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

Jan, 27 2026

When you start taking a blood thinner-whether it’s for a blood clot, atrial fibrillation, or another condition-you’re told about the big risks: strokes, clots, internal bleeding. But no one talks about your period.

Yet for women of reproductive age, heavy menstrual bleeding (HMB) is one of the most common side effects of blood thinners. In fact, about 70% of menstruating women on oral anticoagulants experience bleeding so heavy it disrupts their lives. That’s not rare. That’s the norm. And most doctors don’t ask about it.

You might be changing pads or tampons every 30 minutes. You might be leaking through your clothes. You might be skipping work, avoiding social plans, or carrying emergency changes in your bag. If this sounds familiar, you’re not alone-and you’re not imagining it. This isn’t just "normal period stuff." It’s a medical issue tied directly to your medication.

Why Blood Thinners Make Periods Heavier

Blood thinners, also called anticoagulants, work by slowing down your body’s ability to form clots. That’s great when you’re trying to prevent a dangerous clot in your lung or brain. But it also means your uterus can’t stop bleeding as efficiently during your period.

Normally, about 10% to 30% of women experience heavy periods. But when you start a blood thinner? That number jumps to 66%-70%. A 2022 study in Blood found that two out of every three women had abnormally heavy bleeding within months of starting anticoagulant therapy. And the worst part? Many women had never had heavy periods before. This wasn’t a pre-existing issue-it was caused by the drug.

It’s not just about volume. It’s about disruption. Women report having to plan their entire day around their period. One woman on Reddit said she stopped going to the gym because she was afraid of leaking. Another missed five days of work each month. A third said she cried in the bathroom because she didn’t have enough pads to get through the day.

This isn’t "minor bleeding." The National Blood Clot Alliance calls it "patient-relevant bleeding"-meaning it doesn’t kill you, but it ruins your life.

Which Blood Thinners Cause the Most Bleeding?

Not all blood thinners are the same when it comes to menstrual bleeding. Research shows some are much more likely to cause heavy periods than others.

Among the direct oral anticoagulants (DOACs), rivaroxaban is linked to the highest risk of HMB. Studies show women on rivaroxaban are significantly more likely to need medical help for bleeding than those on other DOACs.

On the other end of the spectrum, apixaban and dabigatran carry a lower risk. That doesn’t mean they’re safe-many women still experience heavy bleeding on these drugs-but the odds are better.

Warfarin, the older blood thinner, also causes heavy periods, but because it’s harder to control and requires frequent blood tests, many doctors now switch patients to DOACs. Still, even with newer drugs, bleeding risk remains high.

If you’re on rivaroxaban and your periods have become unbearable, talk to your hematologist about switching. It’s not a sign you’re being difficult. It’s a sign you’re being smart.

First-Line Treatments: Hormonal Options That Work

The good news? You don’t have to suffer. There are safe, effective treatments that won’t interfere with your blood thinner.

The most powerful option is the levonorgestrel intrauterine system-better known as the Mirena or Kyleena IUD. This small device releases a low dose of progesterone directly into your uterus. It doesn’t affect your blood thinner. It doesn’t increase clot risk. And it works.

Studies show the levonorgestrel IUD reduces menstrual bleeding by 70% to 90% within 3 to 6 months. Many women report their periods becoming light or stopping entirely. One woman on the r/anticoag subreddit said: "After getting Mirena while staying on Eliquis, my periods went from ER visits to nearly nonexistent. I got my life back."

Other hormonal options include:

• Subdermal implants (like Nexplanon)-also progesterone-based, effective for reducing bleeding
• Progestin-only pills-taken daily, can help regulate flow
• High-dose progestin therapy (norethisterone 5 mg three times daily for 21 days)-recommended by the American Society of Hematology for acute control

Combined estrogen-progesterone birth control (pills, patch, ring) is also an option for women who don’t have contraindications to estrogen. These can reduce bleeding by 40%-60% and are safe to use alongside most anticoagulants.

Important: Don’t stop your blood thinner to start hormonal therapy. These treatments work together. Your hematologist and gynecologist can coordinate care.

Non-Hormonal Options: Tranexamic Acid and NSAIDs

If you don’t want hormones-or can’t use them-there are other choices.

Tranexamic acid is a prescription medication that helps your blood clot locally in the uterus. You take it only during your period-usually 1-2 tablets every 8 hours for up to 5 days. Clinical trials show it reduces bleeding by 30% to 50%. It’s not a long-term fix, but it’s great for managing acute episodes.

One caveat: Take it at the same time every day during your period. Don’t mix it with NSAIDs unless your doctor says it’s safe. Timing matters.

NSAIDs like ibuprofen or naproxen can reduce menstrual bleeding by 20%-40%. But here’s the catch: they also thin the blood. Taking them with anticoagulants can increase bleeding risk. If you use NSAIDs, stick to the lowest effective dose and avoid long-term daily use. Ask your doctor if it’s safe for you.

Aspirin? Skip it. It’s a blood thinner too. Adding it to your regimen is like pouring gasoline on a fire.

What Doesn’t Work (and What’s Dangerous)

Some women try to fix heavy bleeding by skipping or cutting back on their blood thinner. That’s a dangerous mistake.

Stopping your anticoagulant-even for a few days-can increase your risk of a recurrent blood clot by up to five times. That’s not a gamble worth taking. You’re trading one risk for a much bigger one.

Another common mistake: assuming endometrial ablation is safe. This procedure burns or removes the uterine lining to stop bleeding. It works well for many women-but not for those on blood thinners. The risk of uncontrolled bleeding during or after the procedure is too high. Even if you’re told you’re "a good candidate," your hematologist must approve any surgery. Bridging with heparin adds complexity and risk.

And don’t wait for your doctor to bring it up. Studies show 68% of hematologists never ask female patients about menstrual changes after starting anticoagulation-even though 72% of those women have problems.

What to Ask Your Doctor

If you’re on a blood thinner and your period has changed, here’s what to say:

• "My periods have gotten much heavier since I started [drug name]. Is this expected?"
• "What are my options for reducing bleeding without stopping my anticoagulant?"
• "Can we switch to a different blood thinner with lower bleeding risk?"
• "Can you refer me to a gynecologist who understands anticoagulant-related bleeding?"
• "Should I be tested for iron deficiency or anemia?"

Bring this data with you: "I’m changing pads every 30 minutes. I’ve missed work. I’m exhausted. I think this is related to my medication."

Doctors are trained to think about strokes and clots. They’re not always trained to think about periods. You have to be the advocate for your own body.

Iron Deficiency Is Common-and Treatable

Heavy bleeding over time drains your iron. You might not feel it right away, but symptoms like fatigue, dizziness, shortness of breath, or cold hands aren’t just "being tired." They’re signs of anemia.

The National Blood Clot Alliance recommends that all premenopausal women on anticoagulants get a simple blood test for ferritin and hemoglobin. If your iron is low, you’ll need supplements. Oral iron can cause stomach upset, so some women need IV iron-especially if bleeding is ongoing.

Treating anemia doesn’t fix the bleeding, but it helps you feel better while you work on the root cause.

The Bigger Picture: Why This Isn’t Being Fixed

Here’s the frustrating truth: there are no official guidelines for how to screen for heavy bleeding in women on anticoagulants. No checklist. No standard question. No training.

Only 22% of hematology clinics routinely ask about menstrual changes, according to a 2023 survey. That’s not negligence-it’s ignorance. The medical system hasn’t caught up to the reality that millions of women are on blood thinners, and most of them are still menstruating.

But change is coming. In 2024, the American Society of Hematology and the American College of Obstetricians and Gynecologists announced they’re developing joint guidelines for managing this issue. They’re expected to be released in mid-2025.

Until then, you’re on your own. And that’s unfair. But you’re not powerless.

Heavy periods on blood thinners are common. They’re treatable. And you deserve to live without fear, shame, or exhaustion.