Treatment

Youmay not need treatment for heavy periodsifthere isn't a serious cause or if the bleeding doesn't bother you.

Bleeding can vary over time for some women, so it may simply be that your bleeding is currently heavier than usual.

If you do need treatment, the aim is to:

• reduce or stop excessive menstrual bleeding
• treat or prevent Iron deficiency anaemia caused by heavy bleeding

The various treatments forheavy periodsare outlined below. You can also read a summary of the pros and cons of the treatments for heavy periods , allowing you to compare your treatment options.

Medication

Medication is usually tried first.

If a particular medication isn'teffective or suitable for you, anothertype may be recommended. Some medications make your periods lighter and others may stop bleeding completely. Some are also contraceptives.

Your GP will explain how each type of medication works and any possible side effects. This will help you decide whichtreatment is most suitable.

The different types of medication used to treat heavy periods are outlined below.

Levonorgestrel-releasing intrauterine system (LNG-IUS)

The levonorgestrel-releasing intrauterine system (LNG-IUS) is a small plastic deviceinserted into your womb. It slowly releases a hormone called progestogen.

It prevents the lining of your womb growing quickly and is also a form of contraceptive. LNG-IUS doesn't affect your chances of getting pregnant after you stop using it.

Possible side effects of using LNG-IUS include:

• irregular bleeding that may lastmore than six months
• breast tenderness
• acne
• stopped or missed periods

LNG-IUS has been shown to reduce bleeding bymore than90% and it's usuallythe preferred treatment to try first for women with heavy menstrual bleeding.

Tranexamic acid

If LNG-IUS is unsuitable for example, if contraception isn't wanted tranexamic acid tablets may be considered. The tablets work by helping the blood in your womb to clot. They've been shown to reduce blood loss by around 50%.

Two or three tranexamic acid tablets are taken three times a day for a maximum of three to four days.

Treatment should be stopped if your symptoms haven't improved within three months.

Tranexamic acid tablets aren't a form of contraception and won't affect your chances of becoming pregnant. If necessary, tranexamic acid can be combined with a non-steroidal anti-inflammatory drug (NSAID).

Possible side effects of tranexamic acid include indigestion and diarrhoea .

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) may also beused to treat heavy periods if LNG-IUS isn't appropriate.

NSAIDs have been shown to reduce blood flow by 20-50%. They're taken in tablet form from the start of your period or just beforeuntil heavy bleeding has stopped.

The NSAIDs recommended for treating menorrhagia are:

• mefenamic acid
• naproxen
• ibuprofen

Naproxen is usually taken twice a day, and ibuprofen and mefenamic acid are usually taken three 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 can also help relieve period pain . They're not a form of contraceptive.

You can keep taking NSAIDs for as long as you need to if they're reducing blood loss and not causing significant side effects. However, treatment should be stopped after three months if NSAIDs arenot effective.

Combined oral contraceptive pill

The combined contraceptive pill, often referred to as "thepill",can be used to treat heavy periods. It contains the hormones oestrogen and progestogen.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 heavy periods is they offer a more readily reversible form of contraception than LNG-IUS.They reduce heavy bleeding by around 40% and have the benefit of regulating your menstrual cycle and reducing period pain.

The pill works by preventing your ovaries releasing an egg each month. As long as you're taking it correctly, it should prevent pregnancy.

Common side effects of the combined oral contraceptive pill include:

• mood changes
• nausea (feeling sick)
• fluid retention
• breast tenderness

Oral norethisterone

Norethisterone is a type of man-made progestogen (one of the female sex hormones). It can be used to treat heavy periods, and 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 growing quickly. It isn't suitable if you're trying to conceive because it's likely to inhibit ovulation.

It can reduce heavy bleeding bymore than80%, but isn't an effective form of contraception and can have unpleasant side effects, including:

• weight gain
• breast tenderness
• short-term acne

Oral progestogens, such as norethisterone, aren't as effective as tranexamic acid and may not always be able to control heavy bleeding.

Injected progestogen

A type of progestogen called medroxyprogesterone acetate is also available as an injection and is sometimes used to treat heavy periods. It prevents the lining of your womb growing quickly andreduces bleeding by up to 50%. It's also a form of contraception.

Injected progestogen doesn't prevent you becoming pregnant after you stop using it, although there may be a delay of six to 12 months after stopping before you're able toget pregnant.

Common side effects of injected progestogen include:

• weight gain
• irregular bleeding
• stopped or missed periods
• premenstrual symptoms, such as bloating, fluid retention and breast tenderness

You'll need to have progestogen injected once every 12 weeks for as long as treatment is required.

Gonadotropin releasing hormone analogue

Gonadotropin releasing hormone analogue (GnRH-a) is a hormone sometimes given as an injection to treat fibroids (non-cancerous growths in the womb).

Studies have shown GnRH-a is effective in reducing blood loss during periods by almost 90%.However,it can be expensive andmay cause hormone abnormalities (hypogonadism) similar to the menopause ,with effects including hot flushes, increased sweating and vaginal dryness . This meansGnRH-a isn't a routine treatment, but may be used while you await surgery.

Surgery

Your specialist may suggest surgery if medicationisn't effective in treating your heavy periods.

Ifthe cause isfibroids, you may be recommended either:

• uterine artery embolization
• myomectomy

If your heavy periods aren't caused by fibroids, your options include:

• endometrial ablation where the womb lining is destroyed
• hysterectomy surgical removal of the womb

Your specialistcan discuss these procedures with you, including the benefits and any associated risks.

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE)involves insertinga small tube into your groin. Small plastic beads are injected through the tubeinto the arteries supplying blood to the fibroid. This blocks the arteries and causes the fibroid to shrink over the following six months.

Advantages of UAE include:

• it's usually effective in treating heavy periods caused by fibroids
• serious complications are rare
• you only need to spend one night in hospital

However, having UAE maycause somepain after the blood supply is removed, and strong painkillers are needed for about eight hours. There are also other complicationsyour specialist will be able to discuss with you.

If you plan to get pregnant in the future, you may choose notto have UAE, as there are potential risks to your fertility.

In around 10-20% of cases,UAEmay be required again later on.Your specialist will discuss this with you.

Myomectomy

Sometimes fibroids can be removed using a surgical procedure called a myomectomy. However, it isn't suitable for every type of fibroid.

Your specialist will be able to tell you whether a myomectomy is possible and what the possible complications are.

When they're appropriate, myomectomies are effective. However,in some cases the fibroids grow back.

These include:

• microwave endometrial ablation a probe that uses microwave energy (a type of radiation ) is inserted into the womb to heat and destroy the womb lining
• thermal balloon ablation a balloon is inserted into your womb andinflated and heated to destroy the womb lining

These procedures can be carried out either under local anaesthetic or general anaesthetic . They're fairly quick procedures, taking around 20 minutes, and you can often go home on the same day.

You may experience some vaginal bleeding for a few days after endometrial ablation, 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 after the procedure. These can be treated with painkillers, such as paracetamol or ibuprofen .

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

It's usually recommended that you don't get pregnant after having endometrial ablation because the risk of problems,such as miscarriage , is high.

The failure rate for endometrial ablation is about 25-35%. If it fails, you may be offered a repeat treatment.

For further information, the Royal College of Obstetricians and Gynaecologists (RCOG) have produced a leaflet called Information for you after an endometrial ablation(PDF, 1.05Mb) .

Hysterectomy

A hysterectomy (removal of the womb) will stop any future periods, butshould only be considered after other options have been tried or discussed. The operation and recovery time are longer than for other surgical techniques for treating heavy periods.

A hysterectomy is only used to treat heavy periods after a thorough discussion with your specialist to outline the benefits and disadvantages of the procedure.

You won'tbeable toget pregnantafter having a hysterectomy.