What is the best birth control for heavy periods?

Periods can seriously suck. There are no two ways about it. They turn up uninvited (often when you reeeeally don’t want them to). They can ruin plans, make you feel terrible, and cost you money. 

The thing is, no two period stories are the same. Not only do the lengths of our cycles vary, but the amount we bleed differs too. You might be lucky enough to ‘enjoy’ light periods, or maybe you’ve opted for regular or semi-regular bleeds by taking hormonal birth control on tailored regimens. Or, you might have to deal with heavy periods, which, as no doubt you know, can be inconvenient at best, debilitating at worst. 

If you’re a heavy period sufferer, know that you’re not alone. Read on as we explain the official definition of a heavy period, a few tactics to control your periods (of course, if that is what you’d like to do), as well as the best birth control for heavy periods.

First things first, what is a heavy period?

Chances are, if you feel like your period is heavy; it probably is.

‘Menorrhagia’ is the official term for heavy/long menstrual bleeding. Another fancy clinical term for heavy periods is Heavy Menstrual Bleeding (HMB), and it’s largely defined as losing 80ml or more of blood per cycle(1,2). You know those mini travel shampoo and conditioner bottles you can take on planes? It’s almost the same size as one of these, so it’s hardly surprising that this could cause some discomfort.

However, you can also be diagnosed with HMB with a blood loss of 80mL or less if it interferes with your physical, emotional, social, and material (i.e. economic) quality of life(2).

A few more pointers that you may have menorrhagia include soaking through one or more pads or tampons every hour for several hours in a row, doubling up on pads to control your menstrual flow, or changing pads or tampons during the night(3).

How is period blood different from regular blood?

If you’ve ever questioned how the red stuff in your pants is different to what’s running through the rest of your body, then we’ve got you. Here’s the bloody breakdown:

• Endometrial cells: These cells make up the endometrium (our womb lining). This is probably the key factor that distinguishes ‘period blood’ from ‘normal blood’. You’re essentially releasing the tissue that was growing to support a baby(1).
  

• Immune cells: Lots of immune cells have been found in the endometrium (womb lining). Here they help to break down our womb lining, remodel it and repair it. So, when our womb lining sheds, we lose some of them too(4)(1).
  

• Vaginal fluid: Also known as ‘vaginal discharge’. Fluid found in our underwear a few days before our periods contains bacteria from the vagina and looks thick and cloudy (due to higher levels of progesterone). However, in the middle of our cycles, discharge tends to be runnier and clearer (due to higher levels of estrogen)(1,5,6).
  

• Red blood cells: The fancy name for these is ‘erythrocytes’. These are what give our periods their red color. Fun fact—people with very heavy periods may lose more red blood cells than their body can make; and because red blood cells carry iron, this can sometimes lead to anaemia which can then cause fatigue(1,7).

What are period blood clots?

While we’re here, let’s talk about heavy periods with blood clots—as it’s definitely something that people with heavy periods can grow pretty accustomed to. 

Our bodies are incredible things, and usually, increased menstrual blood flow will lead to your body producing more anti-coagulants to reduce blood clotting. However, sometimes your blood flow is too quick...and this can lead to some clotting seen in your period(8).

HMB is common—but that doesn’t make it okay

Even if it’s the first time you’ve heard the acronym, HMB is pretty common. 18-30% of total gynecologist appointments in the US are due to people suffering from HMB(2).

Whether you speak openly about your heavy periods or you prefer to keep them quiet, you may feel like the issue is still not taken seriously enough. HMB has knock-on impacts beyond just blood loss, for example links with iron-deficient anemia, which leads to fatigue. People with menorrhagia tend to report side effects like dysmenorrhea (painful periods), mood change, and a feeling that you’re losing more blood than usual as  ‘severe problems’ more often than the blood loss element.

Heavy periods are more than an ‘uncomfortable’ or ‘annoying’ part of being a person with a cycle—they can affect so much. The economic burden of heavy periods alone shows how much this narrative should change. 

The indirect cost tied to HMB  through days off work and other factors that impact quality of life(2) is estimated to be as high as ~ $12 billion. Not to mention the $1 billion(2) direct cost tied to HMB (e.g. tampon and sanitary pad purchases), which people with cycles have the joy of paying for.

The thing is, just because it’s common doesn’t mean we should put up with it. It shouldn’t just be accepted as part of being a person with a cycle.

How can I stop heavy periods?

Now let’s be clear, we don’t want to assume that everyone with HMB hates it. It’s personal preference after all, but we’re here for you if you’d like to lighten the load or stop your heavy periods entirely.

Stopping HMB starts with working out what’s causing it, as it can be due to an underlying condition including endometriosis, uterine fibroids, polycystic ovary syndrome (PCOS) or polyps(9,10). Often, a pelvic examination and/or ultrasound(11) will help to identify what’s behind a particular case of HMB.

Can birth control help with heavy periods?

Hormonal birth control can help to manage heavy periods(11), with combined birth control and the hormonal IUD  commonly used to control HMB(11), However, seeing as no two women with cycles are the same, when you join Tuune, we really get to know you before making any birth control recommendations.

Combined birth control helps with HMB because the estrogen and progestin within it work to thin the womb lining(12), which makes it more difficult for an egg to implant itself, reducing the likelihood of you getting pregnant. This means that when (or if) you take a break from your pill (i.e. you take a week off your hormonal birth control), the withdrawal bleed you have during the hormone-free interval will be much lighter since there is essentially ‘less to shed’(12).

Remember, although it may look and feel like one, the bleed you experience when taking hormonal birth control is a withdrawal bleed rather than a period. You can read all about what that means here.

So, what is the best birth control for heavy periods?

• A pill that contains the estrogen, Estradiol Valerate and the progestin, Dienogest has shown to be clinically successful for the treatment of HMB(12).
  

• Also, the hormonal IUD (a progestogen-only method) may be a successful treatment for HMB (menorrhagia). By reducing menstrual blood loss, it has shown to be more effective than some other medical treatments for HMB, helping to treat heavy periods for up to 5 years(13).

How birth control pill regimens can help with heavy periods

If you take hormonal birth control like the pill, you may have grown used to having a monthly or regular bleed (fun fact, this was partly down to the pope).

However, this isn’t actually medically necessary. AJOG (American Journal of Obstetrics and Gynecology) says this pattern of monthly withdrawal bleeding was originally introduced to mimic “naturalness” but also assure people with cycles that they’re not pregnant(14). Back in the day, they felt the monthly bleed was medically necessary to prevent adverse effects related to the accumulation of the endometrial (uterus) lining, but this has since been debunked(14).
It means that if you take birth control pills on a tailored regimen, i.e. extended (where you decrease the hormone-free interval) or continuous (where you skip the hormone-free interval entirely), you can reduce how often you bleed (14,15(15,16). Using combined hormonal birth control on a continuous regimen has shown to cause amenorrhea (when your bleeds stop) in 80-100% patients after 10-12 months of using the method(2).

Examples: Birth control methods for alleviating HMB via different regimens

1. Some pills e.g. Yaz are taken on a 24/4 regimen. You take hormone pills for 3 additional days in each cycle, which shortens the hormone-free period to 4 days (instead of 7).

2. Other newer pills, like Lo Seasonique (US), are taken on an  84/7 extended regimen. This means that you take hormone pills containing both an estrogen (Ethinyl Estradiol) and a progestin (Levonorgestrel) continuously for 84 days. Then you take low dose estrogen-only pills for 7 days. During these 7 days you may experience a withdrawal bleed (due to a sudden reduction of hormones in your body). This means that you will most likely only have a bleed 4 times a year(15).

3. Some combined hormonal birth control methods e.g. pills, patches, and rings can also be taken on tailored/continuous regimens to manage heavy periods.

To summarize…

Heavy periods don’t have to ruin your life. Thankfully, we no longer need to suffer just because we have a cycle—these days, there are lots of ways to help manage heavy periods.

If you feel like your heavy periods are stopping you from living your best life, chat to us. Your first step will be taking an online assessment, the Tuune 360, where we’ll ask you loads of questions about your birth control and medical history, your current conditions including heavy periods, as well as your well-being goals.

Then, you can have a hormone test to rule out any hormone-related conditions and connect with one of our top-notch gynecologists for you to talk through any concerns or ask questions. Once we get to know you, we’ll be able to look through all the birth control options out there to make a personalized recommendation based on what’s right for you.

Sound okay to you? We can’t wait to meet you.

Written by

Hermione Wright (she/her)

An NCTJ-qualified journalist, Hermione writes for national and local publications in addition to creating thought leadership for brands with a purpose. Passionate about telling the stories that matter, she helps our community make their own clued-up choices about their healthcare.

Medically reviewed by

Dr. Alejandra Elder Ontiveros, MD, PHD (she/her)

Ale is a PhysicianScientist with a doctoral degree in Development Biology and Embryology and is currently a Postdoctoral Scholar at UCSF. Ale believes that the union of academia and business can lead to transformative discoveries for women’s health.

Scientifically researched by

Hannah Durrant (she/her)

Hannah is a Biomedical Content Writer at Tuune, with a BSc in Biomedical Sciences from University College London. She is passionate about bringing together the scientific community and the general public by disseminating modern science via digestible, engaging and thought-provoking content.