Heavy periods - Treating heavy periods

Medication is the main treatment for heavy periods (menorrhagia), but surgery may be used in some cases.

If menorrhagia is diagnosed, your GP will discuss possible treatment options with you, including:

the effectiveness of treatments
the likelihood of any adverse effects after treatment
whether contraception will be required
the implications for your fertility

In some cases, treatment is not necessary. If the heavy bleeding doesn't affect your life or no serious cause is suspected, you may just be reassured that bleeding can vary over time for some women.

The aim of treating menorrhagia is to:

reduce or stop excessive menstrual bleeding
improve the quality of life of women with menorrhagia
prevent or correct iron deficiency anaemia caused by heavy menstrual bleeding

Read on to learn about the different treatments you may be offered. You can also see a summary of the pros and cons of these treatments, which allows you to easily compare your options.

Medication

Medication is recommended as the first line of treatment for women who:

have no symptoms or signs that suggest a serious underlying cause
are waiting for the results of further investigations

If a particular medication is not suitable for you, or a medication is not effective, another type may be recommended. Some medications make your periods lighter and others may stop bleeding completely. Some are also contraceptives.

Your GP will explain how each type of medication works and any possible side effects. This will help you and your GP decide which is the most suitable treatment.

The different types of medication used to treat menorrhagia are outlined below.

Levonorgestrel-releasing intrauterine system (LNG-IUS)

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small plastic device that is inserted into your womb and slowly releases a hormone called progestogen.

It prevents the lining of your womb growing quickly and is also a form of contraceptive. LNG-IUS does not affect your chances of getting pregnant after you stop using it.

Possible side effects of using LNG-IUS include:

irregular bleeding that may last more than six months
breast tenderness
acne
no periods at all (amenorrhoea)

LNG-IUS has been shown to reduce blood loss by 71-96% and is the preferred first-choice treatment for women with menorrhagia, provided that long-term contraception using an intrauterine device is appropriate.

Tranexamic acid

If LNG-IUS is unsuitable (for example, if contraception is not desired), tranexamic acid tablets may be considered. The tablets work by helping the blood in your womb to clot. They have been shown to reduce blood loss by 29-58%.

Two or three tranexamic acid tablets are taken after heavy bleeding has started. They are taken three times a day for a maximum of three to four days.

The lower end of this dosing range will usually be recommended – for example, two tablets, three times a day for four days. Treatment should be stopped if your symptoms have not improved within three months.

Tranexamic acid tablets are not a form of contraception and will not affect your chances of becoming pregnant. If necessary, tranexamic acid can be combined with a non-steroidal anti-inflammatory drug (NSAID).

Possible side effects include indigestion and diarrhoea.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) may also be used to treat menorrhagia as a second-choice treatment if LNG-IUS is not appropriate.

NSAIDs have been shown to reduce blood loss by 20-49%. They are taken in tablet form from the start of your period or just before until heavy bleeding has stopped.

The NSAIDs that are recommended for treating menorrhagia are:

These are usually taken three or four times a day.

NSAIDs work by reducing your body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods. NSAIDs are also painkillers.

They are not a form of contraceptive. However, if necessary, they can be used with the combined oral contraceptive pill. Common side effects include indigestion and diarrhoea.

NSAIDs can be used for an indefinite number of menstrual cycles, as long as they are relieving symptoms of heavy blood loss and not causing significant adverse side effects. However, treatment should be stopped after three months if NSAIDs are found to be ineffective.

Combined oral contraceptive pill

, often referred to as the pill, can be used to treat menorrhagia. They contain the hormones oestrogen and progestogen. You take one pill every day for 21 days before stopping for seven days. During this seven-day break you get your period. This cycle is then repeated.

The benefit of using combined oral contraceptives as a treatment for menorrhagia is they offer a more readily reversible form of contraception than LNG-IUS. They also have the benefit of regulating your menstrual cycle and reducing painful periods (dysmenorrhoea).

The combined oral contraceptive works by preventing your ovaries releasing an egg each month. As long as you are taking the pills correctly, they should prevent pregnancy.

Common side effects of the combined oral contraceptive pill include:

mood changes
nausea (feeling sick)
fluid retention
breast tenderness

Oral norethisterone

Norethisterone is a type of man-made progestogen (one of the female sex hormones). It is another type of medication that can be used to treat menorrhagia. It is taken in tablet form two to three times a day from days 5 to 26 of your menstrual cycle, counting the first day of your period as day one.

Oral norethisterone works by preventing your womb lining growing quickly. It is not an effective form of contraception and can have unpleasant side effects, including:

weight gain
breast tenderness
short-term acne

Oral progestogens such as norethisterone are not as effective as tranexamic acid and may not always be able to control heavy bleeding.

Injected progestogen

A type of progestogen called medroxyprogesterone acetate is also available as an injection and is sometimes used to treat menorrhagia. It works by preventing the lining of your womb growing quickly and is a form of contraception.

It does not prevent you becoming pregnant after you stop using it, although there may be a delay after you take it before you are able to get pregnant.

Common side effects of injected progestogen include:

weight gain
irregular bleeding
absence of periods (amenorrhoea)
a delay in your ability to become pregnant for 6 to 12 months after stopping the injection
premenstrual symptoms such as bloating, fluid retention and breast tenderness

You will need to have this form of progestogen injected once every 12 weeks for as long as treatment is required.

Gonadotropin releasing hormone analogue

Gonadotropin releasing hormone analogue (GnRH-a) is a type of hormone sometimes given as an injection to treat fibroids (non-cancerous growths in the womb).

Studies have shown GnRH-a is effective in reducing blood loss during periods. However, it can be expensive and may cause hormone abnormalities (hypogonadism) similar to the menopause, with effects including hot flushes, increased sweating and vaginal dryness. This means GnRH-a is not a routine treatment, but may be used while you await surgery.

Surgery

Your specialist may suggest surgery if medication is not effective in treating your menorrhagia.

There are several types of operation that can be used to treat menorrhagia. Two are only suitable if your heavy periods are caused by fibroids (non-cancerous growths in the womb). These are:

uterine artery embolisation
myomectomy

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE) is a minimally invasive procedure carried out through a small tube inserted into your groin. Small plastic beads are injected through the tube into the arteries supplying blood to the fibroid. This blocks the arteries and causes the fibroid to shrink over the subsequent six months.

Advantages of UAE include:

it is usually successful in women whose heavy periods are caused by fibroids
serious complications are rare
you only need to spend one night in hospital

However, having UAE may cause some pain after the blood supply is removed, and strong painkillers are needed for about eight hours. There are also other complications your specialist will be able to discuss with you.

If you plan to get pregnant in the future, you may choose not to have UAE, as there are potential risks to your fertility.

In around 10-20% of cases, UAE may be required again later on. Your specialist will discuss this with you.

Myomectomy

Sometimes fibroids can be removed using a surgical procedure known as a myomectomy. However, this operation is not suitable for every type of fibroid.

Your gynaecologist (specialist in the female reproductive system) will be able to tell you whether a myomectomy is possible and what the complications are.

When they are appropriate, myomectomies are effective. However, in some cases the fibroids grow back.

Endometrial ablation

There are different techniques used for endometrial ablation. These include:

microwave endometrial ablation - a probe that uses microwave energy (a type of radiation) is inserted into the womb to heat up and destroy the womb lining
thermal balloon ablation - a balloon is inserted into your womb and inflated and heated to destroy the womb lining

These procedures can be carried out either under local anaesthetic or general anaesthetic. They are fairly quick to perform, taking around 20 minutes, and you can often go home the same day.

You may experience some vaginal bleeding for a few days after endometrial ablation, which is similar to a light period. Use sanitary towels rather than tampons. Some women can have bloody discharge for three or four weeks.

You may also experience tummy cramps, similar to period pains, for a day or two after the procedure. These can be treated with painkillers, such as paracetamol or ibuprofen.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

It is usually recommended that you don't get pregnant after you have had endometrial ablation, as the risk of problems such as miscarriage is high.

The failure rate for endometrial ablation is about 25-35%. If it fails, you may be offered a repeat treatment.

More information about endometrial ablation is available from the Royal College of Obstetricians and Gynaecologists (RCOG), who have produced a leaflet called Information for you after an endometrial ablation (PDF, 3.75Mb).

Hysterectomy

A hysterectomy (removal of the womb) will stop any future periods, but should only be considered after other options have been tried or discussed. The operation and recovery time are longer than for other surgical techniques for treating heavy periods.

A hysterectomy is only used to treat menorrhagia after a thorough discussion with your specialist to outline the benefits and disadvantages of the procedure.

You will no longer be able to get pregnant after a hysterectomy.