Know your treatment options
Know your treatment options
Know your treatment options

Know your treatment options

Know your treatment options

There are many effective treatment options available for heavy menstrual bleeding that can put you back in control of your life. Treatment options typically fall in to one of three categories: non-hormonal, hormonal or surgical and your healthcare provider can help you find the choice that is right for you depending on the cause of your heavy menstrual bleeding, your medical history and your preferences.

HMB is a symptom which can be caused by several underlying medical conditions. In clinical practice there are several treatments that are used despite not being specifically approved for HMB. The following section is intended to give an overview of what is clinical practice. Please be aware that the label of a specific product may vary from country to country.

A note on anemia…

It is very common that women with heavy menstrual bleeding develop anemia, due to excessive blood loss. If this is happening to you your doctor may recommend that you take regular iron supplements either to treat or prevent anemia. Don’t forget to eat well iron is present in plenty of foods, so next time you go shopping for groceries keep our suggestions in mind.

Non-hormonal treatment options

The two main non-hormonal treatments are NSAIDs and tranexamic acid. They can be prescribed alone, together or in combination with hormonal treatment options.

Tranexamic acid

Tranexamic acid

Reduction of bleeding
40-60%
How is it taken

Orally

How does it work

It reduces bleeding by helping the blood to clot

Regimen

Every month at the start of the menstrual period, for a maximum of 4 days

More info

They are usually prescribed in association with other treatments and have no contraceptive effect

Possible side effects

Diarrhea, nausea, vomiting

NSAID (Nonsteroidal anti-inflammatories)

NSAID (Nonsteroidal anti-inflammatories)

Reduction of bleeding
40-60%
How it is taken

Orally

How does it work

They reduce the production of a substance called prostaglandin, which is linked to heavy periods

Regimen

Every month at the start or just before the menstrual period.

More info

In addition to reducing bleeding, they also relieve period pain. They are usually prescribed in association with other treatments and have no contraceptive effect

Possible side effects

Stomach pain, heartburn, stomach ulcers

Hormonal treatment options

Hormonal treatments can be highly effective at alleviating heavy menstrual bleeding and there are a number of options available depending on your preferences and needs.

IUS – Intrauterine System

IUS – Intrauterine System

Reduction of bleeding
> 90%
How is it taken

Placed in the womb (by your doctor)

How does it work

A small intrauterine device releases a progestin (levonorgestrel), which makes the uterine lining thin and decreases menstrual blood flow and cramping. It can even make your periods stop altogether!

Regimen

Lasts up to 5 years

More info

It reduces your bleeding and is also approved as contraceptive

Possible side effects

Irregular bleeding (especially in the first 3 months after placement), breast tenderness, acne

Birth Control Pills

Birth Control Pills

Reduction of bleeding
70-90%
How it is taken

Orally

How does it work?

Combined oral contraceptives regulate menstrual cycles and make the uterine lining thinner, reducing episodes of excessive or prolonged menstrual bleeding

Regimen

Daily (around the same hour)

More info

It not only reduces your bleeding, it is also an effective contraceptive, as long as you take it correctly

Possible side effects

Mood changes, nausea, headache, breast tenderness

Estrogen containing pills can increase the risk of blood clots. This is a serious, but rare adverse event

Selective progesterone receptor modulators

Selective progesterone receptor modulators

REDUCTION OF BLEEDING
70-90%
How is it taken

Orally

How does it work

It blocks a hormone receptor and reduces the size of fibroids effecting the lining of the womb

Regimen

One 12 week cycle prior to surgery (repeated cycles only if you are not eligible for surgery)

More info

They are not contraceptives: although it is unlikely that you get pregnant during this treatment, it is recommended to use a barrier method (such as condoms)

Possible side effects

Changes in the lining of the uterus, headache, dizziness, nausea, hot flushes

Gonadotrophin-releasing hormone analogue (GnRH-a)

Gonadotrophin-releasing hormone analogue (GnRH-a)

Reduction of bleeding
70-90%
How is it taken

Injection

How does it work

Monthly injections reduces the size of fibroids by simulating menopause

Regimen

Monthly injection, for 3 months usually prior to surgery

More info

Reduces heavy bleeding by stopping periods completely through simulating menopause Although it is unlikely that you get pregnant during this treatment, it is recommended to use a barrier method (such as condoms)

Possible side effects

Menopausal-like symptoms (hot flushes, increased sweating, vaginal dryness)

High dose oral progestogens

High dose oral progestogens

Reduction of bleeding
60-70%
How is it taken

Orally

How does it work

They prevent the uterine lining from building up, making menstrual bleeding lighter

Regimen

It is taken for more than 3 weeks

More info

They can also be taken as contraceptives

Possible side effects

Weight gain, breast tenderness, headaches

Surgical options

Some women with heavy menstrual bleeding might require a surgical procedure, especially if there is a uterine disease or where medical treatment fails to control the symptoms or is not tolerated.

Dilation and Curettage (D&C)

Dilation and Curettage (D&C)

What it is and when it’s done

Commonly referred to as D&C or “scraping”, it is a surgical procedure where the surgeon dilates the cervix (the entrance to the uterus) and scrapes away the lining of the uterus, which is then sent for analysis. It is often performed in women with severe bleeding that need to be stopped quickly

How it works

By removing the lining of the uterus, it stops heavy bleeding. Since the lining will grow again, the effect is only transient, so another treatment should be started after the surgery

More info

As a sample is analyzed, significant information can be obtained regarding a possible cause for the heavy menstrual bleeding.

The procedure is performed under general anesthetic

What to expect after the procedure and possible risks

In the 2 or 3 days after the procedure you may experience tummy cramps like period pains. You may also have some vaginal bleeding, like a light period. D&C has a few risks, including perforation and infection

Endometrial ablation

Endometrial ablation

What it is and when it’s done

Endometrial ablation involves destroying the lining of the womb. Different techniques can be used and it is usually performed under local anesthetic. After the procedure you can usually go home on the same day.

It is usually performed only when medical treatment fails to control heavy menstrual bleeding and in women that don’t want to get pregnant in the future

How it works

By destroying the lining of the uterus, it stops heavy bleeding

More info

It is unlikely you’ll be able to get pregnant after endometrial ablation. If you do, you’ll have an increased risk of miscarriage and complications. The procedure is not recommended if you still want to have children. Often not all tissue is destroyed so some kind of bleeding may return

What to expect after the procedure and possible risks

In the 2 or 3 days after the procedure you may experience tummy cramps like period pains. You may also have a thin watery discharge mixed with blood, which can last a few weeks. Endometrial ablation has few risks including infection, bleeding and perforation. With some methods, there is also a risk of burning

Uterine artery embolization (UAE)

Uterine artery embolization (UAE)

What it is and when it’s done

This procedure involves blocking the blood vessels that supply the fibroids, causing them to shrink. This is done under X-ray, guidance, with a small tube inserted into the large blood vessel in your thigh.

It is done when heavy menstrual bleeding is caused by fibroids, in women that don’t want to get pregnant in the future

How it works

Small particles are injected through the tube to block the arteries supplying blood to the fibroid, causing it to shrink and reduce heavy menstrual bleeding

More info

This procedure is not recommended for women who wish to get pregnant in the future

What to expect after the procedure and possible risks

In the 2 or 3 days after the procedure you may experience heavy pain and cramps.

As with other surgical procedures, there is a risk of infection and damage to other organs. Since the ovaries and the uterus share some blood vessels, there might be disruption of ovarian blood supply that can lead to menopause

Myomectomy

Myomectomy

What it is and when it’s done

This surgical procedure involves removing the fibroids that are causing heavy menstrual bleeding.

It is carried out when heavy menstrual bleeding is caused by fibroids, in patients that wish to preserve their uterus . It is also indicated for some women with fibroids and infertility before undergoing assisted reproduction techniques

How it works

It involves surgery to remove fibroids from your womb

More info

After the procedure, it is not recommended to get pregnant for at least 6 months

What to expect after the procedure and possible risks

After the surgery, you will need to take medication for the pain and to prevent infection. You can have some vaginal spotting or staining.

Risks associated with the surgery may include heavy blood loss during surgery and infection. In some cases, removal of the uterus might be required. A myomectomy can increase certain risks during pregnancy and delivery. This surgery is performed under anesthetic

Hysterectomy

Hysterectomy

What it is and when it’s done

This surgical procedure consists of removing the uterus, stopping any future periods.It is carried out when all other treatments have been tried or discussed. You should be informed about the benefits and disadvantages of the procedure

How it works

By removing the uterus, you will not have periods anymore

More info

This procedure is not recommended for women who wish to get pregnant in the future

What to expect after the procedure and possible risks

After the surgery you will need to take medication for the pain and to prevent infection. You can have vaginal discharge for several days to weeks. The operation and recovery time are longer than for other types of surgery to treat heavy menstrual bleeding. Some complications might occur, including infection, bleeding and damage to other organs. This surgery is performed under anesthesia

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