To stop heavy menstrual bleeding with clots, several treatment options are available depending on the cause, severity, and individual health factors:

Medications

• Tranexamic acid : This antifibrinolytic medication helps reduce menstrual blood loss by preventing blood clots from breaking down too quickly, thereby reducing bleeding and clots. It is taken during menstruation, typically 3-4 times a day for 3-5 days. It can reduce bleeding by nearly half but does not shorten the duration of bleeding or relieve pain

• Nonsteroidal anti-inflammatory drugs (NSAIDs) : Drugs like ibuprofen or naproxen reduce prostaglandin levels in the uterine lining, which can decrease bleeding and alleviate cramps. They reduce blood loss by about 25% but do not reduce bleeding days

• Hormonal therapies :
  • Combined oral contraceptives (COCs) : These pills stabilize the uterine lining, reducing thickness and bleeding. They can be taken continuously to avoid periods or cyclically to regulate bleeding. They also help with pain and reduce bleeding by about a third

* **Progestogen-only options** : These include progestogen-only pills, injections, implants, or hormonal intrauterine devices (IUDs). They thin the uterine lining, leading to lighter or absent periods and are effective in reducing heavy bleeding

* **Gonadotropin-releasing hormone (GnRH) agonists** : Used short-term to reduce estrogen and stop the uterine lining from thickening, helpful before surgery or in fibroid-related bleeding

• Iron supplements : Recommended if anemia develops due to heavy bleeding

Procedures (if medication is ineffective)

• Dilation and curettage (D &C): Scraping or suctioning the uterine lining to control bleeding and diagnose causes like polyps or fibroids

• Endometrial ablation : Destroying the uterine lining using heat, laser, or radiofrequency to reduce or stop periods. Not suitable for women planning future pregnancies

• Myomectomy or uterine artery embolization : Surgical removal or blood flow blockage of fibroids causing heavy bleeding

• Hysterectomy : Removal of the uterus, considered a last resort

Supportive measures

• Stay hydrated to maintain blood volume during heavy bleeding

• Dietary adjustments to support iron levels may be helpful but are adjunctive

Summary

For heavy menstrual bleeding with clots, initial treatment usually involves medications such as tranexamic acid and NSAIDs to reduce bleeding and clot formation. Hormonal therapies like contraceptive pills or hormonal IUDs regulate and thin the uterine lining, further reducing bleeding. If medications fail, surgical options like D&C, endometrial ablation, or fibroid removal may be necessary. Iron supplementation is important if anemia develops. Always consult a healthcare provider to determine the best individualized treatment plan