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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