Heavy Periods--Tranexamic Acid? Hysterectomy?

May 21, 2024 2:29 PM

I have a question based on personal experience with heavy periods (NOT expecting medical advice, I know you are not my doctor, etc.)

I've had heavy periods since age 12. My cycle is also pretty short like 21-24 days. When I have my period it is VERY heavy unless im on estrogen-containing BC which I can no longer take (no estrogen b/c ocular migraines). I've tried IUDs and it made stuff better but I will not get another (so please don't suggest it). Tried Nexplanon, had a 3 week bleeding period when it wasn't even at the end of its life. Got it removed, now on a progesterone-only pill (Camilla) and I have my period after 21 days since the last one began. And they are HEAVY! Like last night I bled through my menstrual disc and even on days when they don't leak like that, they are super full. And the periods always last for several days w/ quite a few heavy days.

OK, SO! My very experienced gyn rxed me tranexamic acid to try. But I also asked her about a hysterectomy b/c I feel desperate and so annoyed. I figured she wouldn't even consider it but she said she's done it for quite a few patients in my situation and they patients were happy.

I am exactly 42 and 10 months old today. I have no partner at all (I do sleep with a FwB so the birth control is nice for that only since it obviously does not do anything for my periods). I have never had kids and probably don't plan to bc 1. I don't think I want them although I used to waver when I was younger and married. 2. I don't think I want to pass on some issues I have (mental health, very bad migraines, fatigue) but am also not interested in a donor egg. 3. I don't want to be a single parent.

OK! Has anyone had a similar experience or can relate any stories that may resonate? Thanks very much!

posted by bookworm4125 to Health & Fitness (15 answers total)

My doctor offered an endometrial ablation to deal with my incredibly-heavy periods. She said she had a number of patients who had been very happy with the results. If it didn't work for her patients, the next step was usually a hysterectomy. I ended up deciding not to have one because I wanted to look for less-invasive solutions. (You have to be sure that you do not want kids before having an ablation.)

The thing that has helped me the most for the past few years is taking a NSAID (Ibuprofen) for several days before my period starts. It definitely decreased the bleeding.
posted by belladonna at 2:41 PM on May 21 [2 favorites]

Make sure your tranexamic acid is the right dosage for your weight - I've had some gynos recommend utterly ineffective dosages. For heavier women especially you can do 1 gram up to four times per day and it's magic.

Keep an eye on your ferritin, especially if you do end up having a hysterectomy. Anaemia is a pain and a half.
posted by I claim sanctuary at 3:17 PM on May 21

I had an endometrial ablation last year and I am so so happy with it. I’m almost 50 and perimenopause was giving me atrocious periods. I took transexamic acid for several months before the ablation and it worked ok. It can cause headaches but I get migraines around then routinely anyway so I was taking triptans anyway.

I had it done in a surgery center under general anesthesia. The recovery was fine - totally recovered within a few days. My cycle didn’t completely go away but it’s panyliner-level as opposed to the elevator-in-The-Shining-level it was before.

I was sterilized almost a decade ago so fertility wasn’t a consideration. You do really have to be sure about kids though before you do it.
posted by jeoc at 3:41 PM on May 21 [1 favorite]

Tranexamic acid has been a game-changer for me. I use it as needed on heavy days and it helps make things bearable and gives me more confidence to participate in life without dealing with heavy flow and leaks. It sometimes makes my stomach feel ick (not nauseous, not pain, just a hard to describe ick), but the trade off is worth it to me.

As a side note , I wonder if your fatigue is related to low iron levels caused by blood loss. If you haven’t had your blood iron levels checked lately, you might consider asking your doctor about that.
posted by smokyjoe at 3:54 PM on May 21 [1 favorite]

Seconding endometrial ablation. I've had it and I am now on pantyliners if that.

Friend who was in your exact situation with ridiculously heavy periods had it done and it made a huge difference. Hysterectomy is radical surgery and can easily mess with your hormones. Endometrial ablation is a great alternative.
posted by tafetta, darling! at 4:10 PM on May 21 [1 favorite]

Usual IANAD or nurse disclaimer here.

My first comment is biased, because I work for one, but have you considered being worked up by an endocrinologist in addition to OB/GYN? We see a lot of patients for symptoms you are describing. A lot. Even if an endocrinologist does not work for you, a very thorough medical workup will ALL the labs cannot hurt. (Everything from anemia to a Vitamin D deficiency, and a lot of stuff in between, can contribute to fatigue, but again, not a doctor.)

My second comment is that I have a 27 year old friend who recently had a hysterectomy (but not removal of her ovaries) because of her awful menstrual and other issues since age 12. She cannot be on oral or other BCP, she tried every IUD on the market, she suffered so much ugh. She has never had any desire to become pregnant or be a parent, and says if she changes her mind about having a family, she will find another way. This is purely anecdotal, of course.

Third comment, also anecdotal, is that I am older than you, have strongly NEVER wanted to have biological children, partly because of genetic issues I would pass along but also because of emotional issues I won’t bore you with, and suffered for too many years with all the menstrual BS, which began at age 11 for me. If I had not finally found a doctor who was able to treat my horrific periods, I would have definitely pursued surgical intervention, whether ablation, hysterectomy, or whatever.

I hope you are able to get help and relief from suffering. Best wishes.
posted by kyraU2 at 5:25 PM on May 21 [1 favorite]

For a more modern progesterone-only pill, Slynd can have the side effect of no bleeding whatsoever. This has been my experience (and I am loving it.) The downside is it is generally not covered by insurance, but there is a manufacturer's coupon.
posted by lolibrarian at 5:48 PM on May 21

I had heavy periods, and these caused iron deficiency issues. Upon further investigation, they found fibroids.

My OB/GYN gave me a choice between just removing the fibroid, or getting a hysterectomy. She wanted me to take at least 48 hours to think about it. On the 49th hour, I emailed her back, and asked for the Hysterectomy. My health insurance needed me to sign a form acknowledging that this procedure will make me sterile, which I happly did. I got it in 2018, and it's been such a relief to not have to worry about periods, fibroids, anemia, and the possibility of a surprise pregnancy.

As a bonus, I'm also a transgender male - it's like I won transman Powerball here.
posted by spinifex23 at 6:05 PM on May 21 [10 favorites]

I had very heavy periods and when I was your age. I started Tranexemic acid 1 gram four times a day. That decreased my flow by about 20 percent. Then a year later I had a uterine artery embolization. That also decreased my flow by about 20 percent. For me, that was enough to manage until thankfully menopause happened. In retrospect I wish I had gotten an ablation though, it seems to be more effective.
posted by SyraCarol at 6:52 PM on May 21 [2 favorites]

There's other formulations of progesterone you can take that's meant for heavy bleeding/HRT. LUPANETA/Aygestin is 5mg of the same thing in Camilla, and prescribed for heavy bleeding, so there's a huge range in how much you can take. I've taken TXA and while it reduced my bleeding 20-40%, it wasn't very predictable. Maybe it worked great but the next month not so much.
My MD warned not to take both, but that might be because of my age or whatever. Surgical methods are usually the most effective. Ablation or the uterine artery embolization mentioned above will have a more surefire result than pills. I'm just waiting for my "change of life" to kick in so I don't have to deal with any of it.
posted by fiercekitten at 10:21 PM on May 21

I had a hysterectomy a few months ago, for recent-onset heavy periods that turned out to be due to a pre-cancerous condition (that had in fact developed into very early-stage cancer by the time I had the procedure). I was 46, single, with no desire for children, so it seemed like a no-brainer to go for the hysterectomy rather than start trying implants and whatnot, with the spectre of cancer hanging over me.

As people have said, it's major surgery. Mine was laparoscopic, and I was feeling like myself again within a few days - but I still needed someone staying with me for the first week or so, I had six weeks off work, I didn't regain my normal energy levels for eight weeks, and I was on lifting restrictions for three months.

My body is still settling and adjusting, four months on. I'm very glad no longer to be dealing with nightmarishly long and heavy periods, and I don't think the loss of fertility is upsetting me, but I'm struggling with some of the physical consequences of the hysterectomy, which are turning out to be just as limiting in their own ways as the bleeding was. It's still comparatively early days, and there's every reason to think things will improve with time... but I'm very aware that right now, if they had not found cancer, I would be regretting my decision and wishing I had tried a less drastic option first. So if you're prone to self-recrimination, that might be a thing to keep in mind.
posted by ManyLeggedCreature at 2:24 AM on May 22 [2 favorites]

Response by poster: Wow, these answers are all so very helpful. I msged my dr about seeing an endocrinologist.
posted by bookworm4125 at 11:02 AM on May 22

I tried tranexamic acid last month for the first time and oooh boy what a difference. Had no side effects whatsoever and my period went from Carrie's prom levels of blood bath to polite trickle. Being able to sleep through the night without fear of drenching everything improved my mental health considerably, as did the prospect of not requiring constant iron infusions to deal with the anemia. I'd like to tell you that the second dose was just as effective but, of course, menopause is a bitch and this period seems to be MIA. Do see an endocrinologist if you can, and make sure you get your ferritin levels checked too (maybe also your B vitamins - you need B12 for your body to use and retain dietary iron and some medications strip it out of your system or make absorption difficult).
posted by ninazer0 at 3:49 PM on May 22

Seconding the endocrinologist consult, and labs. (A comprehensive iron panel, particularly; heavy bleeding leads to anemia and then anemia worsens already-heavy bleeding. If you're anemic, campaign for infusions.)

Ask to be tested for bleeding disorders. Heavy menstrual cycles are a sign of having a disorder, which can have system-wide effects at any age.
posted by Iris Gambol at 4:35 AM on May 23 [1 favorite]

Tranexamic acid was super helpful for my heavy periods. Before that, they were so heavy that I was regularly becoming anemic. The prescription reduced them to a much lighter flow and a shorter duration as well.

I can also vouch for ablation - I haven't had a period in several months now!
posted by cp311 at 5:00 PM on May 31