As the amount of blood that is lost during a woman's period varies considerably from one person to another, menorrhagia (heavy periods) is not always diagnosed.
If menorrhagia is diagnosed, your GP will discuss all the possible treatment options with you. Your GP will inform you about:
- the effectiveness of treatments
- the likelihood of any adverse effects following treatments
- whether contraception will be required
- the implications of treatment on fertility
The aims of treating menorrhagia are:
- to reduce or stop excessive menstrual bleeding
- to prevent or correct iron-deficiency anaemia caused by heavy menstrual bleeding
- to use surgical treatments for women who may benefit from them
- to improve the quality of life of women with heavy menstrual bleeding
Medication
Medication is recommended as the first type of treatment for use in cases of menorrhagia 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 if you try a medication and it is ineffective, another one may be recommended. Some medications make your periods lighter and others may stop bleeding completely. Some medications 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 that are used to treat menorrhagia are outlined below. They are listed in the order in which the National Institute for Health and Clinical Excellence (NICE) recommends they are tried (as long as they are considered suitable).
Levonorgestrel-releasing intrauterine system (LNG-IUS)
The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small plastic device that is placed in your womb and slowly releases a hormone called progestogen. It prevents the lining of your womb from growing quickly and it 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 for more than six months
- breast tenderness
- acne
- headaches (although they tend to be minor and short-lived)
- 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 (it is usually used for a minimum of 12 months).
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 or four 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) (see below).
Possible side effects include:
- indigestion
- diarrhoea
- headaches (although this is uncommon)
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) and until bleeding has stopped. As with tranexamic acid, treatment should be stopped if your symptoms have not improved within three months.
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 (see below).
Common side effects of NSAIDs 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 are not causing significant adverse side effects. However, treatment should be stopped after three months if NSAIDs are found to be ineffective.
See the Health A-Z topic about NSAIDs for more information about this type of medication.
Combined oral contraceptive pill
Combined oral contraceptive pills, often referred to as the pill, can be used to treat menorrhagia. They contain the hormones oestrogen and progestogen. When you're on the pill 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 that they offer a more readily reversible form of contraception than LNG-IUS. They also have the benefit of regulating your menstrual cycle and reducing menstrual pain (dysmenorrhoea).
The combined oral contraceptive is a contraceptive that works by preventing your ovaries from 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
- headaches
- nausea (feeling sick)
- fluid retention
- breast tenderness
See the Health A-Z topic about the Combined contraceptive pill for more information.
One study looked at using gonadotropin releasing hormone analogue (GnRH-a) as well as the combined oral contraceptive pill. It found that women who were treated with both had significantly reduced blood loss compared with women who only used the combined contraceptive pill.
GnRH-a is a type of hormone that is usually used to treat fibroids (non-cancerous growths in the womb). Although more research is needed, GnRH-a may be a possible treatment in the future for women with particularly heavy periods.
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 five to 26 of your menstrual cycle, counting the first day of your period as day one.
Oral norethisterone works by preventing your womb lining from growing quickly. It is not an effective form of contraception and can have unpleasant side effects, including:
- weight gain
- bloating
- breast tenderness
- headaches
- acne (which does not usually last long)
Oral progestogens, such as norethisterone, are not as effective as tranexamic acid. However, if bleeding is very heavy or has been continuing for a while, a high dose of oral norethisterone can stop bleeding in 24 to 48 hours.
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 from growing quickly, and it 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 (see below).
Common side effects of injected progestogen include:
- weight gain
- irregular bleeding
- absence of periods (amenorrhoea)
- a delay in ability to become pregnant for six to twelve 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 twelve weeks, for as long as treatment is required.
Surgery
Your specialist may suggest surgery if the above medications are 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 (UAE)
- myomectomy
Uterine artery embolisation (UAE)
Uterine artery embolisation (UAE) is a minimally invasive procedure that can be carried out through a small tube inserted into your groin. Through this tube, small plastic beads are injected into the arteries supplying blood to the fibroid. This blocks the arteries and causes the fibroid to shrink over the subsequent six months.
People who have UAE may suffer pain after the blood supply is removed, and strong painkillers are needed for about eight hours. There are some other complications that your specialist will be able to tell you about.
The advantage of UAE is that:
- it is successful in 95% of people who have heavy periods caused by fibroids
- serious complications are rare
- you only need to spend one night in hospital
- your womb and ovaries are not removed, so if you still want children this is possible
Further research needs to be carried out into the success rate of pregnancy after UAE. Sometimes, further embolisations or other procedures are needed after UAE. Your specialist will discuss this with you.
Myomectomy
Sometimes, the fibroids can be removed using a surgical procedure known as a myomectomy. However, the 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 possible, myomectomies are very effective operations. However, in a quarter to a third of all people who have a myomectomy, the fibroids grow back again.
See the Health A-Z topic about Fibroids - treatment for more information.
If your heavy periods are caused by something other than fibroids, there are several surgical procedures that can be carried out. Your specialist will be able to discuss them with you, including the benefits and any associated risks.
Common surgical procedures for treating heavy periods that are not caused by fibroids include:
- endometrial ablation: where the womb lining is destroyed
- hysterectomy: surgical removal of the womb, which may sometimes also involve the removal of the cervix (neck of the womb), fallopian tubes and ovaries (oophorectomy)
Endometrial ablation
There are different techniques that can be used for endometrial ablation. These include:
- microwave endometrial ablation: in which 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: in which a balloon is inserted into your womb and is inflated and heated to destroy the womb lining
These procedures can be carried out under local anaesthetic (painkilling medication) or general anaesthetic (where you are unconscious). 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. These can be treated with painkillers, such as paracetamol.
More information about endometrial ablation is available from the Royal College of Obstetricians and Gynaecologists who have produced a leaflet called information for you after an endometrial ablation.
Hysterectomy
A hysterectomy (removal of the womb) will stop any future periods, but it should only be considered after other options have been tried or discussed. The hysterectomy operation and recovery time are longer than for other surgical techniques for treating heavy periods.
A hysterectomy is only used to treat menorrhagia following a thorough discussion with your specialist to outline the benefits and disadvantages of the procedure. See the Health A-Z topic about Hysterectomies for more information.
