Treatment options for heavy periods 

Treatment
Pros
Cons

Medication

Levonorgestrel-releasing intrauterine system (LNG-IUS)

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

  • Can reduce blood loss by over 70%
  • Also acts as a contraceptive
  • Possible side effects include irregular bleeding, breast tenderness, acne and absent periods
  • Also acts as a contraceptive
  • Has to be fitted and removed by a qualified health professional
    Tranexamic acid

    Tranexamic acid is taken as a tablet three times a day from the start of your period, for a maximum of three to four days. It helps the blood in your womb clot

    • Can be used if LNG-IUS is not suitable
    • Some forms are available without prescription
    • Can reduce blood loss by 30-60%
    • Doesn’t act as a contraceptive

    • Possible side effects include indigestion and diarrhoea
    • Less effective than LNG-IUS
    • Doesn’t act as a contraceptive

    Non-steroidal anti-inflammatory drugs (NSAIDs)

    NSAIDs are common painkillers that can reduce the production of a number of chemicals linked with heavy periods. They are taken regularly from the start of - or just before - your period until heavy blood loss stops

    • Can be used is LNG-IUS is not suitable
    • May be combined with tranexamic acid or the combined oral contraceptive pill
    • Can also reduce painful periods
    • Easily available
    • Can reduce blood loss by 20-50%
    • Doesn’t act as a contraceptive

    • Possible side effects include indigestion and diarrhoea
    • Doesn’t act as a contraceptive
    • Should not be used by women with bleeding or clotting disorders, or women at a high risk of stomach ulcers

    Combined oral contraceptive pill

    Combined contraceptive pills, often referred to as the pill, can be used to treat menorrhagia. You take one pill every day for 21 days, before stopping for seven days. During this seven-day break you get your period

    • Can reduce blood loss by about 40%
    • You have more control over starting and stopping contraception than with LNG-IUS
    • Also reduces painful periods
    • Also acts as a contraceptive
    • Possible side effects include mood changes, nausea, fluid retention and breast tenderness
    • Also acts as a contraceptive

    Oral norethisterone

    Norethisterone is a man-made hormone that can be taken as a tablet 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

    • Can reduce blood loss by over 80%
    • Not an effective form of contraception
    • Possible side effects include weight gain, breast tenderness and short-term acne
    • Not an effective form of contraception

    Injected progestogen

    A type of progestogen called medroxyprogesterone acetate is an injection that is sometimes used to treat menorrhagia

    • Bleeding stops completely in up to 50% of women after a year of treatment
    • Only one injection needed every 12 weeks
    • Also acts as a contraceptive
    • Possible side effects include weight gain, bloating and breast tenderness
    • Also acts as a contraceptive

    Gonadotropin releasing hormone analogue

    Gonadotropin releasing hormone analogue (GnRH-a) is a type of hormone sometimes given as an injection to treat heavy periods

    • Bleeding stops completely in 89% of women
    • Can be used while you wait for surgery
    • Can cause hormonal changes, similar to the menopause – including side effects such as hot flushes, increased sweating and vaginal dryness
    • Not a routine treatment due to side effects

    Surgery

    Uterine artery embolisation (UAE)

    If your heavy periods are caused by fibroids, UAE is an operation that can cause the growths to slowly shrink

    • Often successful in women with heavy periods caused by fibroids
    • Serious complications are rare
    • Only requires one night in hospital and local anaesthetic
    • Can cause pain for a few hours afterwards
    • In 10-20% cases, UAE is required again later on
    • Not effective if your heavy periods are not caused by fibroids
    • The effects of UAE on your ability to get pregnant are uncertain
    Myomectomy

    Myomectomy is the surgical removal of fibroids from your womb

    • Can reduce blood loss caused by fibroids
    • Not suitable for all types of fibroid
    • Fibroids sometimes grow back
    • Not effective if your heavy periods are not caused by fibroids
    • Requires general anaesthetic and a hospital stay of up to five days
    Endometrial ablation

    Endometrial ablation is an operation that can be used to treat heavy periods by destroying most of your womb lining with heat, a laser or microwaves

    • Should stop heavy bleeding
    • Fairly quick to perform and you can often go home the same day
    • You may experience vaginal bleeding and tummy cramps afterwards, which can last for a few days or weeks
    • Womb lining may grow back, so surgery may need to be repeated
    • Attempting to get pregnant after endometrial ablation is not recommended, as the risk of problems like a miscarriage is high

    Hysterectomy

    A hysterectomy is the surgical removal of the womb

    • Stops any future periods
    • You will no longer be able to get pregnant
    • Requires general anaesthetic and a hospital stay of up to five days
    • Complications include early menopause and infection