9 Things You Can Do About Your Heavy Periods

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 people who have abnormally heavy periods, that’s exactly what it does.

A heavy menstrual flow might leave you feeling weak, tired, and paranoid about leaks and constant bathroom breaks. You may even cancel plans and stay home on days when bleeding is heaviest.

What Is a Heavy Period?

There’s a technical definition for excessive menstrual bleeding. Linda Yang, MD, associate professor of obstetrics and gynecology at Loyola University Medical Center, told Health. Excessive menstrual bleeding is often defined as a person who menstruates losing more than 80 milliliters of blood throughout their period.

“Of course, that’s not very practical,” said Dr. Yang. “Most women can’t exactly quantify how much blood they’re losing, so as doctors, we ask about other things.”

Your menstrual period may be considered heavy if you:

• Soak through a pad or tampon every hour or two
• Have menstrual bleeding for more than seven days in a row
• Have menstrual blood with clots larger than a quarter

“Another flag would be if you feel your period disrupts your day-to-day activities,” said 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 healthcare provider. Heavy periods could be caused by a bigger issue—like a clotting disorder or a uterine polyp or fibroid—that could cause pain, infertility, and other problems. 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 healthcare provider, either, Sawsan As-Sanie, MD, associate professor of obstetrics and gynecology at the University of Michigan, told Health. “In general, any significant change in someone’s period—or anything that causes you distress—is worth investigating,” said Dr. As-Sanie.

Here are some common treatments for heavy periods healthcare providers might recommend.

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,” said 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 cramping and blood flow during menstruation.

One 2019 review compared the effectiveness of NSAIDs to placebo or other medical treatments in females with regular heavy periods. The researchers concluded that NSAIDs reduce heavy menstrual bleeding compared to the placebo but were less effective than other treatments such as tranexamic acid or progestogen.

Dr. As-Sanie recommended 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,” said Dr. As-Sanie. “It certainly won’t be sufficient for all women, but for some, it may help enough to make a real difference.”

NSAIDs do carry risks for some people. NSAIDs such as ibuprofen may cause ulcers, bleeding, or holes in the stomach or intestine. Other than aspirin, NSAIDs may increase your heart attack or stroke risk.

Birth Control Pills

Healthcare providers often recommend hormonal contraceptives to reduce heavy menstrual bleeding if over-the-counter drugs aren't cutting it. The estrogen in many types of birth control pills (and also in the ring and the patch) can promote blood thickening and clotting, reducing menstrual flow for many people.

One type of birth control pill, sometimes called the mini-pill, contains only the hormone progestin. People who menstruate take this pill every day, without any “break” weeks—which can lessen menstrual bleeding and make periods irregular. Some people on the mini-pill stop getting their period altogether.

It’s also safe to skip your period by continuously taking combination pills, including estrogen and progestin, without a break. Don’t make this change without talking to your healthcare provider first since some drugs are better suited for continuous use than others.

Before you start taking any new birth control, make sure your healthcare provider gets a complete health history. People with a history of venous thromboembolism (blood clots in a vein) or who get migraines with aura should not take combined birth control pills, for example, although other hormonal treatments may still be safe.

Individuals with pre-existing cardiovascular conditions or who smoke should not use oral contraceptives. Oral contraceptive pills can cause hypertension in 4 to 5% of healthy females and worsen hypertension in about 9 to 16% of females with pre-existing hypertension. People with diabetes mellitus might need to increase insulin intake to regulate blood glucose levels within the desired range while taking birth control pills. 

Iron Supplements

“Many women who have heavy periods also have an iron deficiency because they’re losing so much blood so frequently that their body doesn’t have a chance to replace those iron stores,” said Dr. Yang. “When we start our evaluation, we will check blood count and also iron levels. Depending on what those labs show, we may recommend using iron supplements.”

Iron supplements won’t reduce blood flow, but they may prevent anemia and help people with heavy periods feel better. According to a 2014 study, 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,” said Dr. Yang.

The advantages of antifibrinolytic medicines over other medical treatments include the following:

• Slows bleeding quickly (within two to three hours)
• Need to take medicine only a few days each month
• Do not affect your chances of becoming pregnant

Tranexamic acid can be a good option for people who don’t want to or can’t use hormonal treatments, said Dr. As-Sanie, and it may be helpful for people with uterine fibroids.

However, it does carry an increased risk of blood clots, so people who have had blood clots in the past should not take it. If you take hormonal birth control, you should not take tranexamic acid unless your health care provider approves.

GnRH Agonists

People who menstruate and 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 estrogen production, sending the body into menopause and stopping the menstrual cycle altogether.

This treatment might be recommended for people waiting for surgical treatment.

“We use these drugs less commonly than other treatment options because it’s not recommended as a long-term treatment,” said Dr. Yang. “We’ll use it for women who have fibroids that require a reduction in size: The agonist can shrink the fibroid temporarily before surgery.”

GnRH agonists are not usually recommended for longer than six months due to the risk of weakened bones when used for long periods.

IUD

A hormonal intrauterine device—which releases the hormone progestin—can be “very effective in reducing bleeding,” said Dr. Yang. In fact, one hormonal IUD currently on the market—Mirena—has been FDA-approved for treating heavy periods.

It’s common for people 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. Some people with hormonal IUDs stop having periods altogether. Like birth control pills, an IUD only makes sense if you’re not looking to get pregnant any time soon.

IUDs carry some risks, such as:

• You could get pregnant, although it's a slight chance.
• You're more likely to have an ectopic pregnancy if you become pregnant while using an IUD.
• The device could puncture your uterus, and removing it could require surgery.

Endometrial Ablation

Endometrial ablation is a treatment that destroys or removes most of the lining of the uterus. It can reduce heavy menstrual bleeding or stop menstrual bleeding altogether. It is less invasive than uterine surgeries. “The way it works is it burns away the lining of the uterus so that with each subsequent period, the flow is lighter,” said 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, said Dr. Yang. The procedure can be done with heated fluids, radio waves, microwave energy, or electric current. Cryoablation, in which endometrial tissue is frozen off, may also be an option.

You may not be able to get pregnant after endometrial ablation. If a person gets pregnant after an ablation procedure, there is a greater risk that the pregnancy will miscarry or have other problems because of the uterine scar tissue.

Other risks may include:

• Your body could absorb too much fluid when using the heated fluid procedure.
• You could have an allergic reaction to substances used in the process.
• You could experience cramps and pain afterward.
• You might sustain damage or burns from procedures that use heat.

Myomectomy or Hysterectomy

People who don’t succeed with medication or less invasive treatment options may consider having part or all of their uterus removed. This is sometimes the case for people 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,” said Dr. As-Sanie. People can still become pregnant after undergoing a myomectomy, although it can increase the risk of pregnancy or childbirth complications.

A full hysterectomy is the only 100% cure for heavy bleeding and other menstrual symptoms, said Dr. As-Sanie, but it’s often considered a last resort. Pregnancy is not possible after having a hysterectomy.

“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,” said Dr. Yang. Healthcare providers may also recommend a hysterectomy for people whose bleeding is so heavy that they become anemic and require blood transfusions, added Dr. Yang.

Hysterectomy is a major surgery. Like all surgeries, it involves risks. Some risks of a hysterectomy include the following:

• Surgery might damage your bladder and the ureters, and tubes leading to it from the kidneys.
• Sexual intercourse might be painful.
• You could go into early menopause if your ovaries are also removed.
• You might have a lower sex drive.
• You might have an increased risk of heart disease if your ovaries are removed before you'd typically experience menopause.

Uterine Artery Embolization

If fibroids cause your heavy bleeding, your healthcare provider may recommend uterine artery embolization. During this minimally invasive procedure, a healthcare provider 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 (causing an embolism) to those fibroids. This causes the fibroid to shrink within weeks to several months after the treatment and decreases other fibroid symptoms, including heavy menstrual bleeding.

“Over time, it reduces the size of fibroids,” said Dr. As-Sanie. For many, this means lighter and less painful periods. The procedure usually involves an overnight hospital stay but can also be done as an outpatient procedure.

Risks may include:

• The procedure may not work or may not work for your symptoms.
• An artery or your uterus may be injured.
• It could reduce your chances of becoming pregnant.
• You could go through menopause early, lose your periods, or have ovarian problems.
• Your healthcare provider might miss diagnosing a rare cancer that can present in fibroids. It's called leiomyosarcoma.

Finding the Best Treatment Option for You

“There’s a lot of stigma and minimizing of symptoms out there,” said Dr. As-Sanie. “You might think, 'Oh, this is normal; deal with this.' Some healthcare providers may not even recognize this as a serious and treatable condition.”

But finding a healthcare provider who will help address your concerns is essential, said Dr. As-Sanie.

“You don’t have to get to the point of being anemic or not leaving your house before you can get help,” said Dr. As-Sanie. “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.”

A Quick Review

If your life is disrupted by heavy periods, treatment options range from supplements to oral medications, in-patient procedures, or surgery. It is important that you speak with your healthcare provider about your symptoms and the best treatment options for you.