Treating heavy periods
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 for heavy periods are outlined here.
Medication
Medication
is usually tried first. If a particular medication isn't effective or
suitable for you, another type may be recommended.
Some
medications make your periods lighter and others may stop bleeding completely.
Some are also contraceptives.
The
different types of medication used to treat heavy periods are outlined below.
Progestogen
It prevents
the lining of your womb growing quickly and is also a form of contraceptive.
Possible side effects of using progestogen include:
· irregular
bleeding that may last more than six months
· breast
tenderness
· acne
· stopped or
missed periods
progestogen
has been shown to reduce bleeding by more than 90% and it's
usually the preferred treatment to try first for women with heavy
menstrual bleeding.
Combined
oral contraceptive pill
The combined
contraceptive pill, often referred to as "the pill", 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 OC as a treatment for heavy periods is they offer a more
readily reversible form of contraception than progestogen.
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 5 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 by more than 80%, 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 and reduces 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 6 to 12 months after stopping before
you're able to get 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%.
But it
can be expensive and may cause hormone abnormalities (hypogonadism)
similar to the menopause, with effects including hot flushes,
increased sweating and vaginal dryness.
This
means GnRH-a isn't a routine treatment, but may be used while you await
surgery.
Tranexamic
acid
If the
progestogen is viewed inapropriate – 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
Surgery
Your
specialist may suggest surgery if medication isn't effective in treating
your heavy periods.
If the
cause is fibroids, 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
specialist can discuss these procedures with you, including the benefits
and any associated risks.
Uterine
artery embolisation (UAE)
Uterine
artery embolisation (UAE) involves inserting a small tube into your
groin.
Small
plastic beads are injected through the tube into 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
But having
UAE may cause some pain after the blood supply is removed, and strong
painkillers are needed for about eight hours. There are also other
complications your specialist will be able to discuss with you.
If you plan
to get pregnant in the future, you may choose not to have UAE, as there
are potential risks to your fertility.
In around
10-20% of cases, UAE may 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. But 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. But in some cases the
fibroids grow back.
Read more
about treating fibroids.
Endometrial
ablation
Different
techniques can be used for endometrial ablation.
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 and inflated 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.
Hysterectomy
A hysterectomy (removal
of the womb) will stop any future periods, but should only be considered
after other treatment options had failed, because this procedure implies total
inability to conceive.
The
operation and recovery time are longer than for other surgical techniques for
treating heavy periods.
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