Tablets (Medical therapy)

There are several different types of tablets used to control heavy bleeding.  The main problem with all of these tablets is that they affect different women in different ways. Some women's bleeding is dramatically reduced while others aren't helped at all. If one sort doesn't work for you, other types of tablets can be considered.

Contraceptive Pill

Main uses:

Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.

How does it work?

The combined contraceptive pill is very effective in controlling heavy bleeding and is useful if you also want to use it as contraception.  The pill suppresses the menstrual cycle and stops ovulation (egg release).  At one time women over 35 were advised not to take the pill but we now feel that women can continue it up to 45 if there are no risk factors such as smoking, or raised blood pressure. The pill can also be useful for intermenstrual bleeding.

Progestogens

Irregular bleeding - investigations normal.

Treatment with these hormones is based on the theory that women with unexplained heavy bleeding are not ovulating (releasing an egg) and so they are not producing their own progesterone (the natural progestogen).  Without enough progesterone, the lining of the womb continues to build up until it eventually breaks down, causing heavy bleeding.  But most women with heavy bleeding and regular cycles are ovulating so the theory doesn't seem to stand up. As with many medical treatments, it hasn't been evaluated carefully to show whether it does cut down blood loss.  But it seems to work for many women.  Possible side effects include weight gain, acne, breast tenderness, bloating and breakthrough bleeding; the majority of women experience only minor side effects.

A high dose taken for a long time can increase the risk of heart disease especially in women who smoke heavily, are fat or have high blood pressure. Different progestogens have been tried for differing numbers of days in the menstrual cycle. Common progestogens used are norethisterone, medroxyprogesterone (Provera) and dydrogesterone (Duphaston). They may be given for five to 10 days starting somewhere between day 16 and day 25 of the menstrual cycle (counting day 1 as the first day of bleeding).

Danazol (Danol)

Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.

This is a synthetic hormone similar to the male sex hormone testosterone.  It is not known exactly how it works but it blocks and lowers natural hormone levels in the body and is very effective in cutting down menstrual blood loss.  However, it is a powerful drug and often has unpleasant side effects such as weight gain, muscle cramping, decreased breast size, hot flushes, acne, growth of facial hair, voice changes, depression and mood changes, oily skin and hair, and bloating.  Some of these side effects such as voice changes may be irreversible. If you begin to suffer from distressing side effects, it is better to go back to go back to your doctor rather than finishing the course.  In the doses given, Danazol is not effective as a contraceptive.  A woman who needs contraception shouldn't take the contraceptive pill while on Danazol but should use some other form of contraception.

GNRH analogues

Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.
Problem bleeding - problem found on investigation.

These are powerful drugs which include buserelin, goserelin and nafarelin, taken by injection or sniffing (intranasally).  They act by suppressing ovarian activity, which reduces blood loss, and many women stop having periods altogether.  But because oestrogen levels are reduced, menopausal side effects are common and they should not be used for more than a few months without some form of hormone replacement therapy being included.

Drugs that stop the body from making prostaglandins

Regular heavy bleeding - investigations normal

Examples of this kind of drug are aspirin and mefenamic acid (brand name Ponstan).  Studies have shown that Ponstan can reduce blood loss by half in women with heavy bleeding.  These drugs can be taken by women of all ages but shouldn't be prescribed for those with peptic ulcers.  Side effects can include indigestion, diarrhoea, headache, dizziness, skin rashes, peptic ulcers and inflammatory bowel disease if used long term.

Drugs that affect bleeding mechanisms

Regular heavy bleeding - investigations normal

These drugs are only taken while bleeding. They include aminocaproic acid (brand name Epsikapron), tranexamic acid (brand name Cyklokapron) and ethamsylate (brand name Dicynene).  They have been shown to reduce blood loss in some women and can be used at any age.  Side effects can include headache, nausea, dizziness, rashes, vomiting and diarrhoea. Aminocaproic acid and tranexamic acid should not be taken by women with a history of thrombosis.

Hormone coils

Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.

This type of coil is similar to other coils in that it offers contraception.  It has the added benefit of reducing the amount of blood lost every month by releasing a small amount of hormone, which causes the womb lining to shrink. In the first few months after insertion common problems include irregular spotting, but this tends to settle within a few months.

Treatment of anaemia

If you are losing so much blood during your period that you become anaemic, you can correct this by taking iron tablets and/or changing your diet.  Good sources of iron are meat, liver, fish, prune juice, legumes, soybeans, wheat, dried fruits, leafy green vegetables, almonds, pumpkin seeds, and molasses.  Citrus fruits or vitamin C supplements help with the absorption of the iron.  Another way to add iron to your food is to cook in iron pans.

Holistic and alternative treatments

Regular heavy bleeding - investigations normal

There are a number of alternative therapies that can be tried before deciding that a hysterectomy is the only answer to your problems. Here we will give you a brief overview of what is available. For more information you have to ask for a leaflet which deals entirely with alternative medicine. 

Herbalism

Some of the main herbs that are used are the roots or dried rhizome of the lily Beth Root, the rhizome of the geranium American Cranesbill. These herbs are taken as a tea drunk three times a day in the week leading up to your period and during the bleeding.

Homeopathy

There are a number of recommended homeopathic remedies for heavy bleeding. The remedy chosen depends on the nature of the bleeding and any other symptoms you have. A visit to a homeopath is recommended before trying any of the remedies.

Aromatherapy

This is the use of essential oils derived from aromatic plants and trees for healing.  Cypress oil and rose oil are recommended for heavy periods.  They can be taken by mouth, used in a bath, inhaled or given as compresses or douches.

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