For example, if you regularly soak a pad or a tampon faster than every two hours, feel dizzy or lightheaded during your period, or bleed for longer than seven to 10 days every month, those are all red flags that you might be losing too much blood. “Another flag would be if you feel your period disrupts your day-to-day activities,” says 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 care physician. Heavy periods could be caused by a bigger issue—like a clotting disorder or a uterine polyp or fibroid—that could also cause pain, infertility, and other problems. And 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 doctor, either, says Sawsan As-Sanie, MD, associate professor of obstetrics and gynecology at the University of Michigan. “In general, any significant change in someone’s period—or anything that causes you distress—is worth investigating,” she says. Here are some of the common treatments for heavy periods doctors might recommend.
“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,” says 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 both cramping and blood flow during menstruation.
Dr. As-Sanie recommends 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,” she says. “It certainly won’t be sufficient for all women, but for some it may help enough to make a real difference.”
Birth control pills
If over-the-counter drugs aren’t cutting it, doctors often recommend hormonal contraceptives as a way to reduce heavy menstrual bleeding. The estrogen in many types of birth control pills (and also in the ring and the patch) can promote thickening and clotting of blood, which can reduce menstrual flow for many women.
One type of birth control pill, sometimes called the mini-pill, contains only the hormone progestin. Women take this pill every day, without any “break” weeks—which can lessen menstrual bleeding and make periods irregular. Some women on the mini-pill stop getting their period altogether.
It’s also safe to skip your period by taking combination pills, which include both estrogen and progestin, continuously without a break. Don’t make this change without talking to your doctor first, since some pills are better suited for continuous use than others.
Before you start taking any type of new birth control, make sure your doctor gets a full health history: Women with a history of blood clots or who get migraines with aura should not take traditional birth control pills, for example, although other hormonal treatments may still be safe.
“Many women who have heavy periods also have iron deficiency, because they’re losing so much blood so frequently that their body doesn’t have a chance to replace those iron stores,” says Dr. Yang. “So when we start our evaluation we will check blood count and also iron levels. Depending on what those labs show, we may recommend the use of iron supplements.”
Iron supplements won’t reduce the flow of blood, but they may prevent anemia and help women with heavy periods feel better. According to a 2014 study published in Acta Obstetricia et Gynecologica Scandinavica, treating women for period-related anemia improved their energy levels and physical and social functioning ;and decreased anxiety and depression symptoms.
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,” says Dr. Yang.
Tranexamic acid can be a good option for women who don’t want to or can’t use hormonal treatments, says Dr. As-Sanie, and it may be helpful for women with uterine fibroids, as well. However, it does carry an increased risk of blood clots, so women who have had blood clots in the past should not take it.
Women who 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 the production of estrogen in the body, essentially sending the body into menopause and stopping the menstrual cycle altogether.
“We use these drugs less commonly than other treatment options, because it’s not recommended as a long-term treatment,” says Dr. Yang. “We’ll use it for women who have fibroids that require reduction in size: The agonist can shrink the fibroid temporarily before surgery.”