Treatment - Heavy periods

Many treatment options are available for heavy periods. Not all the treatments may be suitable for you.

Your treatment options depend on:

• your symptoms
• your general health
• any underlying cause for your heavy periods
• if you're trying to get pregnant or want to in the future
• your personal preferences

Discuss the benefits and risks of the different options with your GP or specialist doctor. Some treatments may have an impact on your future fertility.

Intrauterine system (IUS)

The levonorgestrel-releasing intrauterine system or IUS is a small plastic device that slowly releases a hormone called progesterone. Your doctor or nurse inserts the device into your womb.

The treatment prevents the lining of your womb from growing quickly. It's also a contraceptive. An IUS does not affect your chances of getting pregnant after you stop using it.

Possible side effects of using an IUS include:

• irregular bleeding that may last more than 6 months
• breast tenderness
• acne
• stopped or missed periods

An IUS is often the preferred first treatment for heavy menstrual bleeding. But it can take at least 6 periods for you to start seeing the benefits.

Tranexamic acid

Your GP may prescribe tranexamic acid if an IUS is unsuitable or you're waiting for more tests or another treatment.

You take tranexamic acid as tablets. It works by helping the blood in your womb to clot.

Tranexamic acid tablets are usually taken 3 times a day for 4 days. You start taking the tablets as soon as your period starts.

Tranexamic acid tablets are not a form of contraception. They do not affect your chances of becoming pregnant.

Your GP may prescribe tranexamic acid with a non-steroidal anti-inflammatory drug (NSAID).

Possible side effects of tranexamic acid include:

• diarrhoea
• feeling sick
• being sick

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs can treat heavy periods if an IUS is not an option, or you're waiting for more tests or another treatment. You can take them in tablet form.

You can take NSAIDs from just before or the start of your period until the heavy bleeding stops.

NSAIDs for treating heavy menstrual bleeding include:

• ibuprofen
• mefenamic acid
• naproxen

You need a prescription for mefenamic acid and naproxen.

NSAIDs work by reducing your body's production of a hormone-like substance called prostaglandin. This 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 reduce the bleeding and do not cause serious side effects.

Make sure you do not take more than the recommended daily dose listed on the packet.

Combined oral contraceptive pill

The combined contraceptive pill can treat heavy periods. It contains the hormones oestrogen and progestogen.

The combined oral contraceptive pill is a more reversible form of contraception than the IUS. They also regulate your menstrual cycle and reduce period pain.

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

Common side effects of the combined oral contraceptive pill include:

• mood changes
• feeling sick (nausea)
• headaches
• breast tenderness

Cyclical progestogens

If other treatments have not helped, your GP may prescribe cyclical progestogen medication.

It's taken in tablet form for part of your menstrual cycle. Your GP will tell you how to take it.

It's not an effective form of contraception.

It can have unpleasant side effects, including:

• breast tenderness
• bleeding between your periods

Endometrial ablation

Endometrial ablation involves thinning, removing or destroying the lining of the womb (the endometrium).

It may lighten your periods or stop them completely. This depends on how much of your womb lining remains.

There are different techniques for endometrial ablation, including using heat or ultrasound energy.

During endometrial ablation using heat, your doctor uses an electrical source, radio waves or lasers to destroy the womb lining. They do the procedure through the vagina and cervix.

During endometrial ablation using ultrasound energy, your doctor uses high levels of ultrasound energy from outside the body to destroy fibroids. This does not harm healthy womb lining

You can have these procedures in a hospital under local anaesthetic or general anaesthetic. You can usually go home on the same day.

You may have some vaginal bleeding, like a light period, for a few days after endometrial ablation. Use sanitary towels rather than tampons. You may have bloody discharge for 3 or 4 weeks.

You may also have tummy cramps, like period pains, for a day or 2 after the procedure. To treat this, your doctor may recommend painkillers, such as paracetamol or ibuprofen.

In rare cases, you can have more severe or continued pain after having endometrial ablation. If this happens, speak to your GP or hospital care team. They may prescribe a stronger painkiller.

It's unlikely you'll be able to get pregnant after endometrial ablation. If you do, you'll have an increased risk of miscarriage or other complications. The procedure is not recommended if you still want to have children.

Sometimes endometrial ablation does not lighten the periods and heavy periods may come back. If this happens you may have a repeat treatment.

Uterine artery embolisation (UAE)

If fibroids cause your heavy periods, UAE may be an option. This blocks the blood vessels that supply the fibroids and causes them to shrink.

Under x-ray guidance, your doctor inserts a small tube into the large blood vessel in your thigh. They inject small particles through the tube to block the arteries supplying blood to the fibroid.

Myomectomy

Myomectomy is another treatment option for heavy periods caused by fibroids. It involves surgery to remove fibroids from the wall of your womb.

Removal of the womb (hysterectomy)

A hysterectomy will stop any future periods. It is only considered after other options have been tried or discussed.

A hysterectomy is only used to treat heavy periods after you discuss the benefits and risks of the procedure with your specialist.

The operation and recovery time are longer than other types of surgery for heavy periods.

You will not be able to get pregnant after having a hysterectomy.