MANAGE: Heavy periods (antiinflammatories)

Challenging periods are not just about the pain, but the actual volume of bleeding

For many people, managing periods isn't just about discomfort — it's about being able to function at school, work, or with whānau. Using the right medication at the right time can reduce pain, blood loss, iron deficiency, and even avoid more invasive treatments down the line.

First-Line Strategy: Anti-inflammatories + Tranexamic Acid

1. Strong Anti-inflammatory (NSAID):

• Ibuprofen slow-release 800mg once or twice per day
• OR Naproxen 500mg twice daily
• OR Naproxen SR 1000mg once daily

( Note: Mefenamic acid / Ponstan is excellent too but unfunded in NZ and needs to be taken 3 times per day.  Ibuprofen 400mg to be taken three times a day is the dose available for purchase over the counter)

2. Tranexamic acid (TXA)

500mg — take 2 tablets three times a day during your period (but sometimes even 2 tablets once can improve heavy bleeding).  

How They Work:

• NSAIDs reduce inflammation in the uterus, which helps ease cramping and pain — and also reduces bleeding. Inflammation is part of the reason the lining sheds, so reducing this can make periods lighter.
• Tranexamic acid helps your blood clot better by stabilizing clots in the womb lining. This means less blood loss and often less pain.

Used together, they can reduce bleeding by up to 40% and help thin the lining for the next cycle.  Improvement can be seen over 3 cycles when used consecutively

How to Take:

1. Start the day before your period if you can — or as soon as you feel it coming. Once pain and bleeding are in full swing, it’s harder to settle them down.Take after food to protect your stomach.
2. It doesn’t matter if your period comes a couple of days late, or even if it doesn’t show up — a few extra days of these meds is not harmful.
3. If you're using a long-acting NSAID, you don't need to remember multiple doses — making it easier and more practical.
4. Benefits Beyond Just Bleeding - Ease of use with long-acting versions (SR) means fewer tablets, fewer missed doses.

These meds are a non-hormonal option, which may be important for:

• Teenagers who may want to avoid the pill
• Perimenopausal women with heavy bleeding who wish to avoid hormonal IUDs or surgery
• Preserving iron levels is vital for mood, energy, brain function — reducing bleeding can help avoid the need for iron tablets or infusions.
• For some, this can be an effective alternative to the Mirena or hysterectomy.

Tailoring to the Individual

Everyone responds differently. Some people find ibuprofen or celecoxib works best (fewer side effects, better symptom control). Others find Ponstan (mefenamic acid) more effective — it has better action at uterine prostaglandin receptors, but the need for 3x daily dosing and lack of funding in NZ can make it harder to use.

If symptoms aren’t improving with one NSAID, it’s reasonable to trial a different one — some people genuinely tolerate and respond better to one over another.

Side Effects — And How to Minimise Risk

• NSAIDs can irritate the stomach, especially on an empty tummy.
• If you're using them for more than a few days in a row or have a history of reflux or ulcers, you can add a proton pump inhibitor (PPI) like omeprazole (Losec) for protection.
• Sometimes these medications can prolong the length of your period (but at a much light level - particularly I see this with tranexamic acid)
• Tranexamic acid has a very small risk of blood clots, but this is rare. It's not the same as hormonal contraceptives, and many people can take it safely even if they can’t take estrogen.

Myth-Busting: Antidepressants and Period Medications

🧠 "Can I take these if I’m on antidepressants (like an SSRI)?"  SSRIs/SNRIs can slightly reduce how well your platelets stick together, so there’s a tiny increased risk of bleeding, especially in the gut.  NSAIDs can also irritate the stomach, and that’s where the concern comes in — but it’s very low risk, especially for short courses.

Context Is Everything

The goal isn’t to throw medication at every period — it’s to support you to live the life you want.  If your periods are heavy, painful, or interfering with school, work, or mood, it’s absolutely worth using the tools available to:

• reduce pain
• prevent iron loss
• improve quality of life
• avoid more invasive treatment later on
• You don’t need to “just put up with it.”

Symptoms that are not  improving with the medications above are a sign that a medical review is recommended