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What are the treatment options for heavy periods?

Created: ; Last Update: May 4, 2017; Next update: 2020.

There are various treatment options available for women who have very heavy periods, including medication, hormonal contraceptives and surgery. Knowing about the advantages and disadvantages of each can help make it easier to choose an appropriate treatment.

If very heavy periods become too much of a problem, treatment can help you to cope better. Different types of medication can reduce the bleeding and related problems. If one medication doesn't work, it is usually possible to try out other kinds.

Hormonal contraceptives like birth control pills or intrauterine devices (IUDs) affect the menstrual cycle and lessen the amount of bleeding. Any fibroids or polyps that are found to be the cause can be surgically removed. If the effects of heavy periods are particularly bad, other procedures can be considered.

The choice of treatment and best time for treatment will depend on whether a woman is planning to become pregnant. The most effective treatments all limit a woman's ability to get pregnant – either temporarily, like the pill, or permanently, like the surgical removal of the womb (hysterectomy).

But as long as the heavy periods aren’t causing anemia, they don’t necessarily need to be treated. Some women learn ways to prepare as well as possible for “heavier” days. But it’s a good idea to see a doctor and try to find out what the cause is.

What can I do myself?

If heavy periods become such a problem that they interfere with your everyday life, then you can try taking things a little easier on those days. Some women find that relaxation techniques or yoga help them feel more relaxed and reduce stress. Getting a lot of exercise can also help.

Women with heavy periods are often advised to change their diet: For instance, certain fatty acids, vitamins or fibers are claimed to help. But making changes to your diet hasn’t been proven to reduce heavy menstrual bleeding or the related problems. This is also true for sports, homeopathic products and acupuncture.

Foods that are rich in iron can help to prevent anemia. Examples include meat, legumes, green leafy vegetables and wholegrain bread.

What non-hormonal medications are an option?

Painkillers like ibuprofen and diclofenac – both of which are non-steroidal anti-inflammatory drugs (NSAIDs) – are often used for the relief of menstrual pain and cramps, and also for heavy periods. In addition to relieving the pain, they may also help to lower the amount of blood lost. Acetylsalicylic acid (ASA, the drug in medicines like Aspirin) is not suitable for heavy periods because it has an anti-clotting effect so it can increase the amount of blood lost during menstruation.

The most common side effects of NSAIDs are stomach problems, nausea, vomiting, headaches and drowsiness. The women who took NSAIDs for heavy periods in studies didn't experience many more side effects than women who took a placebo (fake medicine) for comparison.

Another medication that can help in the treatment of heavy periods is tranexamic acid. It affects blood clotting and reduces the tendency to bleed. Studies have shown it to be more effective than NSAIDs. Tranexamic acid may cause headaches, tiredness and muscle cramps. But these side effects are not more common than with NSAIDs.

There is no good-quality research on whether herbal products can relieve heavy periods.

If excessive loss of blood is causing extreme tiredness, iron deficiency anemia is probably the reason. It is normally treated by taking iron tablets. Iron supplements may have side effects such as stomach ache and constipation, and can cause your stool to turn black.

How can hormones help?

Painkillers like ibuprofen and diclofenac – both of which are non-steroidal anti-inflammatory drugs (NSAIDs) – are often used for the relief of menstrual pain and cramps, and also for heavy periods. In addition to relieving the pain, they may also help to lower the amount of blood lost. Acetylsalicylic acid (ASA, the drug in medicines like Aspirin) is not suitable for heavy periods because it has an anti-clotting effect so it can increase the amount of blood lost during menstruation.

The most common side effects of NSAIDs are stomach problems, nausea, vomiting, headaches and drowsiness. The women who took NSAIDs for heavy periods in studies didn't experience many more side effects than women who took a placebo (fake medicine) for comparison.

Another medication that can help in the treatment of heavy periods is tranexamic acid. It affects blood clotting and reduces the tendency to bleed. Studies have shown it to be more effective than NSAIDs. Tranexamic acid may cause headaches, tiredness and muscle cramps. But these side effects are not more common than with NSAIDs.

There is no good-quality research on whether herbal products can relieve heavy periods.

If excessive loss of blood is causing extreme tiredness, iron deficiency anemia is probably the reason. It is normally treated by taking iron tablets. Iron supplements may have side effects such as stomach ache and constipation, and can cause your stool to turn black.

How can hormones help?

The menstrual cycle is influenced by various hormones: The female sex hormone estrogen is responsible for the maturation of one egg cell per month. The lining of the womb prepares for a possible pregnancy with the help of the hormone progesterone. Hormones can be used to help reduce menstrual bleeding.

Progesterone tablets

Tablets that contain the hormone progesterone can be taken for the treatment of heavy periods. Progesterone inhibits the growth of the lining of the womb before menstruation, which lessens the bleeding during menstruation. But studies haven’t found progesterone tablets to have any advantages over NSAIDs.

Progesterone tablets are taken between the 7th and 21st days of the menstrual cycle. Then there is a break when menstrual bleeding occurs.

Birth control pills and mini-pills

Birth control pills (“the pill”) are hormonal contraceptives. They contain either a combination of estrogen and progestin (combination birth control pill), or just progestin (mini pill).

Women whose main reason for taking birth control pills is to manage heavy periods often choose to take the mini-pill. The low-dose progestin-only mini-pill is taken every day, without any breaks. This usually causes menstrual bleeding to become irregular, and sometimes women may even stop getting their period.

Combination pills are mainly used as contraceptives. Most women take the combination pill for 21 days per cycle. The bleeding starts during the seven-day break that follows. Low-dose combination pills can be taken continuously (without breaks) too. Then the woman usually stops getting her period completely, and only has light spotting at the most.

But combination pills have not yet been approved for continuous use in Germany. So if they are used in this way it is considered to be “off-label” use (not officially approved). It’s important to discuss the possible consequences of this type of use with your doctor.

The possible side effects of birth control pills include fluid retention, headaches and breast tenderness. The combination pill in particular increases the likelihood of blood clots (thrombosis), so women who have a greater risk of thrombosis (for example, smokers) are advised not to take it.

Hormonal intrauterine devices

Hormonal IUDs (intrauterine devices, also called coils) are implanted in the womb (uterus) and can remain there for about five years. They prevent pregnancy, like birth control pills, by releasing a continuous amount of the progestin hormone called levonorgestrel. Studies show that an IUD containing progestin can reduce the loss of blood and related problems more effectively than birth control pills or NSAIDs.

In fact, in one study in Great Britain where women who were waiting to have a hysterectomy used a progestin-releasing IUD, they were so pleased with the effect that they canceled their planned operation.

The most common side effects of hormonal IUDs are acne, spotting (vaginal bleeding between periods) and breast tenderness, but they don't occur as often as when the mini-pill is used. Hormonal IUDs may also cause benign cysts to grow on the ovaries. But these usually go away on their own within one year. IUDs are rejected in about 1 out of 10 women, so they need to see the doctor again.

If an IUD has been prescribed to treat heavy periods rather than for use as a contraceptive, statutory health insurers usually cover the costs in Germany.

What surgical options are there?

Removal of fibroids or polyps

Surgery may be necessary if benign growths in or on the wall of the womb (fibroids or polyps) are causing heavy periods. Doctors can remove fibroids through the vagina or abdominal cavity. This operation is called fibroidectomy or myomectomy. The uterus is not removed during this procedure, so the woman can usually still get pregnant afterwards.

Removal of the lining of the womb

Another option is to remove the lining of the womb (endometrium). Here the tissue is removed using surgical instruments (endometrial resection) or destroyed, for instance using laser beams or microwave energy (endometrial ablation). After the procedure, the woman often stops having periods, or her periods are much lighter. This makes pregnancy unlikely.

But the lining of the womb can grow back. If heavy periods start again as a result, the procedure can be repeated. About 20 out of 100 women have this kind of surgery again within two years.

Endometrial ablation or resection can sometimes be performed as outpatient surgery. Women recover relatively quickly afterwards.

Removal of the womb (hysterectomy)

If the periods are very heavy and distressing, and previous treatments weren't successful, surgical removal of the womb (hysterectomy) is considered. This is a bigger operation, though, which may have emotional consequences in addition to the physical consequences. If a woman has a hysterectomy she will no longer have periods, so the associated problems will stop too. Pregnancy is no longer possible once the womb has been removed. But the balance of hormones in the body remains unaffected because the ovaries are nearly always left intact.

This procedure causes abdominal injuries in about 5 out of 100 women. It is also associated with the usual risks of a larger operation, such as infections or poor wound healing. Women who have a hysterectomy usually need to stay in the hospital for a while afterwards.

How do the options compare?

Compared to the various other medications and hormonal treatments, hormonal IUDs are the most effective at reducing bleeding and the related problems. The effect of hormonal IUDs is comparable to that of surgery to remove the lining of the womb. There was no real difference between the two treatments in the studies.

Hysterectomies have the greatest benefits of the various surgical procedures: The less invasive procedures that involve removing or destroying the endometrium don't reduce the problems associated with heavy periods as completely as a hysterectomy does. Those procedures may also have to be repeated if the lining grows back. But serious side effects and complications are much less common after endometrial ablation or resection than after hysterectomy.

How can I find the right solution for me?

Different women experience their periods differently, and the amount of menstrual blood they lose can vary naturally from month to month. But the amount of stress caused by heavy periods can only be determined by the woman herself: Whereas some women who have heavy periods may not think it’s a big problem, others already feel very uncomfortable with less heavy periods.

It’s important to first have a doctor look for possible causes of the heavy periods. In most cases you can then take your time to decide whether to start treatment and consider which of the treatment options is right for you. If you're not sure, it may be a good idea to get a second medical opinion – especially if a hysterectomy (surgery to remove the womb) has been recommended. Our decision aid may help here. It briefly summarizes the main pros and cons of the different treatments.

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