Abnormal menstrual bleeding, also known as abnormal uterine bleeding, is one of the most common reasons for visits to the gynecologist. And for those who experience it, it can be really disruptive to everyday life.

So when WHA providers treat patients for heavy menstrual bleeding, we like to start with management options that have the least amount of intervention possible, so as not to further interrupt life. This means we often start with medications, prescribing based on your specific experience, symptoms and preferences before considering any surgical options.

Medication can be a highly effective treatment option, typically helping symptoms subside within a couple of weeks or a menstrual cycle. While medication can help manage excessive menstrual bleeding, it’s not permanent, so it’s likely something you’ll have to stay on long-term (usually until menopause) for it to keep working. Which is worth considering.

Depending on the specific cause, several medications can work as heavy menstrual bleeding solutions.

When is heavy menstrual bleeding considered abnormal?

People wonder if their period is normal. Abnormal menstrual bleeding can mean different things; it can be unusually heavy bleeding (completely saturating a maxi pad or super tampon every one to two hours), bleeding longer than seven days at a time or bleeding more or less frequently than every 21 to 35 days. It can also mean regularly having spotting that occurs between periods or after sex. Understandably, this can cause significant stress, discomfort and an upheaval to routines or just daily activities.

It is also much more common than you might think; one out of every five menstruators in the U.S. experiences heavy menstrual bleeding that lasts for more than seven days.

If you’re unsure if you’re experiencing it, know that your perception of “abnormal” is part of it, too. So if your flow doesn’t feel normal for you, then it’s worth a conversation with your provider.

What causes heavy periods?

Some understandably worry that heavy menstrual bleeding is a sign of a serious health condition. While that can be the case, it’s not the first thing we think of. There are several potential causes of heavy menstrual bleeding, such as:

  • Pregnancy
  • Hormones
  • Fibroids, polyps and cervical lesions
  • Polycystic ovary syndrome (PCOS)
  • Bleeding disorders
  • Cancer
  • No known reason

Abnormal menstrual bleeding can also look different at different ages.

  • In the adolescent ages (13-18), abnormal menstrual bleeding is not uncommon because the brain and the ovaries are still learning how to communicate and work together to regulate hormones.
  • The reproductive years (19-40s) is when we most often see abnormal bleeding from various causes.
  • During the perimenopausal stage (40s-early 50s) we may see irregular menstrual bleeding caused by declining estrogen levels.
  • Once in menopause (defined as the absence of periods for 12 consecutive months), bleeding becomes more suspicious for uterine cancers and should always prompt the individual to seek evaluation.

You can read more about abnormal menstrual bleeding symptoms and causes here.

When should I see a doctor about heavy menstrual bleeding?

If you’re experiencing new symptoms related to heavy bleeding, or it’s affecting your life in any way, make an appointment with your provider. In that first appointment, we’ll work together to determine the cause and discuss management options.

We’ll discuss your history of periods and bleeding patterns and any associated pain. We’ll also go through your family history and any medications you may be on, too. Your provider may perform a physical exam to assess any structural causes (polyps, adenomyosis, leiomyomas and malignancy). They will also ask more questions to determine whether symptoms may be caused by non-structural causes (coagulopathies, ovulatory disorders, endometrial disorders, iatrogenic causes or not otherwise classified).

This will help us identify whether medication is the right path forward so we can discuss which works best for your lifestyle and needs.

Medications used to stop abnormal periods

Birth control pill

Can birth control help with heavy periods? Yes, the birth control pill is proven to reduce menstrual flow.

The most common medical treatment option for abnormal bleeding is birth control pills. Birth control pills are tried first because they are safe, inexpensive and will work for most people with abnormal bleeding.

In addition to reducing the amount of menstrual flow, cycles usually become regular, too. Birth control pills may offer other medical advantages, like correcting anemia and reducing premenstrual symptoms—plus, preventing conception. If you still have abnormal bleeding after trying birth control pills for two to three months, your provider may perform further tests, such as an ultrasound to evaluate for any anatomic abnormalities like fibroids or polyps.

We would skip birth control pills as treatment if you are a smoker over the age of 35, have a clotting disorder or experience certain types of migraine headaches.

Hormonal IUD

How does an Intrauterine Device (IUD) affect your period? It can treat heavy, prolonged menstrual bleeding and in many cases, make periods stop altogether, though it is important to know that irregular bleeding can be normal for the first 3-6 months after IUD insertion.

The Levonorgestrel Intrauterine Device (LNG-IUD), marketed as the Mirena IUD, is also an excellent way to control heavy menstrual bleeding. Its use will significantly decrease menstrual bleeding within the first six months, and it is not uncommon for some to stop having their periods entirely after six to 12 months of use. This is because the IUD releases a small amount of progestin that thins the lining of the uterus. (This does not pose a problem for future fertility, if that’s something you’re interested in.)

Other advantages include not having to take a pill every day and being one of the most reliable forms of reversible contraception available. Research has also shown they are just as effective at treating abnormal uterine bleeding as the surgical option of endometrial ablation and can also be used to help prevent conditions that may lead to precancerous conditions of the uterus.

We would skip IUDs as a treatment if you have fibroids or a congenital condition that distorts the inside of the uterus.

Progesterone-only pills

How do you stop bleeding on progesterone-only pills? This is essentially an oral form of the LNG-IUD and decreases bleeding by thinning the uterine lining. Taken consistently, the progesterone-only pill can also prevent ovulation.

Progesterone-only pills are another method to control abnormal bleeding. This option is usually not as effective as combination birth control pills or the LNG-IUD, but may be a very good alternative if you cannot take or tolerate estrogen and do not want a device inserted into your uterus. These will often be used for 10-14 days during the month, or daily.

We would skip progesterone-only pills if you have certain medical conditions or a history of breast cancer.

Tranexamic Acid (Lysteda)

How long does it take for Tranexamic Acid (Lysteda) to start working? It’s quick! Most will see a reduction in their menstrual flow within 24 hours.

Tranexamic acid, marketed as Lysteda, is a non-hormonal medication that helps manage heavy periods. It is taken for three to five days during your period and has been shown to decrease the amount of menstrual bleeding.

We would skip Lysteda as a treatment if you have any risk factors for blood clots.

Medication can be a highly cost-effective treatment for heavy menstrual bleeding with few side effects. But it’s not the only option and not the right one for everyone. In some cases, your provider may talk through surgical options to treat abnormal menstrual bleeding.