Conservative treatment of heavy periods should be considered first unless a serious underlying cause is suspected.
The different types of medications that are used to treat heavy periods are outlined below in the order given by the National Institute for Health and Clinical Excellence (NICE):
Levonorgestrel-releasing intrauterine system (Mirena coil)
Mirena coil is a small plastic device that is placed in the womb and slowly releases the hormone progestogen. It prevents the lining of the womb from growing quickly, and is also a form of contraceptive. Mirena coil has been shown to reduce blood loss by 71-90%. Possible side-effects of using it may include:
- irregular bleeding that may last for more than six months;
- breast tenderness;
- acne - inflamed skin on the face
- no periods at all.
If LNG-IUS is unsuitable, for example if contraception is not desired, tranexamic acid tablets may be considered. The tablets have been shown to reduce blood loss by 29-58%, and work by helping the blood in the uterus (womb) to clot.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are also used to treat menorrhagia as a second choice of treatment, if LNG-IUS is not appropriate. NSAIDs have been shown to reduce blood loss by 20-49%, and are taken in tablet form from the start of your period (or just before) and for the duration of bleeding, until it has stopped.
The NSAIDs that are recommended as a treatment for menorrhagia are mefenamic acid (500mg three times daily), naproxen (500mg as the first dose, then 250mg every six to eight hours), and ibuprofen (400mg three or four times daily).
Combined oral contraceptive pill
Combined oral contraceptive pills can be used to treat menorrhagia. They contain the hormones oestrogen and progestogen. One pill is taken every day for 21 days, before stopping for seven days. This cycle is then repeated.
As its name suggests, the combined oral contraceptive is a contraceptive, and it works by regulating the menstrual cycle. Common side effects include:
- mood changes,
- fluid retention
- breast tenderness.
Oral progestogen is a form of medication for treating menorrhagia. It is taken in tablet form two to three times a day from days 5-26 of the menstrual cycle, counting the first day of the period as day one.
Oral progestogen works by preventing the lining of the womb from growing quickly. Oral progestogen can have particularly unpleasant side effects including:
- weight gain,
- breast tenderness,
- acne (which does not usually last for long).
High-dose oral progestogen can be particularly useful in stopping very heavy menstrual bleeding (flooding), and has been shown to reduce blood loss by 83%.
The hormone-like substance, progestogen, is available as an injection (depot medroxyprogesterone acetate) and is sometimes used to treat menorrhagia. It works by preventing the lining of the womb from growing quickly.
Common side effects of injected progestogen include:
- weight gain
- irregular bleeding or absence of periods,
- a delay in being able to become pregnant of six to 12 months after stopping the injection
- premenstrual symptoms, such as bloating, fluid retention and breast tenderness