Managing Heavy Menstrual Bleeding While on Blood Thinners: What Works and What Doesn’t

If you’re a woman taking blood thinners and your periods have suddenly become unbearable-soaking through pads every hour, leaking onto clothes, or leaving you exhausted and anemic-you’re not alone. And you’re not imagining it. About 70% of menstruating women on anticoagulants experience heavy menstrual bleeding (HMB) that’s severe enough to need medical help. Yet, most doctors never ask about it. This isn’t just inconvenient. It’s a real health issue that can make you miss work, avoid social events, and live in constant fear of public accidents. The good news? There are proven ways to manage it without stopping your blood thinner.

Why Blood Thinners Make Periods So Much Heavier

Blood thinners-like warfarin, apixaban, rivaroxaban, and dabigatran-work by slowing down your blood’s ability to clot. That’s great for preventing strokes or clots in your legs. But it also means your uterus can’t stop bleeding as efficiently during your period. Normally, 10-30% of women have heavy periods. On anticoagulants? That jumps to nearly 7 out of 10. A 2022 study in Blood found that two-thirds of women saw their bleeding get worse within months of starting these medications. And it’s not just a minor annoyance. Women report changing pads every 30 minutes, carrying emergency supplies everywhere, and skipping work for days at a time.

The Hidden Risk: Skipping Your Blood Thinner

It’s tempting to cut your dose or skip pills when your period is awful. But that’s dangerous. Stopping or reducing your anticoagulant-even for a few days-can raise your risk of a life-threatening blood clot by up to five times. That’s not a guess. It’s from Dr. Bethany Samuelson Bannow’s research at Oregon Health & Science University. The goal isn’t to stop the bleeding by stopping the medication. It’s to manage the bleeding while keeping you protected from clots. That’s why treatment needs to be smart, not desperate.

First-Line Treatment: Hormonal Options That Work

The most effective way to reduce heavy bleeding while staying on blood thinners is with hormonal therapy. These don’t interfere with your anticoagulant-they work alongside it.

• Levonorgestrel IUD (Mirena, Kyleena): This small device releases progesterone directly into the uterus. Studies show it cuts menstrual blood loss by 70-90% within 3-6 months. Many women end up with light spotting or no periods at all. One woman on Eliquis posted on Reddit: “After getting Mirena, my ER visits stopped. My periods became nearly nonexistent.”
• Subdermal implant (Nexplanon): A tiny rod placed under the skin of your arm. It releases progestin and can reduce bleeding significantly, though some women have irregular spotting at first.
• Oral progestins: High-dose norethisterone (5 mg three times a day for 21 days) is recommended by the American Society of Hematology. It’s taken only during your period week and can cut bleeding by half in many cases.
• Combined hormonal birth control: Pills, patches, or rings with estrogen and progestin are safe to use with most blood thinners and can make periods lighter and more predictable.

Tranexamic Acid: A Non-Hormonal Option

Tranexamic acid is a pill you take only during your period. It helps your blood clot better locally in the uterus without affecting your overall clotting system. Clinical trials show it reduces menstrual bleeding by 30-50%. You start taking it when your period begins and keep it up for up to 5 days. It’s not a daily medication, so it doesn’t add long-term side effects. But it must be timed right-take it too early or too late, and it won’t help. Talk to your doctor about when to start it based on your anticoagulant schedule.

What About NSAIDs Like Ibuprofen?

Ibuprofen and other NSAIDs can reduce menstrual flow by 20-40% in some women. But here’s the catch: they also thin blood a little. Taking them with anticoagulants can increase your bleeding risk, especially if you’re already prone to heavy periods. It’s not off-limits, but it’s not a first choice. If you want to try it, use the lowest effective dose for the shortest time. Don’t combine it with aspirin unless your doctor says it’s safe. For most women on blood thinners, hormonal options are safer and more effective.

When Surgery Might Be Considered

Endometrial ablation-a procedure that destroys the lining of the uterus-is highly effective for heavy periods in women not on anticoagulants. But for those taking blood thinners? It’s risky. You need to stop your anticoagulant before surgery, which raises your clot risk. Even with bridging therapy (temporary heparin injections), the chance of bleeding complications is higher. Most experts recommend saving this option only for women who’ve tried all other treatments and don’t plan to have children. ACOG advises that you must continue using birth control after ablation, because pregnancy after the procedure can be dangerous.

Iron Deficiency Is Common-And Treatable

Heavy bleeding drains your iron. Many women don’t realize they’re anemic until they’re dizzy, pale, or out of breath climbing stairs. The National Blood Clot Alliance recommends all women on anticoagulants with HMB get tested for iron levels and anemia. If you’re low, iron supplements (oral or IV) can help restore energy and prevent long-term damage. Don’t wait for symptoms to get bad. Ask for a ferritin blood test-it’s the best way to see if your iron stores are running low.

Why So Many Women Are Left Behind

Here’s the frustrating part: most hematologists don’t ask about your periods. A 2023 survey by the National Blood Clot Alliance found that 68% of women said their hematologist never brought up menstrual changes after starting blood thinners. Meanwhile, 72% of those women had bleeding problems. This gap in care is systemic. There are no official guidelines yet requiring doctors to screen for HMB after starting anticoagulants. But that’s changing. The American Society of Hematology and ACOG are working on new joint guidelines expected in mid-2025. In the meantime, you need to speak up. If you’re on a blood thinner and your period is overwhelming, say so. Bring this article. Ask for a referral to a gynecologist who understands anticoagulation.

Which Blood Thinners Carry the Least Risk?

Not all anticoagulants are equal when it comes to bleeding. Research shows apixaban and dabigatran are linked to lower rates of heavy menstrual bleeding than rivaroxaban. Warfarin has a higher risk than newer drugs too. If you’re newly starting anticoagulation and have a history of heavy periods, talk to your doctor about choosing the safest option for you. If you’re already on rivaroxaban and struggling, switching to apixaban might help. It’s not a guaranteed fix, but it’s a real possibility worth exploring.

What to Do Next

1. Track your bleeding: Use a period app or journal. Note how often you change pads, if you pass clots, if you leak, and how tired you feel.

2. Ask for an iron test: Request a ferritin and hemoglobin blood test. Don’t wait until you’re faint.

3. Request a referral: Ask your hematologist for a gynecologist who works with anticoagulated patients.

4. Discuss hormonal options: Bring up the levonorgestrel IUD, implant, or oral progestins. These are safe and effective.

5. Don’t stop your blood thinner: Even if your period is awful, never skip or reduce your dose without medical advice.

Real Talk: You’re Not Overreacting

If you’ve ever cried in a bathroom because you soaked through your pants, or canceled plans because you didn’t know if you’d make it home, you’re not being dramatic. This is a real, documented problem affecting hundreds of thousands of women. You deserve care that sees the whole picture-not just your clot risk, but your quality of life too. The tools to help you exist. You just have to ask for them.