Treatments for heavy menstrual bleeding

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When looking to treat heavy periods, people have many options, including hormonal and nonhormonal contraceptives, nonsteroidal anti-inflammatory drugs (NSAIDs), and other medications.

If a person does not wish to have children in the future, doctors may recommend a surgical procedure such as endometrial ablation or hysterectomy.

If uterine fibroids are causing the bleeding, a doctor may recommend a myomectomy. During this procedure, a surgeon removes the fibroids while leaving the uterus intact, so a person can still have children.

The treatment that is most suitable depends on each person’s individual situation. A person can discuss their treatment options with a healthcare professional.

Various contraceptives can help regulate the menstrual cycle and reduce the volume of menstrual bleeding. Options include:

• Combined oral contraceptives: Besides being an effective form of birth control, these can make periods more regular, lighter, and less painful.
• Progestin-only pills: These are suitable for people who cannot take estrogen. They can reduce or sometimes stop menstrual bleeding.
• Levonorgestrel-releasing intrauterine system: This hormonal intrauterine device (IUD) releases levonorgestrel, which can significantly reduce menstrual bleeding within 3 to 6 months of insertion for up to 5 years. It is also a long-term contraception option that can be effective for up to 8 years.
• Contraceptive implant: This is a long-term method of contraception that can last up to 3 years. Some people who use it experience a significant reduction in menstrual bleeding, and some may stop having periods altogether.
• Contraceptive injection (Depo-Provera): This is an effective method of birth control that requires an injection every 3 months. Some people experience reduced menstrual bleeding over time when using this method.

There are some other medications available to treat heavy menstrual bleeding, such as:

Tranexamic acid

This nonhormonal medication helps reduce menstrual blood loss by promoting clot formation and stabilizing uterine clots. It is particularly effective during the heaviest days of menstruation. People take these oral tablets for up to 5 days during the menstrual period.

Possible side effects include nausea, vomiting, diarrhea, and headaches. Serious side effects are rare.

Oral progestins

These medications can help regulate the menstrual cycle and reduce bleeding in people who do not respond well to other treatments.

People take these for a specified period during the menstrual cycle. They can be an option for people who are looking for non-contraceptive benefits. Weight gain, mood changes, and bloating are possible side effects.

Iron supplements

Doctors may recommend iron tablets if a person develops iron deficiency anemia as a result of heavy bleeding.

NSAIDs such as ibuprofen and naproxen can reduce menstrual bleeding and relieve pain by inhibiting the production of prostaglandins, which are involved in inflammation and the stimulation of uterine contractions.

Besides reducing menstrual blood loss, they provide effective relief from menstrual cramps. Possible side effects include gastrointestinal issues such as stomach pain and ulcers, which can occur with long-term use.

Healthcare professionals can use the following surgical procedures to treat heavy menstrual bleeding.

Any surgical procedure has risks and can cause side effects. It is best for a person to speak with a healthcare professional about the pros and cons of surgery for heavy menstrual bleeding.

Endometrial ablation

This procedure, which involves burning or freezing the lining of the uterus, can stop periods or make them lighter. However, the lining can grow back. If that happens, a person may need to repeat the procedure.

This option is for people who do not want to have children in the future.

Hysterectomy

This is surgery to remove the uterus. It is a more extensive procedure than endometrial ablation and is more effective in the long term.

After a hysterectomy, a person will no longer have periods and will no longer be able to conceive or give birth.

Myomectomy

If fibroids or polyps are causing heavy bleeding, healthcare professionals can perform a myomectomy to remove them. This can relieve the symptoms, and a person will still be able to give birth after having this surgery.

Heavy menstrual bleeding has many possible causes, including hormonal imbalances and underlying medical conditions. Understanding the cause is crucial for effective treatment. Common causes include:

• Hormonal imbalance: Hormones such as estrogen and progesterone regulate the buildup of the endometrium (uterus lining), which a person’s body sheds during menstruation. An imbalance can lead to a thicker endometrium and heavier bleeding. Conditions such as polycystic ovary syndrome, obesity, insulin resistance, and thyroid problems can cause an imbalance.
• Uterine fibroids: These are noncancerous growths that can form in the uterus, often during the reproductive years. They can cause heavier or prolonged menstrual bleeding.
• Endometrial polyps: These are small, benign growths that can form on the lining of the uterus and can lead to heavy bleeding or bleeding between periods.
• Adenomyosis: This condition occurs when the tissue that usually lines the uterus begins to grow into the muscular wall of the uterus, causing pain and heavy bleeding.
• IUD use: A nonhormonal IUD is a form of contraception that can increase menstrual bleeding for some people.
• Pregnancy complications: A person may sometimes mistake a pregnancy loss or an ectopic pregnancy for a heavy period if they did not know they were pregnant.
• Cancer: Uterine cancer, cervical cancer, or ovarian cancer can cause excessive menstrual bleeding, although this is less common.
• Inherited bleeding disorders: Some bleeding disorders, such as von Willebrand disease or a platelet function disorder, can cause heavy menstrual bleeding.
• Medications: Certain medications, including anticoagulants, anti-inflammatory drugs, and hormonal medications, can cause or worsen heavy bleeding.
• Other medical conditions: Conditions such as endometriosis, thyroid disorders, kidney or liver disease, and pelvic inflammatory disease can cause heavy bleeding.
• Endometrial hyperplasia: The presence of excess estrogen along with a lack of progesterone can contribute to a thickened endometrium. Without treatment, this condition can lead to uterine cancer.

People should speak with a doctor as soon as possible if they experience any of the following during menstruation:

• the need to use twice as many period products, such as pads or tampons, to manage the menstrual flow
• symptoms of anemia, such as fatigue, shortness of breath, or severe weakness
• bleeding that lasts longer than 7 days
• any symptoms of infection, such as fever, chills, or severe pain

These symptoms can indicate a serious condition that requires prompt medical evaluation and treatment.

Here are the answers to some commonly asked questions about heavy menstrual bleeding.

What is the best way to stop heavy menstrual bleeding?

The best way to stop heavy menstrual bleeding varies depending on the cause, but options include:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), tranexamic acid, oral contraceptives, or a hormonal IUD can be effective.
• Surgical options: If a person is not planning to have children and if medication has not been effective, doctors may recommend a procedure such as endometrial ablation, myomectomy, or hysterectomy.
• Iron supplements: These can help prevent or treat anemia due to heavy bleeding.

A person should consult a healthcare professional to find out the most appropriate treatment for their individual situation.

When should you go to the hospital for heavy menstrual bleeding?

People should go to the hospital for heavy menstrual bleeding if they:

• have bleeding that soaks through one or more pads or tampons every hour for several consecutive hours
• experience severe pain, fever, or symptoms of infection alongside heavy bleeding
• pass blood clots larger than a quarter

A person who is experiencing heavy menstrual bleeding should consult a healthcare professional to discuss the most appropriate treatment options for their situation.

A healthcare professional can find the cause of heavy bleeding and recommend the best treatment based on a person’s overall health, symptoms, and reproductive plans.