Getting your period every month may be a bit of a hassle, but it shouldn’t shut down your normal activities or leave you totally exhausted. But for many women who have abnormally heavy periods, that’s exactly what it does. A heavy menstrual flow can leave women feeling weak, tired, and paranoid about leaks and constant bathroom breaks. Some even cancel plans and stay home on days their bleeding is heaviest.
There’s actually a technical definition for excessive menstrual bleeding, says Linda Yang, MD, assistant professor of obstetrics and gynecology at Loyola University Medical Center: It’s often defined as a woman losing more than 80 milliliters of blood over the course of her period. “Of course, that’s not very practical,” she says. “Most women can’t exactly quantify how much blood they’re losing, so as doctors, we ask about other things.”
For example, if you regularly soak a pad or a tampon faster than every two hours, feel dizzy or lightheaded during your period, or bleed for longer than seven to 10 days every month, those are all red flags that you might be losing too much blood. “Another flag would be if you feel your period disrupts your day-to-day activities,” says Dr. Yang, “where you have days home from work or school, or if it’s regularly staining your clothing or bedsheets.”
If any of this sounds like your monthly routine, it’s worth mentioning to your gynecologist or primary care physician. Heavy periods could be caused by a bigger issue—like a clotting disorder or a uterine polyp or fibroid—that could also cause pain, infertility, and other problems. And even if there’s no identifiable underlying cause, treatments are still available to reduce bleeding and improve quality of life.
You don’t have to meet the technical criteria for excessive bleeding to talk with your doctor, either, says Sawsan As-Sanie, MD, associate professor of obstetrics and gynecology at the University of Michigan. “In general, any significant change in someone’s period—or anything that causes you distress—is worth investigating,” she says. Here are some of the common treatments for heavy periods doctors might recommend.
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NSAIDs
“One of the simplest things women can do for heavy bleeding, especially if their symptoms are not very severe, is take ibuprofen on a regular schedule,” says Dr. As-Sanie. The over-the-counter nonsteroidal anti-inflammatory drug (NSAID) can decrease the production of prostaglandins—chemical compounds that play a role in both cramping and blood flow during menstruation.
Dr. As-Sanie recommends taking 600 milligrams of ibuprofen every six to eight hours, starting two to three days before your period starts and continuing through the first couple of days. (Naproxen, another over-the-counter NSAID, will have similar effects.) “That’s something you can try without necessarily seeing your physician,” she says. “It certainly won’t be sufficient for all women, but for some it may help enough to make a real difference.”
Birth control pills
If over-the-counter drugs aren’t cutting it, doctors often recommend hormonal contraceptives as a way to reduce heavy menstrual bleeding. The estrogen in many types of birth control pills (and also in the ring and the patch) can promote thickening and clotting of blood, which can reduce menstrual flow for many women.
One type of birth control pill, sometimes called the mini-pill, contains only the hormone progestin. Women take this pill every day, without any “break” weeks—which can lessen menstrual bleeding and make periods irregular. Some women on the mini-pill stop getting their period altogether.
Before you start taking any type of new birth control, make sure your doctor gets a full health history: Women with a history of blood clots or who get migraines with aura should not take traditional birth control pills, for example, although other hormonal treatments may still be safe.
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Iron supplements
“Many women who have heavy periods also have iron deficiency, because they’re losing so much blood so frequently that their body doesn’t have a chance to replace those iron stores,” says Dr. Yang. “So when we start our evaluation we will check blood count and also iron levels. Depending on what those labs show, we may recommend the use of iron supplements.”
Iron supplements won’t reduce the flow of blood, but they may prevent anemia and help women with heavy periods feel better. According to a 2014 study published in Acta Obstetricia et Gynecologica Scandinavica, treating women for period-related anemia improved their energy levels and physical and social functioning ;and decreased anxiety and depression symptoms.
Tranexamic acid
This medication is available by prescription only and is taken during the first four or five days of your period. “It interferes with how the blood clotting process occurs, so the amount of blood patients are producing during their periods is reduced,” says Dr. Yang.
Tranexamic acid can be a good option for women who don’t want to or can’t use hormonal treatments, says Dr. As-Sanie, and it may be helpful for women with uterine fibroids, as well. However, it does carry an increased risk of blood clots, so women who have had blood clots in the past should not take it.
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GnRH agonists
Women who have uterine fibroids or endometriosis (both of which can cause heavy menstrual bleeding) are sometimes treated with gonadotropin-releasing hormone agonist drugs, also known as GnRH agonists. These medications stop the production of estrogen in the body, essentially sending the body into menopause and stopping the menstrual cycle altogether.
“We use these drugs less commonly than other treatment options, because it’s not recommended as a long-term treatment,” says Dr. Yang. “We’ll use it for women who have fibroids that require reduction in size: The agonist can shrink the fibroid temporarily before surgery.”
An IUD
It’s common for women to have irregular periods and spotting for the first few months after getting an IUD inserted, but those side effects don’t usually last long-term. Some women with hormonal IUDs stop having periods completely. Like birth control pills, an IUD only makes sense if you’re not looking to get pregnant any time soon.
Endometrial ablation
This procedure is less invasive than uterine surgeries, but it can still help some women with heavy menstrual bleeding. “The way it works is it burns away the lining of the uterus so that with each subsequent period, the flow is lighter,” says Dr. Yang. “In some women, they may not have a period at all.”
In terms of reduced blood flow, results from endometrial ablation are similar to those of hormone-releasing IUDs, says Dr. Yang. The procedure can be done with heat, radio waves, microwave energy, or even electric current. Cryoablation, in which endometrial tissue is frozen off, may also be an option. You may not be able to get pregnant after an endometrial ablation.
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Myomectomy or hysterectomy
Women who don’t have success with medication or less invasive treatment options may consider having part or all of their uterus removed. This is sometimes the case for women with uterine fibroids or other structural causes of heavy bleeding.
“Some women may be candidates for myomectomy procedures, where we remove the fibroids while still preserving the uterus,” says Dr. As-Sanie. Women can still become pregnant after undergoing a myomectomy, although it can increase the risk of pregnancy or childbirth complications.
“This is an option women may choose to proceed with if they don’t respond to other treatments and have continued severe symptoms that are disruptive and impact their quality of life,” says Dr. Yang. Doctors may also recommend a hysterectomy for women whose bleeding is so heavy that they become anemic and require blood transfusions, she adds.
Uterine artery embolism
If fibroids are the cause of your heavy bleeding, your doctor may also recommend uterine artery embolization. During this minimally invasive procedure, a doctor inserts a catheter through the groin and into the artery that supplies blood to the uterus—and to the fibroids growing there.
A substance is injected into the artery to block blood flow to those fibroids. “Over time it reduces the size of fibroids,” says Dr. As-Sanie. For many women, she says, this means lighter and less painful periods—although it’s still unclear whether this is safe for women who want to get pregnant in the future. The procedure usually involves an overnight hospital stay but can be done as an outpatient procedure, as well.
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The bottom line
Women whose lives are disrupted by heavy periods should not suffer in silence, says Dr. As-Sanie. “There’s a lot of stigma and minimizing of symptoms out there,” she says. “You might think, 'Oh this is normal, deal with this.' Some doctors may not even recognize this as a serious and treatable condition.”
But finding a doctor who will help address your concerns is important, she adds. “You don’t have to get to the point of being anemic or not leaving your house before you can get help,” she says. “There are a lot of really effective and safe treatments, so I encourage women to talk to their doctors—and moms to talk to their daughters—because you really don’t have to live this way.”