Treatment options for heavy periods

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. As well as relieving the pain, they can also help to lower the amount of blood lost somewhat. Acetylsalicylic acid (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. 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) instead.

Another medication that can help in the treatment of heavy periods is tranexamic acid. This medication helps to stop blood clots from breaking down, reducing the tendency to bleed. It is more effective than NSAIDs. Tranexamic acid may cause headaches, tiredness and muscle cramps.

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.

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

Heavy periods can be treated with tablets that contain the hormone progesterone. Progesterone inhibits the growth of the lining of the womb before menstruation, which lessens the bleeding during menstruation. Studies have shown that progesterone tablets work about as well as NSAIDs. But progesterone tablets are less effective than hormonal intrauterine devices (IUDs, or "coils") and tranexamic acid.

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

Women who have heavy periods often decide to use the mini-pill. They take this low dose of progestin 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're used in this way it's 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 IUDs (intrauterine devices, also called coils) are placed in the womb (uterus) and can remain there for about five years. Like birth control pills, they prevent pregnancy. They do this by releasing a continuous amount of a progestin called levonorgestrel. Studies show that an progestin-releasing IUDs can reduce the loss of menstrual blood and related problems more effectively than birth control pills or NSAIDs can.

Hormonal IUDs are about as effective as surgery to remove the lining of the womb.

The most common side effects of hormonal IUDs are acne, spotting (vaginal bleeding between periods) and breast tenderness. But these side effects are more likely to occur when using the mini-pill. Hormonal IUDs may also cause benign cysts to grow on the ovaries. These usually go away on their own within one year, though. IUDs are rejected by the body 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.

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 womb is not removed during this procedure, so the woman can usually still get pregnant afterwards.

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. Pregnancy is then unlikely. If she does get pregnant, there is a high risk of miscarriage or premature birth.

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 (without a hospital stay). Women recover relatively quickly afterwards.

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. She will also no longer be able to have children. But the balance of hormones in the body doesn't change 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 surgery, such as infections or poor wound healing. Women who have a hysterectomy usually need to stay in the hospital for a while afterwards.

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 studies.

A comparison of the various surgical procedures shows the following: Having a hysterectomy (removal of the womb) is the most effective way to reduce heavy menstrual bleeding and the related problems. But it is more invasive, and it has more side effects than endometrial ablation or resection do. And many women feel strongly about wanting to keep their womb.

Different women experience their periods differently, and the amount of menstrual blood they lose can vary naturally from month to month. But only they can know how much distress their heavy periods are causing: 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.