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NHS Greater Glasgow & Clyde

Management of Heavy Periods

Management of Heavy Periods

    The amount of blood each woman loses during her period varies widely from one person to another. If heavy periods (heavy menstrual bleeding) are disrupting your life, we will be able to offer treatments to help you. This page explains what treatments are available if you have heavy periods. Usually there is no serious cause but you may be advised to have some tests before starting treatment.

    What tests will be done at the clinic?

    We may do a blood test to check if you have anaemia (not enough iron in your blood). We may do an internal examination and then if necessary offer tests to try and find out what is causing your heavy periods. These may include an ultrasound scan to look at your womb and a test to get a sample from the lining of the womb. Not all women need all the tests.

    Medical treatments (hormonal & non-hormonal)

    If there are no obvious problems with your womb then you could get a number of different drug treatments. Some medicines used to treat heavy periods have hormones and some do not have hormones in them.

    Non hormonal treatments

    These only need to be used whilst you have heavy bleeding and do not need to be taken during the whole month.

    Tranexamic Acid:

    These tablets can be taken 3-4 times a day on heavy days for up to 4 days. They help the blood in the womb to form clots and reduce the amount of bleeding. These can sometimes cause indigestion and diarrhoea. It is not suitable if you have kidney disease or if you have ever had a thrombosis (blood clot).

    Non-steroidal anti-inflammatory drugs (NSAIDs):

    Painkillers such as ibuprofen and naproxen are not only helpful for period pain; they can also reduce the amount of bleeding. They work best if started before your period starts and you continue to take them during your period as their effect builds up with time.

    These tablets can be taken 3 times a day. They may not be suitable if you have had a stomach ulcer, kidney problems, asthma or aspirin allergy. These tablets can cause indigestion and diarrhoea and should be taken with or after food.

     

    Hormone treatments

    These can be in the form of a hormone containing intrauterine device called Mirena or Levosert, or hormone tablets.

    Mirena/Levosert:

    This is a small plastic device that slowly releases progestogen hormone for up to 5 years. This hormone mainly works locally in the womb cavity and thins the lining of the womb. It also acts as a contraceptive. Fertility quickly returns to normal when it is removed.

    Some women can get irregular bleeding or spotting initially for up to 6 months but after that most women completely stop having periods or just have light bleeding. Some women may get breast tenderness, acne or headaches but usually these settle with time and are completely reversible when the device is removed

    The device can be fitted in sexual health / family planning clinics and some GP practices. No general anaesthesia is necessary. You may be offered local anaesthetic. You will be able to go home a few minutes after the device is inserted but you may wish to bring a friend or partner to accompany you home. You may feel some cramping pain for a few hours or sometimes a few days after insertion.

     

    Combined Oral Contraceptives:

    These are contraceptive pills containing hormones oestrogen and progestogen. These can be taken for 21 days with a break of 7 days when you will have a period and then repeat the cycle. You can also take 3 packets of the pills continuously without having a 7 day break in between. You can have the 7 day break after the third packet when you will have a period. Some women can get breast tenderness, nausea or fluid retention with these tablets but it usually settles with time.

     

    Oral Progestogen (Norethisterone):

    You can take these tablets 2 to 3 times a day from the 5th to the 26th day of your cycle. This prevents the lining of the womb from growing quickly but this will not work as a contraceptive. Some women can get breast tenderness, nausea or acne with these tablets but these usually settle with time.

     

    Progestogen Injection:

    This prevents the lining of the womb from growing quickly and also acts as a contraceptive. The injection has to be repeated every 13 weeks. Women can get irregular bleeding initially with this method but later most women stop having periods.

     

     

     

    Surgical Treatments

    There are a number of different operations that can help to control heavy periods. 

    Endometrial ablation:

    This is a minor operation to destroy the lining of the womb. It can be carried out under local anaesthesia or general anaesthesia as a day case. A device is inserted in the womb cavity through the vagina and cervix and it is then heated using either hot fluid (thermal balloon endometrial ablation) or microwave (microwave endometrial ablation). This heat destroys the lining of the womb.

    Most women either completely stop having periods or have light bleeding after this procedure.  It is not suitable if you want to become pregnant at any time in the future. It does not act as a contraceptive. If contraception is required, a suitable method will be discussed with you at the clinic. 

    Ulipristal Acetate (Esmya):

    Ulipristal acetate is a medicine used if the heavy bleeding is due to fibroids of the womb. Fibroids are non-cancerous growths that can develop in the muscle of the wall of the womb. Ulipristal acetate acts by modifying the activity of progesterone, a naturally occurring hormone in the body. It is used to reduce the size of fibroids, to stop or reduce bleeding.

    Uterine Artery Embolisation (UAE):

    This treatment can be offered if the heavy periods are due to large fibroids of the womb. This is a minor operation done under local anaesthesia and sedation (medicines to make you sleepy). In this operation using x-ray guidance small particles are injected into the blood vessels that supply blood to the womb. This blocks the blood supply to the fibroids and causes them to shrink. Some women can get vaginal discharge, nausea, vomiting and fever after this operation. The effects of the procedure on fertility and pregnancy are not clear. 

    Myomectomy:

    This is an operation to remove fibroids which can be offered for some types of fibroids. This can be done either through a cut in your abdomen or through the vagina. You may be able to get pregnant after this procedure.

    Hysterectomy:

    This is a major operation to remove your womb. The womb and cervix can be removed through the vagina or these can be removed through a cut in your abdomen. It may be possible to do the hysterectomy through a key-hole surgery. You cannot have children after a hysterectomy. This is a major operation which can be associated with the risks of excessive bleeding during the operation or damage to other organs such as bowel or urinary tract.

    At Sandyford we can offer all the medical treatments. If necessary we can refer you to the hospital gynaecology clinic for other surgical treatments.