| Choice | Drug | Dosage |
|---|---|---|
| Formulary choices | Mirena® intrauterine device, releasing levonorgestrel 20 micrograms/24 hours | Dose: Insert into uterine cavity within 7 days of onset of menstruation; effective for 5 years |
| or | ||
| Tranexamic acid 500mg tablets | Dose: 1g three times daily on days of heavy bleeding (for up to four days) | |
| or | ||
| NSAID: | ||
| Ibuprofen tablets 200mg, 400mg, 600mg; syrup 100mg/5ml | Dose: Initially 300–400mg 3–4 times daily; increased if necessary to max 2.4g daily; maintenance dose of 600mg–1.2g daily may be adequate | |
| or | ||
| Naproxen tablets 250mg, 500mg | Dose: 500mg initially, then 250mg every 6-8 hours as required; max dose after first day 1.25g | |
| or | ||
| Oral Contraceptive | See Section 7.3 |
Prescribing Notes
- 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.
Cautions
- 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.