Herbs for functional menorrhagia are chosen from the following categories.
• Herbs which affect uterine tone and regulate uterine bleeding: the uterine anti-haemorrhagics, uterine tonics and emmenogogues.
• Herbs which have diverse ‘systemic’ effects, and which improve the overall vitality or constitutional state of the woman: the female tonic herbs and the Liver herbs which reduce bleeding by clearing Heat and (often) aiding oestrogen clearance.
Herbalists refer to anti-haemorrhagics as being Drying — in fact one of the ways to tell if a herb has an astringent effect is to see whether it has the typical drying and puckering sensation in the mouth. This ‘astringent’ effect is caused by tannins, but tannins are not responsible for the effects on the uterus because they are not absorbed from the gut.
The uterine anti-haemorrhagics usually contain the tannins characteristic of most herbal astringents, in addition to other (non-tannin) constituents, primarily flavonoids and saponins which regulate bleeding. Some of these effects are quite complex, and not all of them are understood. They are discussed in greater detail in the section on uterine anti-haemorrhagics herbs in site.
Uterine anti-haemorrhagics used to treat menorrhagia include Trillium erectum, Equisetum arvense, Achillea millefolium, Tienchi ginseng, Capsella bursa-pastoris and Hydrastis canadensis. The important astringents for menorrhagia in adolescence are Achillea millefolium, Alchemilla vulgaris, Capsella bursa-pastoris and Geranium maculatum.
Herbs which affect the muscle tone of the uterus, the uterine tonics, are believed to affect bleeding by normalising the uterine tone. The uterine tonics are accepted as being capable of improving weak muscle activity and relaxing excess spasm and are often combined with the uterine anti-haemorrhagics in the treatment of menorrhagia. In addition, the uterine tonics seem to have diverse and as yet unidentified actions on the endometrium. These are evident at ultrasound when endometrial changes are seen amongst women given uterine tonics for infertility. They include Angelica sinensis, Chamaelirium luteum, Rubus idaeus, Caulopbyllum tbalictroides, Mitcbella repens, and Aletris farinosa, and are discussed in the section on uterine tonics in ‘Herbs’.
Emmenagogues are used to treat menorrhagia associated with a lack of uterine tone. This group of herbs increases muscular activity and the resting tone of the uterus and are indicated for heavy bleeding immediately after delivery, when fibroids interfere with the normal muscular activity of the uterus, after a miscarriage or termination, or following frequent full-term pregnancies. They should only be prescribed by a trained herbalist.
Liver herbs are often used for conditions associated with excess Heat such as irritability, headaches, acne and constipation. When this is confined to the premenstrual phase of the cycle, it is often thought of as an imbalance in the hormone levels caused by a relative oestrogen excess.
Liver herbs are bitter and Cooling. Dietary changes are usually recommended at the same time.
Herbalists recognise a type of uterine bleeding that is associated with a lack of vitality or general body weakness. The usual characteristics are that the woman is unusually tired, weak and pale. This type of bleeding has been recognised for a long time: it is recorded as a cause of bleeding in the Medieval Woman’s Guide to Health as ‘weakness of the woman who cannot keep the blood inside her’.
The cure was reported to be a good diet of ‘plump hens’ and ‘comforting food’ — still good advice. In addition, the uterine and female tonic herbs, of which there are few better than Aletris farinosa and Angelica sinensis, would also be suggested. These are both Warming herbs. Blood, nervine and adrenal tonics might also be indicated when Blood deficiency, nervous or adrenal exhaustion accompany heavy menstrual bleeding. Appropriate herbs might include Angelica sinensis with Paeonia lactiflora, Rebmannia glutinosa and Angelica sinensis for Blood deficiency; Witbania somnifera, Hypericum perforatum and Scutellaria laterifolia for nervous exhaustion; and Eleutberococcus senticosus, Panax ginseng or Glycyrrbiza glabra for adrenal exhaustion.