Progesterone tablets

Heavy periods can be treated with tablets that contain the hormone progesterone. Progesterone inhibits the growth of the lining of the womb before menstruation, which lessens the bleeding during menstruation. Studies have shown that progesterone tablets work about as well as NSAIDs. But progesterone tablets are less effective than hormonal intrauterine devices (IUDs, or "coils") and tranexamic acid.

Progesterone tablets are taken between the 7th and 21st days of the menstrual cycle. Then there is a break when menstrual bleeding occurs.

Birth control pills and mini-pills

Birth control pills (“the pill”) are hormonal contraceptives. They contain either a combination of estrogen and progestin (combination birth control pill), or just progestin (mini-pill).

Women who have heavy periods often decide to use the mini-pill. They take this low dose of progestin without any breaks. This usually causes menstrual bleeding to become irregular, and sometimes women may even stop getting their period.

Combination pills are mainly used as contraceptives. Most women take the combination pill for 21 days per cycle. The bleeding starts during the seven-day break that follows. Low-dose combination pills can be taken continuously (without breaks) too. Then the woman usually stops getting her period completely, and only has light spotting at the most.

But combination pills have not yet been approved for continuous use in Germany. So if they're used in this way it's considered to be “off-label” use (not officially approved). It’s important to discuss the possible consequences of this type of use with your doctor.

The possible side effects of birth control pills include fluid retention, headaches and breast tenderness. The combination pill in particular increases the likelihood of blood clots (thrombosis), so women who have a greater risk of thrombosis (for example, smokers) are advised not to take it.

Hormonal intrauterine devices

Hormonal IUDs (intrauterine devices, also called coils) are placed in the womb (uterus) and can remain there for about five years. Like birth control pills, they prevent pregnancy. They do this by releasing a continuous amount of a progestin called levonorgestrel. Studies show that an progestin-releasing IUDs can reduce the loss of menstrual blood and related problems more effectively than birth control pills or NSAIDs can.

Hormonal IUDs are about as effective as surgery to remove the lining of the womb.

The most common side effects of hormonal IUDs are acne, spotting (vaginal bleeding between periods) and breast tenderness. But these side effects are more likely to occur when using the mini-pill. Hormonal IUDs may also cause benign cysts to grow on the ovaries. These usually go away on their own within one year, though. IUDs are rejected by the body in about 1 out of 10 women, so they need to see the doctor again.

If an IUD has been prescribed to treat heavy periods rather than for use as a contraceptive, statutory health insurers usually cover the costs in Germany.

Removal of fibroids or polyps

Surgery may be necessary if benign growths in or on the wall of the womb (fibroids or polyps) are causing heavy periods. Doctors can remove fibroids through the vagina or abdominal cavity. This operation is called fibroidectomy or myomectomy. The womb is not removed during this procedure, so the woman can usually still get pregnant afterwards.

Removal of the lining of the womb

Another option is to remove the lining of the womb (endometrium). Here the tissue is removed using surgical instruments (endometrial resection) or destroyed, for instance using laser beams or microwave energy (endometrial ablation). After the procedure, the woman often stops having periods, or her periods are much lighter. Pregnancy is then unlikely. If she does get pregnant, there is a high risk of miscarriage or premature birth.

But the lining of the womb can grow back. If heavy periods start again as a result, the procedure can be repeated. About 20 out of 100 women have this kind of surgery again within two years.

Endometrial ablation or resection can sometimes be performed as outpatient surgery (without a hospital stay). Women recover relatively quickly afterwards.

Removal of the womb (hysterectomy)

If the periods are very heavy and distressing, and previous treatments weren't successful, surgical removal of the womb (hysterectomy) is considered. This is a bigger operation, though, which may have emotional consequences in addition to the physical consequences. If a woman has a hysterectomy, she will no longer have periods, so the associated problems will stop too. She will also no longer be able to have children. But the balance of hormones in the body doesn't change because the ovaries are nearly always left intact.

This procedure causes abdominal injuries in about 5 out of 100 women. It is also associated with the usual risks of surgery, such as infections or poor wound healing. Women who have a hysterectomy usually need to stay in the hospital for a while afterwards.