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Home Formulary 7.0 Contraception, Gynaecology and Urinary Tract Disorders 7.1.2 Heavy menstrual bleeding

7.1.2 Heavy menstrual bleeding

ChoiceDrug
Formulary choicesLevonorgestrel 20micrograms/24 hours intrauterine system:

Benilexa® one handed 20micrograms/24 hours intrauterine delivery system, or

Levosert® 20micrograms/24 hours intrauterine system, or

Mirena® 20micrograms/24hours intrauterine device

Or
Tranexamic acid 500mg tablets
Or
NSAID:

Ibuprofen tablets 200mg, 400mg

or

Naproxen tablets 250mg, 500mg

Or

Oral Contraceptive (see 7.3 )

Prescribing Notes

  • Prescribe as per NICE NG88, see also NICE CKS: Menorrhagia. Treatments should be tailored to individual choice.
  • A levonorgestrel-releasing intrauterine system (LNG-IUS) 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 healthcare staff who are fully trained in the technique, 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.

Cautions

  • Mefenamic acid is not listed as a formulary choice. There are concerns that mefenamic acid is more likely to cause seizures in overdose than other NSAIDs; mefenamic acid has a narrow therapeutic window which increases the risk of accidental overdose.

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