Menstruation is the normal cyclical shedding of the uterine lining, typically lasting between two and seven days. When the flow becomes excessively heavy or prolonged, individuals often seek methods for reduction or cessation. Any sudden change in bleeding pattern, particularly if heavy or accompanied by severe pain, requires prompt evaluation by a healthcare provider, as conditions like uterine fibroids, polyps, bleeding disorders, or anemia must be medically assessed before starting treatment.
Managing Flow with Over-the-Counter Options
Immediate relief from heavy menstrual flow and associated pain often starts with non-prescription medications. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen, are commonly used for this purpose because they reduce the production of compounds called prostaglandins.
Prostaglandins cause the uterine muscle contractions that lead to cramping and the shedding of the endometrial lining. By inhibiting prostaglandin levels, NSAIDs reduce the intensity of uterine contractions and the overall volume of blood loss. Studies suggest NSAIDs can reduce menstrual blood loss by 25% to 35%. For maximum effectiveness, they are often taken starting just before or at the onset of the period and continued for the first few days of heavy flow.
Hormonal Therapies for Regulation
Hormonal treatments are a highly effective medical approach for managing and regulating heavy menstrual bleeding (menorrhagia) over the long term. These therapies work primarily by manipulating the hormonal environment to prevent the thick buildup of the uterine lining. Since the amount of bleeding is directly related to the amount of endometrial tissue present, a thinner lining results in a lighter flow.
Combined Oral Contraceptives (COCs) contain both estrogen and progestin, and they are a standard treatment that can reduce blood loss by approximately 50%. The progestin component thins the endometrial lining, while the estrogen component stabilizes it, leading to lighter, predictable withdrawal bleeding. Continuous dosing, where the hormone-free interval is skipped, can suppress bleeding entirely for extended periods. Other combined hormonal methods, like the vaginal ring or transdermal patch, work similarly to maintain a stable, thin endometrium.
Progestin-only treatments also achieve a significant reduction in flow by inducing endometrial atrophy, meaning the lining remains consistently thin. The levonorgestrel-releasing intrauterine system (LNG-IUS), or hormonal IUD, is especially effective, releasing a high concentration of progestin directly into the uterus. This local action is highly successful at reducing or eliminating bleeding over time, often more effectively than oral medications. Other progestin-only options include injections, like depot medroxyprogesterone acetate (DMPA), which can lead to the absence of periods (amenorrhea) in many users.
Non-Hormonal Prescription Interventions
For those who cannot or prefer not to use hormonal treatments, specific non-hormonal prescription medications can acutely target the bleeding process. The most common intervention is tranexamic acid, an antifibrinolytic agent, which directly addresses the mechanism of bleeding by stabilizing blood clots in the uterus.
Tranexamic acid works by preventing the breakdown of fibrin, the main protein structure of a blood clot. By keeping the clot stable, it significantly reduces the volume of menstrual blood loss during the period. This medication is taken only on the heavy bleeding days of the cycle and does not provide long-term cycle regulation or contraception. It is considered a first-line treatment for heavy flow and has been shown to be more effective at reducing blood loss than NSAIDs.
Surgical Options for Chronic Bleeding
When medical management, including hormonal and non-hormonal therapies, is insufficient or contraindicated, surgical procedures become an option. These interventions are typically reserved for individuals who have completed childbearing, as they permanently or semi-permanently alter the ability to become pregnant.
Endometrial ablation is a minimally invasive procedure that destroys the tissue lining the uterus, the endometrium, using methods like heat, cold, or radiofrequency energy. By eliminating the lining that is normally shed each month, the procedure can dramatically reduce menstrual flow, often resulting in lighter periods or complete cessation of bleeding. Because future pregnancies after this procedure are highly dangerous, it is generally only performed when childbearing is complete.
The most definitive method for completely stopping menstrual bleeding is a hysterectomy, which is the surgical removal of the uterus. This major surgery is considered a last resort for severe cases of heavy bleeding that have not responded to any other treatment. Hysterectomy permanently eliminates the source of menstrual flow and may be performed abdominally, vaginally, or laparoscopically. Dilation and Curettage (D&C) involves widening the cervix and gently scraping tissue from the uterine lining. While D&C can temporarily reduce bleeding, its primary role today is for diagnosis or to manage acute, severe bleeding, rather than as a long-term treatment.