TREATING
HEAVY PERIODS
(HEAVY MENSTRUAL BLEEDING)
WHAT IS HEAVY MENSTRUAL BLEEDING (HMB)?
A useful definition of HMB is when your periods are so heavy that they interfere with your quality of life or your ability to carry out day-to-day activities.
Periods are a normal part of life and if you have always had heavy periods you may think this is normal, but if they’re so heavy that you have to take time off work or school, or can’t do the things you normally enjoy, it’s time to speak to your doctor.
HOW DO I KNOW IF I HAVE HMB?
Think about the impact that your periods have on your life. If you answer ‘yes’ to any of these questions, you could have HMB:
I bleed so much that I have to change my pad/tampon/menstrual cup every 1-2 hours
I need to use two types of period products (e.g. a tampon and a pad) at the same time
My periods last longer than 8 days
I pass large clots during my period
I have had problems with “flooding” when I bleed through to my clothes
I need to get up in the night to change my pad/tampon or I have to wear a nappy, put a towel in my bed or use large maternity pads when I sleep
My period is so heavy that it stops me from doing physical activities like going to the gym, cycling, swimming, etc
My period is so heavy that it sometimes stops me from going to work or social events
WHAT CAUSES HMB?
HMB can be caused by a lot of different things. Hormonal changes – for example leading up to the menopause – are a common cause of HMB.
Other potential causes include:
- Gynaecological problems such as uterine polyps or fibroids, endometriosis, pelvic infections or endometrial hyperplasia
- Blood disorders which prevent clotting
- Certain medical treatments such as the copper intrauterine device (IUD) or anticoagulant medicines
Some causes of HMB can be identified through medical investigations, but often no definite explanation can be found.
It is important to speak to your doctor if your period is so heavy that it makes it difficult for you to do your normal daily activities, or if you have any other concerns about your periods. Even if no obvious reason for your HMB can be found – which is often the case – there are still effective treatments available.
WHAT CAN I EXPECT WHEN I TALK TO MY HEALTHCARE PROFESSIONAL ABOUT HMB?
Your healthcare professional may ask you questions about your periods and any other symptoms you have or any medications you are taking. They may also ask other questions about your health and sexual history to try and get some clues about what might be causing your HMB.
Your healthcare professional may also need to do a physical examination. This may include (with your consent) an internal examination of your vagina and cervix and what is called a ‘bimanual examination’ of your uterus (womb) to look for any abnormalities. This will involve your doctor placing their fingers inside your vagina to feel your uterus. You may also need to have other tests or scans if an underlying cause is suspected.
WHAT TREATMENTS ARE AVAILABLE FOR HMB?
If no underlying cause is suspected or found, your doctor may recommend certain common medical or surgical treatments to reduce or stop your heavy bleeding and/or manage other symptoms.
Medical treatments include:
An intrauterine system
(also called a ‘hormonal IUD’), known by the brand name Mirena® (52 mg levonorgestrel intrauterine contraceptive device). A small T-shaped device inserted into the uterus by a healthcare professional. It is effective for 5 years for heavy menstrual bleeding (idiopathic menorrhagia) ). Mirena should be removed or replaced when the heavy menstrual bleeding or painful menses return or after 8 years at the latest.
Oral hormonal pills
such as combined oral contraceptive pills or pills that contain a specific type of progestogen.
Non-hormonal treatments
such as tranexamic acid, mefenamic acid and non-steroidal anti-inflammatories (NSAIDs).
HMB treatment may depend on whether you are currently trying to get pregnant or plan to have children in the future. Discuss all your options with your doctor to decide whether you would like treatment and if so, which treatment would be best for you.
HOW DOES MIRENA® WORK TO HELP REDUCE HMB?
Typically, this is how your period works:
- Every month, the lining of your uterus thickens during the first half of your menstrual cycle to prepare for ovulation (release of an egg)
- If ovulation takes place and the egg is not fertilized, the uterus sheds its lining. The blood and tissue from the lining of your uterus passes out of your body through your vagina. This is known as your period
- On average, a woman’s period lasts around 5 days. It may be shorter or longer, depending on the woman
- As well as vaginal bleeding, some women experience pain/discomfort and/or changes in mood around the time of their period
Mirena® can reduce your menstrual bleeding by thinning the lining of the uterus. In a clinical trial in women with HMB and treated with Mirena®, blood loss was reduced by up to 95% at the end of 6 months of use. Mirena® may also reduce the period pain/discomfort that some women have during their period.
WHAT OTHER EFFECTS MIGHT MIRENA® HAVE ON MY PERIODS?
You may notice an initial increase in the number of spotting and bleeding days which then typically decrease in the months that follow. Your bleeding may also be irregular.
Your total blood loss per period may progressively decrease with continued use and you may stop bleeding altogether.
Contact your healthcare professional if your bleeding remains heavier than usual or increases after it has been light for a while.
Mirena® is very effective at preventing pregnancy but if you have any concerns that you may be pregnant while using Mirena®, contact your healthcare professional without delay.
Want to learn more about Mirena®? View the patient information booklet here
MORE INFORMATION
For more information about HMB speak to your healthcare professional or download the patient booklet.
MORE INFORMATION
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PP-PF-WHC-NZ-0038-3. TAPS NP25426E, SEPTEMBER 2026