Is drug therapy an option for me?
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Drug therapy can be an option if you potentially want children in the future. There are two types of drugs that may be taken to reduce bleeding: non-hormonal and hormonal. Neither will affect your ability to have children once you stop taking them.
Non-Hormonal Drugs
Non-hormonal drugs are for short-term use only. They reduce bleeding in about 40% of women who take them. However, they must be used continuously and only manage the problem; they do not resolve it. When you stop taking them, your heavy periods are likely to return.
NSAIDs (non-steroidal anti-inflammatory drugs e.g. ibuprofen)
NSAIDs can reduce bleeding 25-35%. Long-term use, however, can increase your risk of gastrointestinal bleeding (bleeding in your digestive track), ulcers and anemia.
Over-the-counter NSAIDs should be taken about every eight hours while you are having your period. Prescription NSAIDs should be taken as prescribed by your doctor. Your heavy periods will return when you stop taking the NSAIDs. The long term use of NSAIDs has been associated with renal damage.
Aminocaproic or Tranexamic Acid (also known as Lysteda®)
Aminocaproic and Tranexamic Acid aid in blood clotting (blood thickening). This medication is taken at the start of your period for a maximum of five days and has shown promising results. These acids can reduce blood flow by up to one third. Because they aid in blood clotting, they may also cause blood clots that can be dangerous. This needs to be closely watched by your doctor. Other possible side effects can include: headache, sinus and nasal symptoms; back, abdominal, musculoskeletal or joint pain; muscle cramps; migraine; anemia; and fatigue.
Hormone-based Drugs / Devices
Hormonal drugs, which contain estrogen and/or progestin, may lighten your period. However, they must be used continuously and only manage the problem; they do not resolve it. When you stop taking them, your heavy periods are likely to return.
Hormone Therapy / Birth Control Pills
Birth control pills stabilize the body's estrogen and progestin levels. As a result, bleeding should become lighter (on average by 45%) and more controlled, as long as you stay on the hormones. They must be taken for three to four cycles to see results. However, 50-59% of women on birth control pills find that this form of hormone therapy does not reduce their heavy periods to the extent they would like.
There are many brands of birth control pills that contain different hormone levels. Ask your doctor which would be best for you.
Birth control pills also help prevent pregnancies and decrease your chance of some types of cancer. While taking birth control pills, you may have nausea, headaches and/or weight gain. Long-term use can increase your risk of blood clots.
Progesterone Hormone Therapy (Progestins and Natural Progesterone)
Progestins are made to act as a replacement for progesterone, a hormone that a woman's body naturally produces. This is an option for women who are producing too much estrogen and not enough progesterone. Polycystic ovary syndrome and anovulation are common conditions associated with this imbalance.
Hormones can be taken in the form of an oral progestin pill, implanted under your skin (Implanon®), or via an IUD (intrauterine device). Both thin the lining of the uterus, reducing blood flow.
An IUD is a device that is inserted into the uterus and releases a steady amount of progestins. On average, oral progestins reduce bleeding by 20-30%, while some IUDs can reduce blood flow up to 90%. In addition, 27% of women with IUDs do not see an improvement in their heavy periods. Only 50% of women on oral progestins claim to have a lighter period.
Approximately 30% of women on these types of hormonal treatments experience side effects. These side effects may include intermenstrual bleeding/spotting, depression, acne, headaches, nausea, weight gain and hair loss. Other potential side effects include abdominal pain, infection, and difficulty inserting the IUD device, requiring cervical dilation. Natural progesterone has recently been developed and may have fewer side effects, but this has not been proven.