Published January 2007
About this Information
NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments they should receive. The information applies to people using the NHS in England and Wales.
This information explains the advice about the treatment and care for women with heavy periods that is set out in NICE clinical guideline 44.
Does this information apply to me?
Yes, if you are woman who has heavy periods.
No if you have:
- heavy periods caused by endometriosis or HRT, or
- bleeding that is not related to your menstrual cycle.
Some treatments may not be suitable for you, depending on your exact circumstances. If you have questions about the specific treatments and options covered in this information, please talk to a member of your healthcare team.
Your treatment and care should take into account your personal needs and preferences, and you have the right to be fully informed and to make decisions in partnership with your healthcare team. To help with this, your healthcare team should give you information you can understand and that is relevant to your circumstances. All healthcare professionals should treat you with respect, sensitivity and understanding and explain heavy periods and the treatments simply and clearly.
The information you get from your healthcare team should include details of the possible benefits and risks of particular treatments. You can ask any questions you want to and can always change your mind as your treatment progresses or your condition or circumstances change. Your own preference for a particular treatment is important and your healthcare team should support your choice of treatment wherever possible. You should be able to get a second opinion if an agreement between you and your healthcare professional on your treatment is not reached.
Your treatment and care, and the information you are given about it, should take account of any
religious, ethnic or cultural needs you may have. It should also take into account any additional
factors, such as physical or learning disabilities, sight or hearing problems, or difficulties with
reading or speaking English. Your healthcare team should be able to arrange an interpreter or an
advocate (someone who supports you in asking for what you want) if needed.
Are heavy periods disrupting your life?
Every woman is different and the amount of blood each woman loses during her period varies widely from one person to another. If heavy periods are disrupting your life, your doctor should be able to offer treatments to help.
First stop: your doctor
Your doctor will ask you about your periods, how much bleeding you have (how often you need to change your tampons/sanitary pads, whether you have clots or experience flooding) and how long your period lasts. If you bleed after sex or have pelvic pain or bleeding between periods, your doctor should offer to examine you to try and find out the cause.
Your doctor may offer tests to try and find out what is causing your heavy periods. A blood test will show the doctor if you have anaemia (not enough iron in your blood).
If your doctor is concerned about the cause of your heavy periods, you may be offered an ultrasound scan. If the scan doesn’t show anything is wrong or is unclear, you may be offered other types of tests. Your doctor may offer to refer you to a specialist if there seem to be large fibroids or other problems with your womb. (A fibroid is a non-cancerous growth in the womb.)
If there are no obvious problems with your womb, your doctor will be able to offer a number of different drug treatments to help you. Some of the treatments are also contraceptives. The options are listed in the table below in the recommended order. Your doctor should discuss the benefits and risks of each treatment with you. If the first treatment isn’t suitable for you, or if you try one treatment and it doesn’t work, it may be possible to try the next option. Some of the treatments make your periods lighter and some may stop the bleeding completely. You should be given information explaining the different options, and be allowed time to make your decision
|Drug treatments in recommended order of what to try first as long as it’s suitable for you||What is it?||How does it work?||Is it a contraceptive?||Could it affect my chances of getting pregnant in the future?||Possible unwanted effects (not everyone experiences these) See note at bottom of table|
|First treatment to consider||Levonorgestrel- releasing intrauterine system||A small plastic device that is placed in the womb and slowly releases the hormone progestogen||Prevents the lining of the womb from growing quickly||Yes||No – not after you’ve stopped using this drug||Common: irregular bleeding that may last for over 6 months; breast tenderness, acne or headaches may occur but are generally minor and short lived Less common: no periods|
Second stop: your specialist
If you think that your care does not match what is described in this information, please talk to a member of your healthcare team.
If treatments offered by your doctor haven’t worked, or if you have large fibroids or other possible problems with your womb, you may be offered a referral to a specialist. Before your appointment you should be given this leaflet or other similar information.
Your specialist may offer you surgery. There are a number of different operations that can help (see the table below). Your specialist should discuss these with you. You should be told about the benefits and risks of each option, and given enough time and support to help you make a decision. Some operations will affect your fertility, and before making a decision about these operations your specialist should discuss in detail the potential impact on you.
Your specialist should be competent in the procedures offered. If your specialist is not trained to undertake a particular treatment you should be referred to another specialist with this training
Questions you might like to ask your doctor
- Please give me more details about any tests I may need.
- How long will it take to have the tests and get the results?
- Please tell me why you have decided to offer me this particular type of treatment.
- What are the pros and cons of having this treatment?
- How will the treatment help me? What effect will it have on my symptoms and
- everyday life? What sort of improvements might I expect?
- How long will it take before I notice a difference?
- Are there any risks if I take this treatment?
- What are my options for taking treatments other than the recommended treatment?
- Is there some written information about the treatment that I can have?
Surgical treatments compared
You should not be offered:
- oral progestogens for use only in the second half of your menstrual cycle
- drugs called danazol and etamsylate
- dilatation and curettage (D and C, which involves scraping out the womb lining) – as a treatment or test on its own
More information about heavy periods
The organisations below can provide more information and support for women with heavy periods. Please note that NICE is not responsible for the quality or accuracy of any information or advice provided by these organisations.
- Fibroid Network, email@example.com, www.fibroidnetworkonline.com
- The Hysterectomy Association, 0871 781 1141, www.hysterectomy-association.org.uk
- Women’s Health Concern, 0845 123 2319, www.womens-health-concern.org
You can also go to NHS Choices (www.nhs.uk) for more information.
© Royal College of Obstetricians and Gynaecologists