Treating HMB
TREATING HEAVY MENSTRUAL BLEEDING (HMB)
Heavy menstrual bleeding (HMB) is a treatable condition, and there are a wide range of treatment options available. Don't be afraid to arrange an appointment to visit your doctor if you feel you may be suffering with HMB.
The treatments discussed below need to be initiated under medical supervision, after a consultation with your healthcare professional. The following information is not a substitute for medical advice or the patient information leaflet. For full information including side effects and eligibility for treatment please consult your healthcare professional.
In addition to the following treatment options for HMB, your doctor may also recommend you take regular iron supplements to help treat anaemia (iron deficiency) due to blood loss.
MEDICAL MANAGEMENT OF HMB
If you are not considering getting pregnant, the following can be considered:
INTRAUTERINE SYSTEM (IUS)
An IUS is fitted once and stays inside the womb for up to 5 years or more depending on the type chosen. It slowly releases a small amount of a hormone called progestogen, which provides reliable contraception and has been shown to reduce HMB by up to 95%.
The fitting can be done at GP surgeries or sexual health clinics offering the service.
Irregular menstrual bleeding can occur particularly during the first months of use and it may take at least 6 months to see the full benefit of treatment.
Taking any medicine carries some risk of side effects.
Common side effects of using an IUS include but are not limited to:
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Vaginal bleeding including spotting
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Absent, light or infrequent menstrual periods
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Bacterial or fungal infections of the vagina and the outer genitalia (vulva)
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Spots (acne)
There are some rare and serious side effects of IUS, these may include:
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Pelvic infection - Small risk of infection during insertion.
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Rejection - Risk of expulsion of the IUS.
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Damage to the womb - It is rare, but the IUS can make a hole in the wall of the womb when it is put in. If it does happen, the IUS may have to be removed by surgery.
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Ectopic pregnancy - Pregnancy outside the womb (ectopic pregnancy) is possible but very rare. If the IUS fails and you become pregnant, there's an increased risk of ectopic pregnancy.
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Cysts - Can cause small fluid-filled cysts on your ovaries – these don’t usually cause any symptoms and tend to go away on their own.
COMBINED HORMONAL CONTRACEPTIVES
Aside from providing birth control, oral contraceptives can help reduce episodes of excessive or prolonged menstrual bleeding. Certain (or some) types of the combined pill, often referred to as 'the pill', have been shown to reduce heavy bleeding and can have the added benefit of regulating the menstrual cycle and reducing period pain.
Taking any medicine carries some risk of side effects.
Common side effects of using the pill include but are not limited to:
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Vaginal bleeding including spotting
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Breast tenderness
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Feeling sick (nausea)
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Headache
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Abdominal pain
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Increased weight
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Mood changes such as depression
There are some rare and serious side effects of using the pill, these may include:
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Blood clots
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Cancer
ORAL NORETHISTERONE
Oral norethisterone (man-made progesterone) can be used to treat heavy periods, and is taken daily in tablet form. It works by preventing your womb lining from growing quickly and can reduce heavy bleeding. Oral norethisterone is not suitable if you are trying to conceive as it is likely to stop ovulation. However, it is important you use some form of contraception (e.g. a condom) while taking norethisterone tablets, as it is not a contraceptive.
Taking any medicine carries some risk of side effects.
Common side effects of oral norethisterone/progestogens include but are not limited to:
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Vaginal bleeding including spotting
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Periods that are much shorter than normal and where blood flow is reduced
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Headache
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Feeling sick (nausea)
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Absence of a period
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Swelling
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Gastrointestinal issues
There are some rare and serious side effects of using oral norethisterone/progestogens, these may include:
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Blood clots
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Allergic reactions
If you are considering getting pregnant and would prefer a non-hormonal treatment, the following can be considered:
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
NSAIDs work by reducing the body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods. They can also help relieve period pain. NSAIDs are not a form of contraception and won't affect your chances of becoming pregnant.
Taking any medicine carries some risk of side effects.
Gastrointestinal issues are the most common side effects seen with NSAIDs.
In rare cases they can be associated with serious problems such as kidney damage, heart attack or stroke.
TRANEXAMIC ACID TABLETS
Tranexamic acid tablets work by helping the blood in the womb to clot, and have been shown to significantly decrease menstrual blood loss. Tranexamic acid tablets are not a form of contraception and won't affect your chances of becoming pregnant.
Taking any medicine carries some risk of side effects.
Gastrointestinal issues are the most common side effects seen with tranexamic acid tablets.
In rare cases they can be associated with serious problems such as blood clots and allergic reactions.
SURGICAL TREATMENT OPTIONS FOR HMB
If medical management is not working to treat your HMB, surgical intervention may need to be considered. Surgical procedures for HMB include:
UTERINE ARTERY EMBOLISATION (UAE)
If HMB is caused by fibroids, this procedure will aim to shrink the fibroids in the uterus. UAE involves inserting a small tube into the groin and injecting small plastic beads through the tube into the arteries supplying blood to the fibroid. This blocks the arteries, stopping blood flow to the fibroid and causing it to shrink.
MYOMECTOMY
This procedure involves surgical removal of uterine fibroids. Depending on the size, number and location of the fibroids, your surgeon may choose to perform the myomectomy using open abdominal surgery, through several small incisions (laparoscopically), or through the vagina and cervix.
ENDOMETRIAL ABLATION
With endometrial ablation, the lining of the uterus is permanently destroyed using laser beams or microwave energy. This procedure is only appropriate if you do not wish to conceive in the future.
HYSTERECTOMY
A hysterectomy is a surgery to remove your uterus and cervix. This is a permanent procedure that causes sterility and ends menstrual periods. It is not usually used as a first-line treatment solely for HMB.
PP-UN-WHC-GB-0049 September 2023
