7.1.2 Heavy menstrual bleeding

ChoiceDrugDosage
Formulary choicesMirena® intrauterine device, releasing levonorgestrel 20 micrograms/24 hoursDose:
Insert into uterine cavity within 7 days of onset of menstruation; effective for 5 years
or
Tranexamic acid 500mg tabletsDose:
1g three times daily on days of heavy bleeding (for up to four days)
or
NSAID:
Ibuprofen tablets 200mg, 400mg, 600mg; syrup 100mg/5mlDose:
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, 500mgDose:
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.