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

If you’re on a blood thinner and your periods have turned into a daily emergency, you’re not alone-and you’re not overreacting. About 70% of menstruating women taking anticoagulants experience heavy menstrual bleeding (HMB) that disrupts work, sleep, and confidence. It’s not a side effect you should just live with. The good news? There are real, effective ways to manage it without stopping your life-saving medication.

Why Blood Thinners Make Periods So Heavy

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. Normal menstrual bleeding affects 10% to 30% of women. On blood thinners? That jumps to nearly 7 in 10. Some women go from light flows to needing a pad change every 30 minutes. Others bleed through clothes, skip work for days, or end up in the ER.

What makes this worse is that most doctors don’t ask about it. A 2023 survey found that 68% of women on anticoagulants said their hematologist never brought up menstrual changes-even though 72% were struggling. That’s a gap in care that’s costing women their quality of life.

Which Blood Thinners Are Least Likely to Cause Heavy Bleeding?

Not all blood thinners are equal when it comes to periods. Research shows clear differences in how much they affect menstrual bleeding:

• Apixaban and dabigatran are linked to the lowest risk of heavy bleeding.
• Rivaroxaban carries the highest risk among the newer drugs (DOACs).
• Warfarin is unpredictable-some women handle it fine, others have severe bleeding.

A 2020 study in Blood Advances confirmed that switching from rivaroxaban to apixaban or dabigatran can reduce bleeding in many women. If you’re on rivaroxaban and your periods are unbearable, talk to your doctor about switching. You don’t need to suffer just because your clotting risk is low.

First-Line Treatments That Actually Work

The best part? You don’t have to stop your blood thinner to fix this. These treatments work alongside anticoagulants and are backed by clinical guidelines:

1. Levonorgestrel IUD (Mirena, Kyleena)

This small, T-shaped device releases progesterone directly into the uterus. It’s the most effective option for HMB on blood thinners. Studies show it reduces bleeding by 70% to 90% within 3 to 6 months. Many women report their periods becoming light or stopping completely. One woman on Eliquis (apixaban) wrote on Reddit: “After Mirena, my periods went from ER visits to nearly nonexistent.” It also lasts up to 5 years and doesn’t interfere with your anticoagulant.

2. Progestin Pills (Norethisterone)

The American Society of Hematology recommends a high-dose progestin regimen: 5 mg taken three times a day for 21 days, starting at the beginning of your period. This thickens the uterine lining and reduces flow. It’s not a long-term fix, but it’s great for short-term control-especially if you’re waiting for an IUD or can’t use hormones long-term.

3. Tranexamic Acid

This prescription pill helps blood clot in the uterus. Taken only during your period (usually 4 times a day for up to 5 days), it cuts blood loss by 30% to 50%. It’s safe to use with blood thinners, but timing matters. Don’t take it every day-only during bleeding. It’s not a hormone, so it doesn’t affect your cycle long-term. If you’ve tried pads, cups, and tampons with no relief, this is worth a try.

What Doesn’t Work (and What to Avoid)

Some common suggestions can make things worse:

• NSAIDs like ibuprofen or aspirin can reduce bleeding by 20% to 40% in some women, but combining them with blood thinners increases your risk of dangerous bleeding. Avoid unless your doctor specifically approves it.
• Skipping or reducing your blood thinner dose is extremely dangerous. Stopping even for a few days can raise your risk of a clot by five times. Don’t do it.
• Endometrial ablation (a procedure to burn off the uterine lining) works for many women-but it’s risky if you’re on blood thinners. It requires stopping anticoagulants temporarily, which brings back the clot risk. Only consider this as a last resort, and only with a hematologist and gynecologist working together.

Check for Iron Deficiency-It’s Common and Easy to Fix

Heavy bleeding drains your iron. If you’re tired all the time, dizzy, or have cold hands and feet, you might be anemic. A simple blood test for ferritin and hemoglobin can confirm it. Iron supplements are safe to take with blood thinners, and they can restore your energy fast. The National Blood Clot Alliance recommends all women on anticoagulants get checked for iron deficiency at least once a year-or sooner if bleeding is heavy.

How to Talk to Your Doctor

Most doctors aren’t trained to connect anticoagulants with menstrual bleeding. You have to lead the conversation. Here’s what to say:

• “My periods have gotten much heavier since I started [drug name]. I’m changing pads every hour and missing work.”
• “I’ve read that apixaban and dabigatran cause less bleeding than rivaroxaban. Can we consider switching?”
• “Can you refer me to a gynecologist who understands anticoagulant-related bleeding?”
• “Can I start tranexamic acid or get a levonorgestrel IUD while staying on my current blood thinner?”

Bring printed info from the American Society of Hematology or ACOG if your doctor seems unsure. You’re not asking for a favor-you’re asking for standard care.

What’s Changing in 2025

Finally, the medical community is catching up. In 2021, the International Society on Thrombosis and Haemostasis added menstrual bleeding to its official bleeding assessment tools. In 2024, ACOG updated its guidelines to include specific treatment pathways for anticoagulant-related HMB. By mid-2025, the American Society of Hematology and ACOG plan to release joint guidelines-finally giving doctors clear steps to follow.

Until then, you’re your own best advocate. If you’re bleeding heavily on a blood thinner, it’s not normal. It’s treatable. And you deserve to live without fear of leaks, exhaustion, or missed days.

Real Stories, Real Relief

One woman in Perth, on apixaban for a past blood clot, started bleeding so heavily she had to carry extra clothes to work. After switching from rivaroxaban to apixaban and getting a Kyleena IUD, her bleeding dropped 85%. She now runs marathons again.

Another woman in Sydney, on warfarin, started taking tranexamic acid only on her heaviest days. Her periods went from 8 days of soaking through to 3 days of light flow. She stopped needing iron infusions.

These aren’t rare cases. They’re the norm for women who speak up.