Why is my period so heavy, part II: Treatments for heavy bleeding

Why is my period so heavy, part II: Treatments for heavy bleeding

Nicole Knight, AHCJ | November 4, 2019 | Women's Health

Heavy menstrual bleeding can prevent you from living your best life, but the unfortunate reality is only about one-third of women with the condition are treated for it (1). The reason for this is that many women think the heavy bleeding is normal and therefore do not seek treatment. 

The good news? Heavy menstrual bleeding is not only treatable — you also have lots of choices to free yourself from a heavy flow.

Last week, we explained why your period might be so heavy. This week we’ll outline the latest and most common treatment options. 

First, a quick recap. Heavy menstrual bleeding is defined as a flow lasting more than 7 days, according to both the American College of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention (1, 2). With a typical menstrual flow, you’ll lose about 2-3 tablespoons of blood (2). With heavy menstrual bleeding — what doctors called menorrhagia — you may lose twice as much blood (2). 

While these guidelines define ‘heavy bleeding’, Dr. Don Aptekar, MD, FACOG explains that ‘heavy bleeding’ is defined by you. If you feel your period is interfering with your life, you should seek treatment. 

In this post we will review treatment pros and cons, but please remember this does not replace speaking with your doctor and may not include all treatments available or side effects. Your doctor should investigate the particular cause(s) for your heavy bleeding prior to treatment. If you have questions on how your doctor might diagnose heavy menstrual bleeding before reading about treatment, check our part one of our Heavy Menstrual Bleeding series.

 

How is heavy menstrual bleeding treated?

Your exact form of treatment is customized to you. Expect your provider to explain your treatment options, which will be based on the reason for the excessive bleeding, how severe it is, and your overall health, age, and life goals. 

For example, certain treatments may prevent you from having children or increase your risk of pregnancy complications. Some treatments are more conservative, while others involve surgery. Typically, your provider starts by recommending medications to treat your heavy menstrual flow before shifting gears to minimally invasive procedures or surgery.

 

What medications reduce heavy menstrual bleeding?

Depending on the cause of your heavy flow, expect your provider to suggest one or more of these medications (1, 2, 3, 4):*Disclaimer: This Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

 

Nonsteroidal antiinflammatory drugs (NSAIDs): These medications (ibuprofen, naproxen, and mefenamic acid) slow down the rate of prostaglandin synthesis in your endometrium, constricting blood vessels and lightening menstrual flow.

Pros: NSAIDs may ease menstrual cramps and help reduce a heavy flow by 20-46% on average (4). The medication is inexpensive, available without a prescription, has few side effects, and doesn’t need to be taken daily (5). Plus, if you’re trying to conceive, NSAIDs do not prevent pregnancy (Although, as a general rule, talk to your provider about possible interactions with prenatal vitamins, supplements, etc.).

Cons: NSAIDs may actually increase bleeding in some women. The most common side effect, however, is an upset stomach (4).

 

Oral contraceptives: Taking hormonal birth control pills may lessen heavy bleeding due to polycystic ovary syndrome (PCOS), fibroids, problems with ovulation, or endometriosis. The combination pill Natazia® is actually FDA-approved to treat heavy periods (4).

Pros: Research suggests taking a combination pill with both estrogen and progestin may reduce your flow by 35-69% (5).

Cons: A combination pill prevents pregnancy, making it a non-starter if you’re trying to conceive. You may experience breast tenderness, nausea, breakthrough bleeding, weight gain, and other side effects (4). The combo pill also carries increased health risks if you smoke, have high blood pressure, or are overweight (5). 

 

Progestin medication: Progestin is the most frequently prescribed medicine for heavy menstrual bleeding (4). It works by countering the effect of estrogen on the growth of your uterine lining (4). Your provider may recommend taking it daily or during days 5-21 of your cycle (6). 

Pros: You can take it if you’re trying to conceive, and research suggests it may curb heavy menstrual bleeding by 33% (5).

Cons: Potential side effects include weight gain, bloating, headaches, and depression (4).

 

Hormonal IUD: Intrauterine devices like Mirena® and LILETTA® release levonorgestrel, a progestin hormone that thins the uterine lining to relieve heavy menstrual bleeding (5, 6).

Pros: Research suggests using a levonorgestrel IUD may reduce your flow by a whopping 97% (4).

Cons: IUDs costs several hundred dollars and your insurance may not cover a levonorgestrel IUD (5). Out-of-pocket costs for Mirena range from $500 - $858, while LILETTA may set you back $50-$684 (7). Potential side effects include headache, vaginitis, ovarian cysts, and breast tenderness (4).

 

Gonadotropin-releasing hormone (GnRH) agonists: This method is not as commonly used and is a short-term option. This medication stops your pituitary gland from releasing follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to suppress ovulation and control a heavy flow (4). 

Pros: GnRH agonists may lessen menstrual bleeding by 30-60% (8).

Cons: GnRH agonists are a short-term option because they may contribute to bone loss and affect the production of high-density lipoprotein (HDL) cholesterol, the good type of cholesterol (4). They also may cause side effects like vaginal dryness and depression (8).

 

Tranexamic acid: This is a nonhormonal FDA-approved prescription medication you take each month at the start of your period. It works by preventing your body from breaking down blood clots. 

Pros: You can take this when you’re trying to conceive (5). Research shows this medication lightens menstrual bleeding by about 40% (and women who took it for a heavy flow reported an improvement in their social, physical, and emotional well-being) (8,4).

Cons: This treatment can be expensive (5). It’s generally only a short-term fix because long-term use is linked to thrombosis, a potentially dangerous condition where clots form in your arteries (5).

If these options don’t work, you might need a minimally invasive treatment or surgical procedure to treat the heavy flow.

 

Which procedures treat heavy menstrual bleeding?

Surgical options range from outpatient procedures that target the source of heavy menstrual bleeding to surgery to remove your uterus. Depending on your condition and other factors, expect your provider to discuss one or more of these treatments (1, 2, 3, 4): 

 

Dilatation and curettage: D&C is an outpatient procedure to temporarily remove your uterine lining (endometrium). 

Pros: It’s a common procedure and it works, but only for a short time (3).

Cons: A D&C only relieves heavy menstrual bleeding for 1-2 months (4). Possible risks include infection, uterine perforation, and uterine scarring (4).

 

Endometrial ablation: This procedure generally uses a laser, radiofrequency energy, heat, or freezing liquid to destroy your endometrium to minimize heavy bleeding or stop it completely (3).

Pros: The success rate depends on the type of procedure. A research review showed that an average of 37% of patients stopped having a period altogether after various types of endometrial ablation (9). Meanwhile, a study looking a cryoablation (freezing) alone found that 85% of women had normal menstrual flow after the procedure (9).

Cons: You shouldn’t get pregnant after this procedure due to a higher risk of ectopic pregnancy (9). Potential complications are rare, but include uterine perforation, uterine scarring, bleeding, and pelvic infection (9).

 

Uterine artery embolization (UAE): This is a nonsurgical procedure to treat fibroids that are causing a heavy flow by cutting off blood supply to the growths. 

Pros: Research shows this treatment is highly effective at reducing or eliminating heavy bleeding, with success rates of 73-90% (10).

Cons: UAE may affect your chances of getting pregnant (5) — although the American College of Obstetricians and Gynecologists doesn’t explicitly advise against this procedure if you want to get pregnant in the future (10). Potential side effects include pain following the procedure and vaginal discharge (10).

 

Myomectomy: Myomectomy is a type of surgery to remove uterine fibroids that cause heavy periods. 

Pros: Research shows that 80% of women who had this procedure were still free of a heavy menstrual flow even two years after treatment (11).

Cons: You may need to wait 3-6 months after this procedure to conceive (11). The surgery also may increase your chances of miscarriage and pregnancy complications, such as placenta previa or preterm birth (6). Fever is a common potential side effect, while more serious complications, such as large blood loss, are less common (11).

 

Hysterectomy: Your provider may suggest surgically removing your uterus if other treatments have failed. 

Pros: You won’t have periods after a hysterectomy, although you won’t actually be in menopause unless your ovaries also are removed (8). In a study looking at whether patients with heavy menstrual bleeding were happiest after a hysterectomy, endometrial ablation, or a levonorgestrel IUD, patients reported the best quality of life following hysterectomy (4).

Cons: A hysterectomy is major surgery, and one that eliminates the possibility of pregnancy. Although ACOG calls this procedure “one of the safest,” it still carries potential risks, including fever, infection, bleeding, injury to nearby organs, and blood clots (12) .

 

We’ve covered a LOT of ground here. Take time to digest and process this information. Then, be sure to loop in your healthcare provider, if you haven’t already done so. Together you can  figure out the best option for you to say sayonara to your heavy flow.

 

Medically reviewed by Dr. Don Aptekar, MD, FACOG  

References:

  1. https://www.acog.org/Patients/FAQs/Heavy-Menstrual-Bleeding?IsMobileSet=false
  2. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
  3. https://www.mayoclinic.org/diseases-conditions/menorrhagia/diagnosis-treatment/drc-20352834
  4. https://emedicine.medscape.com/article/255540-treatment#d8
  5. https://www.uptodate.com/contents/management-of-abnormal-uterine-bleeding
  6. https://www.sciencedirect.com/science/article/pii/S0002937815008455
  7. https://www.bedsider.org/methods/iud#costs
  8. https://www.sciencedirect.com/science/article/pii/S0002937815008455#sec5
  9. https://www.uptodate.com/contents/an-overview-of-endometrial-ablation
  10. https://www.uptodate.com/contents/uterine-leiomyomas-fibroids-treatment-with-uterine-artery-embolization
  11. https://www.uptodate.com/contents/hysteroscopic-myomectomy
  12. https://www.acog.org/Patients/FAQs/Hysterectomy?IsMobileSet=false