7.1.2 Heavy menstrual bleeding


Choice	Drug
Formulary choices	Mirena® intrauterine device, releasing levonorgestrel 20 micrograms/24 hours
		or
		Tranexamic acid 500mg tablets
	or
	NSAID:
	Ibuprofen tablets 200mg, 400mg, 600mg; syrup 100mg/5ml
		or
		Naproxen tablets 250mg, 500mg
		or
		Oral Contraceptive, see section 7.3

Discuss hormonal and non-hormonal options and allow the woman to decide which option suits her best.
See NICE NG88 “Heavy menstrual bleeding” for more information.
A LNG-IUS (levonorgestrel-releasing intrauterine system) is the preferred first choice treatment by NICE, provided that long-term contraception is acceptable (anticipated minimum use of 12 months).
LNG-IUS should always be prescribed by brand name. See MHRA for further information.
IUS insertions should be performed by trained healthcare staff who are regularly updated and who perform frequent insertions (recommendation is 12 or more per year).
A NSAID may be preferred to tranexamic acid where dysmenorrhoea is also a factor.

There are concerns that mefenamic acid is more likely to cause seizures in overdose than other NSAIDs; mefenamic acid has a low therapeutic window which increases the risk of accidental overdose.