Heavy Menstrual Bleeding on Blood Thinners: What You Need to Know and How to Manage It

Imagine having to change your pad or tampon every 30 minutes. Not just once in a while - every day during your period. You’re scared to leave the house. You miss work. You’re exhausted. And your doctor never asked you if your periods got worse since you started your blood thinner.

This isn’t rare. It’s happening to 70% of menstruating women on anticoagulants. That’s not a side effect you can ignore. It’s a major health issue that’s been overlooked for years. If you’re on a blood thinner and your periods have become unbearable, you’re not alone. And more importantly - there are real, effective ways to fix this without stopping your life-saving medication.

Why Blood Thinners Make Periods So Much Heavier

Blood thinners - also called anticoagulants - are designed to stop dangerous clots from forming. That’s why they’re prescribed after a blood clot, for atrial fibrillation, or after certain surgeries. But they don’t just stop clots where they’re dangerous. They also make it harder for your body to stop bleeding when it shouldn’t, like during your period.

Normally, about 10% to 30% of women have heavy menstrual bleeding. But once you start a blood thinner, that number jumps to 70%. A 2022 study in Blood found that two out of every three women on these medications had abnormally heavy periods within months of starting. And for many, it wasn’t just a nuisance - it was a life disruption.

Signs you’re dealing with heavy menstrual bleeding on blood thinners:

• Needing to change your pad, tampon, or menstrual cup every hour or less
• Leaking through products, even on heavy days
• Passing large blood clots (bigger than a quarter)
• Feeling dizzy, tired, or short of breath - signs of iron deficiency
• Having to plan your day around your period, carrying emergency supplies

Many women end up with iron deficiency anemia because of this. Your body loses so much blood that it can’t keep up with making new red blood cells. And if you’re already on blood thinners, your doctor might not even think to check your iron levels. A 2023 survey by the National Blood Clot Alliance found that 68% of women said their hematologist never asked about menstrual changes after they started their medication.

Not All Blood Thinners Are the Same

If you’re on a blood thinner and your periods are terrible, the problem might not be you - it might be the drug.

Research shows that different anticoagulants carry different risks for heavy bleeding. A 2020 study in Blood Advances found that women on apixaban (Eliquis) or dabigatran (Pradaxa) had significantly lower rates of heavy menstrual bleeding than those on rivaroxaban (Xarelto). Warfarin, the older blood thinner, also carries a high risk.

Why does this matter? Because switching might help - without stopping your protection against clots. If you’re on rivaroxaban and your periods are unbearable, talk to your doctor about switching to apixaban. It’s not a guarantee, but for many women, it’s a game-changer. One Reddit user on r/anticoag wrote: “Switched from Xarelto to Eliquis. My bleeding dropped by 60% in two cycles.”

Don’t switch on your own. But do ask: “Is there a different blood thinner that’s less likely to make my periods worse?”

The First-Line Treatment: Hormonal Therapy

The good news? You don’t have to choose between protecting yourself from clots and having a decent quality of life. There are treatments that work while you stay on your blood thinner.

The most effective option? Hormonal IUDs - specifically the levonorgestrel intrauterine system (LNG-IUD), like Mirena or Kyleena. This small device releases progesterone directly into your uterus. It thins the lining, so there’s less tissue to shed. Studies show it reduces menstrual blood loss by 70% to 90% within 3 to 6 months. Some women stop getting periods altogether.

And here’s the key: it’s safe with anticoagulants. No need to stop your blood thinner. No major surgery. Just a quick office procedure.

Other hormonal options:

• Subdermal implant (Nexplanon) - a tiny rod under the skin that lasts 3 years
• Progestin-only pills - taken daily
• Extended progestin regimens - like norethisterone 5 mg three times a day for 21 days, as recommended by the American Society of Hematology

Combined estrogen-progesterone pills can also work, but they’re not always safe for women with clotting risks. Your doctor will need to evaluate your personal risk before recommending them.

Tranexamic Acid: A Non-Hormonal Option

If you don’t want hormones, there’s another option: tranexamic acid. It’s a medication that helps your blood clot more effectively - right at the site of bleeding. It’s taken only during your period, usually two or three times a day for up to five days.

Studies show it cuts menstrual bleeding by 30% to 50%. It’s not as powerful as an IUD, but it’s a solid choice if you’re not ready for long-term hormonal treatment.

Important note: You can take tranexamic acid while on blood thinners. But timing matters. Don’t take it at the same time as your anticoagulant. Space them out by a few hours. Ask your pharmacist or doctor for the best schedule.

What About NSAIDs Like Ibuprofen?

You might think: “I’ll just take more ibuprofen.” But that’s risky.

NSAIDs like ibuprofen and aspirin can reduce bleeding by 20% to 40% in some women. But they also thin the blood. Taking them on top of your anticoagulant? That’s doubling down on bleeding risk. It’s not a safe long-term fix.

If you need pain relief during your period, acetaminophen (paracetamol) is safer. It doesn’t affect clotting. But it won’t reduce bleeding. So don’t rely on it to solve the problem - just for cramps.

What About Surgery?

Some women hear “endometrial ablation” and think it’s the answer. It’s a procedure that destroys the lining of the uterus. It works well - 80% to 90% of women see big improvements. But for women on blood thinners? It’s risky.

Because you can’t stop your anticoagulant before surgery without risking a life-threatening clot. The risk of bleeding during or after the procedure is too high. Even if you bridge with heparin, it’s complex and not always safe.

ACOG and the American Society of Hematology now recommend endometrial ablation only as a last resort - and only if you’ve tried and failed hormonal options.

Why This Is Still Overlooked

Here’s the uncomfortable truth: most doctors aren’t trained to ask about periods.

A 2023 survey of hematology clinics found that only 22% routinely check for heavy menstrual bleeding in women under 50. That’s not because they don’t care. It’s because there are no official guidelines - yet.

That’s changing. In 2021, the International Society on Thrombosis and Haemostasis added menstrual bleeding to its standard bleeding assessment tools. In 2024, ACOG updated its guidelines to specifically address anticoagulant-related heavy bleeding. And by mid-2025, the American Society of Hematology and ACOG plan to release joint guidelines.

But right now, you have to be your own advocate. If you’re on a blood thinner and your periods are wrecking your life, say something. Bring up the numbers: 70% of women on these drugs have this problem. Ask: “Has this been studied? What can we do?”

What You Can Do Right Now

Don’t wait for your doctor to bring it up. Take action.

1. Track your bleeding. Use a period app or journal. Note how often you change products, if you leak, if you pass clots, how long it lasts. Bring this to your appointment.
2. Ask for an iron panel. Check your ferritin, hemoglobin, and hematocrit. Iron deficiency is common and treatable.
3. Ask about switching anticoagulants. If you’re on rivaroxaban or warfarin, ask if apixaban or dabigatran could be safer for your periods.
4. Ask about the LNG-IUD. It’s the most effective, safest option for most women. It lasts 3-5 years. Insertion takes 10 minutes.
5. Ask about tranexamic acid. If you don’t want hormones, this is your best non-hormonal option.
6. Don’t skip doses. Stopping or reducing your blood thinner to manage bleeding increases your risk of stroke or clot by up to five times. That’s not worth it.

One woman on Reddit said: “I thought I had to live with this. Then I got the Mirena. My periods went from ER visits to nearly nothing. I got my life back.”

You deserve that too.