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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

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.



  • 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.