When it’s that time of the month, do you use a tampon and a giant pad—just in case? Or skip activities because you’re worried that there won’t be a bathroom nearby? If so, your monthly flow is probably heavier than normal. Abnormally heavy periods are actually a lot more common than you might think—occurring in up to half of women in their 40s and early 50s—but, of course, friends and acquaintances going through the same struggle probably aren’t shouting it from the rooftops.
“Your everyday life shouldn’t be disrupted by your period,” says Kelly Hodges, MD, assistant professor of obstetrics and gynecology at Baylor College of Medicine in Houston. “If it is, bring it up to your doctor.” She’ll try to figure out what might be to blame (fibroids or hormone levels during perimenopause are common culprits), and then come up with some options for you to consider. Below, five fixes she might mention.
Nonsteroidal Anti-Inflammatories (NSAIDS)
The cramp-fighting meds you probably have at home (like Advil, Motrin, and Aleve) can also lighten your flow: They’ll lower your levels of prostaglandins, a fat compound that increases blood flow. The catch is that in order to notice a difference, you’ll need to take higher doses than you normally would—800 mg of ibuprofen (Advil or Motrin) three times a day, or an initial dose of 500 mg of Naproxen (Aleve) and then 200 to 250 mg four times a day, starting at the first sign of your period and for the next four to five days.
Success rates: The difference will be significant but not dramatic. A 2013 report from the Agency of Healthcare Research and Quality noted that three trials showed that taking NSAIDS reduced menstrual flow by 28% to 49%.
Try it if: This is your first step to towards trying to lighten your period, especially if you don’t need (or want) to use a contraceptive (see below).
Forget it if: You take blood-thinning medication, have a bleeding disorder, peptic ulcer, liver or kidney disease—all are reasons to avoid NSAIDS in general, because they can worsen these conditions.
Birth Control Pills
The hormones they contain prevent ovulation and make the lining of the uterus thinner, so there’s less blood to shed. “Some types of birth control pills allow you to have a period just four times a year, which makes my patients very happy,” says Cheryl Iglesia, MD, a spokesperson for the American College of Obstetricians and Gynecologists. It’s easiest to take “continuous combination” pills, which contain both estrogen and progestin, since you don’t have to take them at the exact same time everyday, as you do with progestin-only mini pills.
Success rates: In two studies of pills that contained both progestin and estrogen, bleeding was reduced by 64% to 69%, according to the Agency of Healthcare Research and Quality.
Try it if: NSAIDS don’t give you enough relief, but you’re not ready for a big-time birth control commitment like an IUD.
Forget it if: You have heart disease, high-blood pressure, diabetes, migraines, a history of cancer, or you’re a smoker over age 35—all are reasons to avoid the Pill because of the increased risk for stroke and blood clots.
IUDs (short for intrauterine devices) are small, t-shaped devices made of flexible plastic that release hormones after they’ve been inserted into your uterus by your gynecologist. Two devices that release progestin—thinning the uterine lining and partially suppressing ovulation—have FDA approval: Mirena (which works for up to five years) and Sklya (good for up to three years).
Success rates: Excellent—you get a 71% to 94% reduction in blood flow, according to the Agency for Healthcare Research and Quality. “For many women, periods stop entirely,” says Iglesia. And don’t worry: You won’t develop a build up of any tissue or blood in your uterus that needs to be “flushed” or “cleaned.” Once the IUD is removed, the lining returns to its normal thickness and pregnancy can happen as soon as the next cycle.
Try it if: Large fibroids aren’t to blame for your miserable periods (because they may make it impossible to insert the IUD properly) and you’re on board for longer-term birth control.
Forget it if: You have uterine cancer, undiagnosed vaginal bleeding, severe liver disease, or large fibroids; your doctor may want to weigh the risks versus the benefits if you have high-blood pressure, heart disease, or other conditions that can be worsened by the hormones the device releases.
It’s a quickie procedure—sometimes done your doc’s office under local anesthesia or light sedation—in which the lining of your uterus (the endometrium) is destroyed, making your monthly flow lighter or even nonexistent. Your doctor can do it a few different ways, but it often involves inserting a wand into the uterus through the cervix, delivering a radiofrequency that destroys the lining.
Success rates: In one review of 20 studies, 30% to 75% of patients said that they stopped bleeding entirely, and 85% to 94% reported being satisfied with the procedure.
Try it if: You’re not a good candidate for any of the above hormonal options and you’re done having kids. (While getting pregnant is still possible after the procedure, it’s very risky).
Forget it if: Uterine cancer is suspected, fibroids are to blame, or your doctor says your uterus is too large for the procedure.
Uterine Artery Embolism
During an hour-long procedure to reduce the size of fibroids, a radiologist uses a catheter to deliver small particles, such as beads or spheres, into the uterine artery to block the blood supply. Without blood flow, fibroids shrink.
Success rates: More than 80% of women will have a significant reduction in bleeding—in fact, the average length of a period dropped from 8 to 5 days with a lighter flow during that time, according to a study by the Ontario Uterine Fibroid Embolization Collaboration Group.
Try it if: You have small to medium fibroids and your doctor says you’re not a good candidate for other options.
Forget it if: You have extremely large fibroids or ones that lurk outside of the uterus, as your doctor may advise against the procedure because of the risk of infection. In that case, you could opt for fibroid removal (myomectomy) or a hysterectomy.