7.1.2 Heavy menstrual bleeding
|Mirena® intrauterine device, releasing levonorgestrel 20 micrograms/24 hours|
|Tranexamic acid 500mg tablets|
|Ibuprofen tablets 200mg, 400mg, 600mg; syrup 100mg/5ml|
|Naproxen tablets 250mg, 500mg|
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.