Treatment with medication

Medication is usually the first treatment option that doctors recommend for heavy periods.

Treatment with medication:

• can be very effective
• often has fewer and less serious side effects than other treatments
• does not affect your ability to have children or cause early menopause
• is suitable for many women.

There are six types of medication used to treat heavy menstrual bleeding.

Tranexamic acid helps your blood to clot, which will reduce the bleeding. It comes as a tablet that you take during your period.

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, as prostaglandin seems to contribute to heavy bleeding and pain. It also comes as a tablet that you take during your period.

Hormone-releasing intrauterine device (IUD) is a small, usually plastic device that sits inside your uterus and releases a small amount of progestogen (a drug that acts like the natural hormone progesterone). With each menstrual cycle the lining of your uterus becomes thick and spongy in preparation for pregnancy. When you don’t get pregnant, the lining sheds and you bleed it out. Progestogen works by reducing the thickness of the lining of your uterus.

The contraceptive pill releases substances that act like the natural hormones oestrogen and progesterone. These stabilise the lining of the uterus so that it doesn’t get so thick.  The Pill can be taken continuously so that you don’t bleed at all, or you can have a period each month. It comes as either a tablet you take daily or as a small, flexible ring that is put inside your vagina and slowly releases the medication. The ring is usually removed after three weeks to allow you to bleed and a new one is put in at the end of your period.

The progestogen-only pill (POP or mini-pill) also works by stabilising the lining of the uterus. If you take progestogen throughout your menstrual cycle, the lining of the uterus is never able to build and thicken and so there is very little to shed when it comes time for your period. 

Your treatment options summarised

	Benefits	Disadvantages
Tranexamic acid	Reduces bleeding by about 40 percent	Requires long-term use
NSAIDS	Reduces bleeding by about 30 percent Relieves period pain	May cause stomach upsets, nausea and diarrhoea Requires long-term use
IUD	Reduces bleeding by about 95 percent after at least three months use May reduce period pain Is also a contraceptive You don’t need to remember to take tablets You can have it removed It only has to be changed every five years	Often causes irregular bleeding or spotting in the first couple of months May cause acne, mood changes and breast soreness May fall out but this is rare Although rare, it may push through your uterus and need to be removed in an operation May not be an option if you have fibroids 20 percent of women (one in five) ask for it to be taken out because of the side effects
Oral contraceptive pill	Reduces bleeding by about 40 percent May reduce period pain Helps keep periods regular Is also a contraceptive Can be used to skip your period entirely Reduces your risk of ovarian and endometrial cancer by about 50 percent	May cause nausea, breast soreness, headaches and changes to sex drive or libido May cause irregular spotting Not suitable for all woman (for example, those who are over 30 years old and smoke, or get blood clots in their veins (called thromboembolism) Requires long-term use
POP or mini-pill	Reduces bleeding by about 85 percent Works quickly and can be used as a short-term treatment or for periods that are particularly heavy	May cause bloating, mood swings and breast soreness May cause irregular bleeding Often requires long-term use

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