Treatment Options for Heavy Periods

In my last blog, I discussed some of the most common reasons for heavy periods in women.  Now I will review treatment choices.  Remember, these options are described for heavy regular bleeding.

The most important thing before initiating treatment is having the correct diagnosis.

Treatment options can be medical or surgical.  Some women don’t want any treatment.  They just want to be sure that there isn’t a malignant reason for their bleeding.  Often reassurance is all that is needed.  But the majority of women who come to the gynecologist are there because the bleeding has interfered with their lives enough to cause them to seek treatment.  Obviously, if the problem is a thyroid issue, treatment with thyroid medication is typically indicated.

NSAIDs like Ibuprofen can slow the bleeding.  They work by decreasing the amount of prostaglandin produced, which in turn makes the vessels clamp down and therefore there is less blood flow to the uterus.

Antifibrinolytic agents like tranexamic acid (Lysteda) are a relatively newer non-hormonal option that also decrease the amount of bleeding by inhibiting the breakdown of clots.  Heavy bleeding is associated with an abnormally high rate of clot breakdown.

Combined hormone therapy (CHT) like the birth control pill, the Nuva Ring, or the Ortho Evra patch, work by suppressing ovulation and causing the uterine lining to become thin over time.    A thin lining equals less prostaglandin production, again, causing less blood flow to the uterus.  CHT can be taken cyclically or continuously.  Some women cannot take CHT due to a history of blood clots or other medical conditions.

There is currently a levonorgestrel (progestin) IUD on the market called Mirena that is FDA-approved to treat heavy bleeding.  In fact, one study showed a 74 to 97 percent decrease in blood loss after one year of use.  Women who were waiting to have hysterectomies actually cancelled their surgery because it worked so well.  Again, the progestin in the IUD works to thin the lining of the uterus so there is little to no bleeding.  An IUD is a T-shaped device that we can put inside the uterus in the office and it works locally on the uterine tissue.

There are also systemic progestins, like progestin-only birth control pills, Depo-Provera (an intramuscular injection that is given 4 times a year), and Nexplanon (a small rod that is inserted in the arm that is good for 3 years).  Each of these keep the lining thin but have more side effects because they need to be processed by the body and then begin their work on the uterus.

There are a couple of other less commonly used options like Danazol and GnRH analogs, but these could be addressed with your provider if one of the more common treatments just doesn’t seem right for you.  The side effects are greater and the cost is often prohibitory.

Wow, this is a huge topic, so I will have to pick up next time with surgical options.