Heavy Menstrual Bleeding on Blood Thinners: What Works and What to Ask Your Doctor

Imagine needing to change your pad or tampon every 30 minutes. Not because you’re having a particularly bad day, but because your body is reacting to a medication you need to stay alive. For many women on blood thinners, this isn’t rare-it’s normal. And yet, most doctors never ask about it.

Why Blood Thinners Make Periods Heavier

Blood thinners, also called anticoagulants, stop clots from forming in your veins and arteries. That’s life-saving if you’ve had a deep vein thrombosis, pulmonary embolism, or have atrial fibrillation. But they don’t know the difference between a clot in your leg and a clot in your uterus. When your period starts, your body tries to form clots to slow the bleeding. Blood thinners block that process. Result? Heavy, prolonged bleeding.

Studies show 66% to 70% of menstruating women on oral anticoagulants develop heavy menstrual bleeding (HMB). That’s more than double the rate in women not on these drugs. And it’s not just inconvenient-it’s exhausting. Women report leaking through products, carrying emergency changes everywhere, missing work, and avoiding social events. One woman on Reddit said she stopped going to the gym because she was scared of bleeding through her leggings.

Not all blood thinners are the same when it comes to periods. Research shows apixaban and dabigatran are linked to less heavy bleeding than rivaroxaban. Warfarin, the older blood thinner, also carries a high risk. If you started bleeding heavily after switching medications, that’s not a coincidence. It’s a signal.

What Heavy Menstrual Bleeding Looks Like

You don’t need a medical degree to know when your period is too heavy. Here’s what to watch for:

• Changing pads, tampons, or menstrual cups every hour or less
• Passing clots larger than a quarter
• Leaking through products onto clothes or bedding
• Feeling dizzy, tired, or short of breath (signs of anemia)
• Periods lasting longer than 7 days

If you’re doing any of these regularly, you’re not just "having a rough cycle." You’re losing too much blood. Over time, this can lead to iron deficiency anemia-something your doctor should check with a simple blood test. Yet, a 2023 survey found that 68% of women said their hematologist never asked about their periods after starting anticoagulants.

First-Line Treatment: Hormonal Options That Work

The good news? You don’t have to stop your blood thinner to fix this. There are safe, effective treatments you can use alongside it.

The levonorgestrel intrauterine system (IUD), like Mirena or Kyleena, is the most effective option. It releases a low dose of progesterone directly into the uterus, thinning the lining so less tissue sheds each month. Studies show it reduces bleeding by 70-90% within 3-6 months. Many women end up with very light periods-or none at all. One user on the r/anticoag subreddit said: "After getting Mirena while staying on Eliquis, my periods went from ER visits to almost gone in three months."

Other hormonal options include:

• Progestin implants (like Nexplanon)-inserted under the skin, last 3 years
• Progestin-only pills (taken daily)
• Depo-Provera shot (every 3 months)

All of these are safe to use with blood thinners. They don’t increase clot risk like combined estrogen-progestin pills might. In fact, the American Society of Hematology recommends them as first-line treatment.

Non-Hormonal Medications: Tranexamic Acid and NSAIDs

If you don’t want hormones, or can’t use them, there are two other options:

Tranexamic acid is a prescription pill you take only during your period-usually 3-4 times a day for up to 5 days. It helps your blood clot normally in the uterus without affecting clots elsewhere in your body. Clinical trials show it cuts menstrual bleeding by 30-50%. It’s safe with blood thinners as long as you don’t take it every day, only during bleeding.

NSAIDs like ibuprofen or naproxen can also help. They reduce bleeding by 20-40% by lowering prostaglandins-the chemicals that make your uterus contract and shed its lining. But here’s the catch: taking NSAIDs with blood thinners increases your risk of stomach bleeding. If you use them, stick to the lowest effective dose for the shortest time. Talk to your doctor before starting.

What Doesn’t Work (And Why)

Some women try to fix heavy bleeding by skipping doses of their blood thinner. That’s dangerous. Stopping or reducing your anticoagulant increases your risk of a new clot by up to five times. You might feel better for a few days, but you’re trading one crisis for a potentially deadly one.

Endometrial ablation-a procedure that burns off the uterine lining-is sometimes offered to women with HMB. But for those on blood thinners, it’s risky. Bleeding during or after the procedure can be severe. Most experts recommend it only as a last resort, and even then, only if you’re on a stable, low-risk anticoagulant and can temporarily switch to heparin for safety.

When to Switch Blood Thinners

If you’re on rivaroxaban and your bleeding is unbearable, switching to apixaban or dabigatran might help. It’s not guaranteed, but studies suggest the risk of heavy periods is lower with these drugs. You don’t need to stop anticoagulation entirely-you just switch medications under your hematologist’s supervision.

This isn’t a decision to make alone. Your hematologist and gynecologist need to work together. One might focus on preventing clots. The other on stopping bleeding. But both are treating the same person. Coordination matters.

What You Should Ask Your Doctor

Don’t wait for them to ask. Take control. Here’s what to say:

• "I’ve noticed my periods have gotten much heavier since I started [medication name]. Is this common?"
• "Can we check my iron levels? I feel constantly tired."
• "What are my options for reducing bleeding without stopping my blood thinner?"
• "Would switching to apixaban or dabigatran help?"
• "Can you refer me to a gynecologist who understands anticoagulant-related bleeding?"

If your doctor says, "It’s just a side effect, you’ll get used to it," find a new one. This isn’t normal. It’s treatable. And you deserve to live without fear of leaking through your clothes.

The Bigger Picture: Why This Is Ignored

Despite affecting up to 750,000 women in the U.S. alone, heavy bleeding on blood thinners isn’t in most clinical guidelines. A 2022 study called it a "major oversight." Only 22% of hematology clinics routinely screen for menstrual changes in women under 50.

But things are changing. The American Society of Hematology and the American College of Obstetricians and Gynecologists are working on joint guidelines expected in mid-2025. The National Blood Clot Alliance now recommends that all women be warned about this risk before starting anticoagulants.

It’s not just about periods. It’s about being seen. It’s about not having to choose between living and bleeding. If you’re on a blood thinner and your period is wrecking your life, you’re not alone. And you don’t have to suffer in silence.

Next Steps: What to Do Right Now

If you’re on a blood thinner and your period is out of control:

1. Track your bleeding for one cycle: note how often you change products, if you pass clots, and if you feel fatigued.
2. Ask your doctor for a blood test to check your iron and hemoglobin levels.
3. Request a referral to a gynecologist experienced in anticoagulant-related bleeding.
4. Ask: "Is switching to apixaban or dabigatran an option?" and "Can I try the Mirena IUD?"
5. If you’re not getting answers, seek a second opinion. This is treatable. You deserve relief.

Heavy bleeding on blood thinners isn’t something you just have to live with. It’s a known, common, and fixable problem. You’re not broken. Your body isn’t failing. The system just hasn’t caught up to you yet. But you can change that-with the right questions, the right care, and the right treatment.