This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
This study compared treatments for heavy periods. It found that most women treated with either a coil or oral medicines 10 years previously:
- had not had surgery for heavy bleeding
- had similar improvements in their quality of life.
The findings highlight the long-term impact of heavy menstrual bleeding on women’s lives, and raise awareness that treatments are effective. The researchers hope the study will encourage clinicians to listen to women with empathy and communicate openly about options.
More information about heavy periods can be found on the NHS website.
The issue: what is the best treatment for heavy periods?
Heavy menstrual bleeding can affect women’s work, social life, relationships and emotional wellbeing for decades. According to Women’s Health Concern, 1 in 3 women describe their periods as heavy, but only about 1 in 20 consult their GP about it.
For some women, heavy periods are caused by an underlying health condition such as pelvic inflammatory disease (infection of womb, ovaries, fallopian tubes) or fibroids (non-cancerous growths in the womb wall). These women may need further tests and specific treatments. But for most others, heavy menstrual bleeding has no obvious cause.
Women whose heavy bleeding has no obvious cause may be treated with a hormone-releasing coil fitted in their womb. Alternatively, they may be given oral medicines such as combined hormonal contraception, non-steroidal anti-inflammatory drugs or tranexamic acid. If heavy bleeding continues, women can consider surgery to destroy the lining of the womb (endometrial ablation) or to remove the womb (hysterectomy).
From 2005-2009, the original ECLIPSE trial investigated whether the coil or oral medicines were more effective at reducing the impact of heavy menstrual bleeding. The study included 571 women from 63 UK general practices. Both treatments were effective. At 2 years, the impact of heavy menstrual bleeding was less for women who received the coil, but by 5 years, the impact was similarly reduced in both groups.
Heavy menstrual bleeding can continue for many years. Despite this, information about how these treatments compare in the long-term is limited.
What’s new?
10 years after the ECLIPSE trial, researchers asked the original participants to complete a questionnaire. 206 women answered questions about their periods, symptoms and quality of life. In addition, 36 of the women were interviewed in depth; their average age was 54. Most (82%) were white.
The responses 10 years after the original trial highlight the long-term impact of heavy periods. Most women had either had surgery, were through the menopause or were continuing with the coil or oral treatment.
At 10 years, of the 206 respondents:
- half (103) had reached the menopause
- 60 women had had surgery
- 88 were using the coil; either alone (56) or in combination with oral treatments (32)
- 89 women had stopped all treatments for heavy menstrual bleeding.
Some women retained their coil after the menopause because they were concerned that their bleeding would return, or because they wanted its ongoing hormonal effects. None of those who were through the menopause continued to take oral treatments.
Surgery was similarly likely, whether women initially had the coil or oral treatment. But both treatments remained effective for many women. At 10 years, compared to before starting treatment, women had:
- improved quality of life
- improved pain, mental health and discomfort.
In the original trial, at 2 years, women using the coil reported greater improvements in quality of life. At 10 years, quality-of-life improvements were maintained for the 88 women still using coil or oral treatments.
Women’s decisions about treatment were influenced by changes in their personal relationships and working lives, and their requirements for contraception. They were concerned about the impact of treatment on their fertility, health, and as a cause of early menopause.
What impact do heavy periods have on everyday life?
Women in the study highlighted anxiety, embarrassment, and the disruption to their lives caused by heavy periods before they started treatment. They described unpleasant sensations of heavy blood flow and the release of clots. Several bled through products onto clothes and bedding. One said: ‘Having to throw clothes away because there was so much blood on them . . . wearing two pads and a tampon when I went to bed at night and then I would get up and it would be completely flooded.’ Many planned social activities around their periods.
Not speaking about periods during childhood led to embarrassment later: ‘If you’re not discussing it with your mum and your sister, the prospect of discussing it with friends or perfect strangers is just ...never going to happen is it?’ Heavy bleeding could affect relationships, work and mental health, often leading to anxiety and a lack of confidence: ‘it always made me really anxious I would get very tearful.’
More than half the women interviewed had positive interactions with clinicians, even if they had to try multiple treatments. They felt informed and knew what to expect from treatment. But some felt ‘fobbed off’ and were told the bleeding was normal: ‘I had asked . . . would I be able to have that? And it was always, “loads of women have fibroids, you just have to kind of put up with it”.’
Why is this important?
Treatments from GPs were effective for most women, with oral medicines and coils improving quality of life 10 years later. Up to 1 in 3 women treated initially in primary care, went on to have surgery to reduce heavy bleeding.
These findings could help doctors and women make shared decisions about managing heavy menstrual bleeding. In the initial consultation, women need a clear explanation when there is no obvious cause for the problem, or if tests would help. They need to know that treatment may need to be changed over time. When starting treatment, it is helpful to arrange follow-up to discuss progress.
By 10 years, most women’s periods had stopped, either because of menopause or surgery for their bleeding. Therefore, only small numbers could provide data for the original main trial outcome (impact of current menstrual bleeding). The researchers say the scale and long time-frame of this study are unprecedented, in spite of the large drop-out rate.
What’s next?
Many women suffer in silence. Better understanding that heavy menstrual bleeding is not normal if it interferes with everyday activities could encourage them to seek help. The researchers also call for initiatives to raise awareness among clinicians of the impact heavy periods can have on women, and the effectiveness of treatments.
Black women are more likely than others to develop fibroids at a younger age. Further research among women from Black and ethnic minority communities is needed.
You may be interested to read
This is a summary of: Kai J, and others. Rates of medical or surgical treatment for women with heavy menstrual bleeding: the ECLIPSE trial 10-year observational follow-up study. Health Technology Assessment 2023; 27.
Information about heavy periods for women.
Information about heavy periods from the Royal College of General Practitioners.
A Research Outreach article on the ECLIPSE trial.
Patients and members of the public involved in the ECLIPSE trial helped to produce a podcast.
A tool from NHS England to help women prepare for consultations about heavy menstrual bleeding.
Funding: This study was funded by the NIHR Health Technology Assessment.
Conflicts of Interest: One of the study authors received funding from a medical device company. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
