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Drug treatments There are several different types of tablets which are commonly prescribed to control heavy bleeding. The main problem with all of these tablets is that they affect different women in different ways. For some women, their bleeding is dramatically reduced while others are not helped at all. For a few women they may make the problem worse. If one kind of tablet does not work for you, go back to your doctor and consider other options. There are no guidelines for how long a woman should be taking most of these tablets. There is very little research into the side effects of long term use of many of them. Drugs that affect bleeding mechanisms These drugs are only taken during bleeding. They include tranexamic acid (brand name Cyklokapron) and ethamsylate (brand name Dicynene). They have been shown to reduce blood loss with some women and can be used at any age. Side effects can include headache, nausea, dizziness, rashes, vomiting and diarrhoea. Tranexamic acid should not be taken by women with a history of thrombosis. |
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 Drugs that stop the body from making prostaglandins Examples of this kind of drug are aspirin and mefenamic acid (e.g. brand name Ponstan). Studies have shown that these drugs can cut down the blood loss in many women with heavy bleeding. They are taken only during menstruation, which is an advantage for women who don't want to take drugs all the time. These drugs can be taken by women of all ages but shouldn't be prescribed for women with peptic ulcers. Side effects can include indigestion, diarrhoea, headache, dizziness, skin rashes, peptic ulcers and inflammatory bowel disease if used long term. Contraceptive pill The combined contraceptive pill is very effective in controlling heavy bleeding and is useful if you also want this form of contraception. The pill suppresses the menstrual cycle and stops ovulation (egg release). At one time women over 35 were advised not take the pill but if a woman does not have any risk factors such as smoking or increased blood pressure, doctors now feel women can continue on the pill indefinitely. Women of any age who are offered the pill should have a medical history taken and examination done before it is prescribed. Progestogens Treatment with these hormones is based on the theory that women with unexplained heavy bleeding are not ovulating (releasing an egg) and are thus not producing their own progesterone (the natural progestogen). Without enough progesterone, the lining of the uterus continues to build up until eventually it starts to break down, causing heavy bleeding. But most women with heavy bleeding and regular cycles are ovulating so this theory doesn't seem to stand up. Progestogens are not as effective as tranexamic acid in reducing blood loss, but nevertheless they do seem to work for many women. Taking progestogen can cause side effects of weight gain, acne, breast tenderness, bloating and breakthrough bleeding, but not all women experience these. A high dose taken for a long time can increase the risk of heart disease especially in women who smoke heavily, are very overweight or have high blood pressure. Different progestogens have been tried for differing numbers of days in the menstrual cycle. Common progestogens used are norethisterone (brand name Primolut N), medroxyprogesterone (brand name Provera) and dydrogesterone (brand name 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).  Mirena Mirena, or the levonorgestrel intrauterine system, is a contraceptive device which is placed in the uterus like an IUD, and which releases a type of progestogen into the uterus. It has been shown to be more effective than tranexamic acid and TCRE in reducing heavy bleeding, although for the first two or three months it may cause a slightly heavier flow. In most women Mirena reduces the amount of blood lost during a period, and in some women periods stop altogether. It is not licensed as a treatment for heavy bleeding, but is useful if the woman also wants contraception. Danazol (brand name Danol) This is a synthetic hormone similar to the male sex hormone testosterone. It is used to treat endometriosis. It is not known exactly how Danazol works but it blocks and actually 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 your doctor rather than waiting until the course is finished. In the doses given, Danazol is not effective as a contraceptive. A woman who needs contraception should not take the contraceptive pill while on Danazol but should use some other form of contraception. GnRH angonists These are powerful drugs (e.g. buserelin, goserelin and nafarelin) which are taken by injection or sniffing (intranasally). They act by stopping the ovaries from working, effectively reducing blood loss. Many women stop having periods altogether. However, because a woman's oestrogen levels are also reduced, menopausal side effects are common. Therefore, GnRH agonists should not be used for more than six months. Bioflavenoids An alternative method of treating heavy bleeding which some women may be interested in trying is to take bioflavenoids. These are also known as flavones or hesperidin and used to be called vitamin P. Bioflavenoids found in cereals are called rutin and those found in the pith of citrus fruits are called citrin. They work with vitamin C to strengthen capillaries and other blood vessels. Bioflavenoids can be taken in the diet where they always accompany vitamin C. The richest natural sources are fresh or tinned citrus fruits (particularly the pith), apricots, cherries, grapes, green peppers, tomatoes, broccoli and buckwheat. They can also be taken as tablets, combined with vitamin C or on their own. There is very little information about the safe doses of bioflavenoid tablets. It is wise to be as cautious about these tablets as about drugs. Complementary therapies  While your doctor may say that your heavy bleeding results from a hormone imbalance or is unexplained, complementary medical practitioners will have a totally different understanding of your condition. These therapies treat the whole person, not just her symptoms. Two women going to the same complementary therapist for heavy bleeding may well end up with completely different remedies. This makes it hard for controlled studies to be done comparing the effectiveness of complementary therapies. But the point is that there are a number of therapies to try before deciding that a hysterectomy is the only answer. If you want to try a complementary therapy it's best to see a qualified practitioner, and to tell both the complementary therapist and your doctor about any other treatments you are taking. Complementary therapies that offer treatment for heavy bleeding include herbalism, homeopathy, aromatherapy, and traditional Chinese medicine (acupuncture and herbalism). For information on how to find a qualified practitioner, contact the organisations listed in the Resources section. |
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All original illustrations © Michelle Forster unless otherwise indicated
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