There are a number of treatment options available for heavy menstrual bleeding. Generally speaking they fall into two categories:
Non-hormonal options can include certain medication, minimally invasive surgery or major surgery such as a hysterectomy.
Hormonal options typically include the oral contraceptive pill or a hormonal intrauterine device (IUD).
Remember, the right choice for you will depend on a number of factors and should be determined in consultation with your doctor.
Click here to view a comparison chart outlining the most common treatment options, including an overview of the advantages and disadvantages of each option.
Your doctor may prescribe one or both of the following medications if you are experiencing heavy menstrual bleeding. These are typically used as first-line treatment options.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are painkillers generally available as over-the-counter medication. They are a suitable option for milder menorrhagia, and can help to reduce the amount of menstrual bleeding, particularly in the first few days of the cycle. NSAIDs have the added benefit of relieving painful menstrual cramps (dysmenorrhea).1
Tranexamic acid works by blocking the breakdown of blood clots. It can also help reduce menstrual blood loss and pain and only needs to be taken at the time of the bleeding. It has been shown to be more effective at relieving symptoms than NSAIDs.2,3 It may reduce the amount of blood flow during each period by 40-60%.4
Your doctor or gynaecologist may recommend a procedure called an endometrial ablation – a minimally invasive procedure performed as day surgery. It is mostly performed under general anaesthetic in Australia and New Zealand.
An endometrial ablation procedure involves removal of the lining of the uterus. It can greatly reduce or, in some cases, completely stop heavy menstrual bleeding. 5
This procedure is intended for women who do not wish to have any (more) children in the future.
Because the treatment is associated with few side effects, women usually return to work or their daily activities the day after having the procedure.
In some cases your doctor may consider a hysterectomy the best option for you. However it involves major surgery to remove the uterus and a longer recovery time (up to 8 weeks).
Hysterectomy is a permanent treatment option and is not generally recommended for first-line management unless less invasive options are unsatisfactory or inappropriate. Australian Clinical Care Standards suggests that therapeutic alternatives to hysterectomy should be consistently used across Australia for women with heavy menstrual bleeding. *
Your doctor may consider a hormone therapy as the right choice for you, which may include the contraceptive pill or a hormonal intrauterine device (IUD).
Oral contraceptives – low doses of female hormones such as birth control pills (oestrogen and/or progestin) – can help regulate menstrual cycles and reduce excessive or prolonged menstrual bleeding as well as provide the added benefit of contraception.
They have been shown to reduce bleeding in around one-third of women treated for heavy periods, however they may take up to 3 months before they start working.6
The hormonal IUD, which is inserted into the uterus, releases a steady amount of progestin called levonorgestrel. This makes the uterine lining thin and decreases menstrual blood flow to control heavy bleeding. It has been shown to reduce menstrual blood loss by 71-95% after 6 months.7 Five year data shows it is effective in 39% of women. 8
Clinical research shows 42% of women treated with an IUD opted for a hysterectomy after 5 years.8 A hormone releasing IUD should be regularly removed and replaced every 5 years. It is not a permanent solution to heavy menstrual bleeding, but is an option for women still wanting to have children.
*Australian Commission on Safety and Quality in Health Care, Clinical Care Standards for Heavy Menstrual Bleeding, October 2017.
1 Panesar K, "Managing Menorrhagia", US Pharmacist. 2011;36(9):56-61. 2 Mayo Clinic. Tranexamic Acid. Available at www.mayoclinic.org/drugs-supplements/tranexamic-acid-oral-route/description/drg-20073517. Accessed February 2016. 3 PubMed Health, Informed Health Online. Treatment options for heavy periods, June 2013. Available at www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072477/. Accessed February 2016. 4 Munro M G, Abnormal Uterine Bleeding, Cambridge University Press. First published 2010. ISBN 978-0-521-72183-7. 5 Cooper J, et al. A randomized multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Gynecol Laparosc. 2002;9:418-428. 6 Cooper KG, et al. A randomised comparison of medical and hysteroscopic management in women consulting a gynaecologist for treatment of heavy menstrual loss. Br J Obstet Gynecol 1997;104:1360-66. 7 Mirena Product Information, 150601. 8 Hurskainen R, et al. Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system of hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA 2004; 291:1456-1463.