(There are many posts here about periods. But I never saw any with practical advice for what to do if your period is very heavy. So I thought I'd write one up while it's very fresh in my mind.)

After a bilateral PE, I was placed on Eliquis. Two days later, I had a period that was about three times heavier than my typical flow. (My periods are short but heavy as I slide into menopause at 47 years old.) I pre-emptively saw my OB-GYN and went on a progesterone-only pill (Slynd) because I knew I'd be traveling during my next period. Eliquis and Slynd were great, no side effects that I noticed.

Then my period started. It was normal for a couple of days, but very quickly I realized that this was probably 15-20x my normal flow. I had my hemoglobin levels checked while traveling and they were low-normal (11.7). I had them checked again when I was home, two days later, and they were 10. The urgent care PA recommended I go to the hospital, so I did. I was admitted, and the next day they got down to 7.2, which is thisclose to transfusion levels.

I was bleeding through an Ultra tampon and flooding a pad about every 30 minutes. I had clots that were 4-5 inches. It was rough.

They ended up stopping my Eliquis and giving me a lot of progesterone to stop the flow, and then I ended up being able to have an ablation to (hopefully) prevent this in the future. I've also had a couple of iron infusions. My hemoglobin has raised a little but will hopefully continue to increase.

I'd seen stuff about periods, and Eliquis was supposed to be the "better" med for them. I thought because I was on a BCP I would be fine. I wasn't fine!

Here's my advice for women starting Eliquis or other blood thinners:

  • Immediately check in with your OB-GYN. Get on their radar so if something happens, they're aware of your situation.
  • If it's appropriate for you medically, start a birth control pill (not estrogen-based, of course). I was actually planning to see if my hematologist is okay with it and quit if they said no. I can't even imagine what my flow would have been like without it!
  • If you're done having kids, you may end up with an ablation. To prepare for this, you could ask your GYN to do a uterine biopsy to check for cancer. Many providers dislike ablations because they can cover up cancer. I happen to have just had a pelvic CT and MRI so I could skip this step. But it can't hurt to do it in advance.
  • If you're not done having kids, consider being prepared for an IUD. Ask in advance for pain relief and something to relax you. It is not just "pressure," it is pain.
  • They may also tell you that you can stop your blood thinners during your period. This will definitely help, but check with your pulmonologist and hematologist before doing so.
  • Also make sure you have a baseline of your hemoglobin. Ask for a referral/order for a hemoglobin/hematocrit test to just have so you can go in after your period starts, if you start getting worried.
  • Trust your instincts. If it feels like you're losing too much blood, you very well might be. If your regular doctor won't see you, go to urgent care and ask for a blood test. You want to know how fast your levels are dropping.
  • Keep an eye on other possible symptoms -- rapid heart rate, insomnia, anxiety, tiredness, shortness of breath, dizziness. These can all signify the onset of anemia.
  • It seems many women have a rough first couple of periods and then it settles down. If I had taken this attitude and not been proactive, I could have ended up bleeding out. If it feels like too much, get checked!!

Headed to the hospital?

  • Stay hydrated. They'll want you to pee in a cup when you're being checked in. I drank three bottles of water and still couldn't pee. This, it turns out, is also a symptom of hemorrhagic shock, which I almost went into. So if that's the case for you, tell them.
  • Leave your meds and jewelry at home. They'll ask what meds you're on. Remind them as time passes which scheduled medications you're missing.
  • Bring stuff to entertain yourself, as well as chargers and a small extension cord.
  • Bring your own big tampons and pads. They kept offering me normal-sized menstrual pads, and I was like, "Those won't work. You need to call maternity and get me post-partum pads." No one did (they kept saying they would), but fortunately the bleeding slowed way down just before I ran out. But don't count on them. I was using Ultra tampons and overnight pads while wearing the Always overnight disposable period panties.
  • Be clear about how much you're bleeding and the need for privacy. When I went to the ER for my PE, I was on a gurney in the middle of the ED. That would have been a nightmare this time, for me and for everyone around me. When I was admitted, they gave me a private room, thank God. (Last time I was in a hallway with no privacy at all.)
  • More randomly: If you want to do something like shower, mention it to your nurse early in the day. They'll need to check with your doctor and get it cleared. Bring your own hairbrush, toothbrush, toothpaste, etc. You'll feel way more human if you can stay clean and neat.

I don't mean to scare anyone. But being aware and proactive let me seek treatment before things got really bad. It could have been so much worse. You must advocate for yourself! This situation isn't just a "complication" of your larger DVT/PE problem. It's a legitimate health emergency unto itself. Don't let anyone tell you otherwise.