By Nancy Lonsdorf, MD

I’m 46, and I’ve been diagnosed with uterine fibroids. My symptoms are very heavy bleeding with menstruation and much longer periods than usual. I’d prefer to avoid surgery. Is there something else that can help?

Whether fibroids are present or not, the most likely cause for heavy bleeding in your age group is perimenopause—the period of changing hormonal patterns that precedes actual menopause. During these years, hormone levels fluctuate widely and ovulation may not occur every month. Both of these factors predispose you to irregular bleeding patterns, including heavy flow, and are the most likely cause of your heavy bleeding, not the fibroid itself. That is why it is important to give nonsurgical approaches a try first, as long as no serious condition exists and you are not dangerously anemic.

Most commonly, perimenopausal hormonal imbalance involves too much estrogen, which builds up the uterine lining, and not enough progesterone, which maintains the lining and helps prevent excessive bleeding. Your doctor may recommend a progesterone-like drug to help slow the flow. If so, request bio-identical progesterone—it’s just as effective as synthetics but comes with fewer side effects. The herb chasteberry (Vitex agnus castus) works to increase your body’s own progesterone production and may help normalize your flow when taken regularly for several months.

Soy foods, licorice root (Glycyrrhiza glabra), and red clover (Trifolium pratense) all have pro-estrogenic effects, so it’s best to avoid them whenever you experience heavy bleeding. Ditto red meat and other products from hormone-treated animals. Lastly, you want to avoid liver toxins such as alcohol and an unhealthy, junk-food diet since impaired liver function can also lead to excess estrogen buildup.