Menorrhagia

Prescribing Notes:

• Discuss hormonal and non-hormonal options and allow the woman to decide which option suits her best.
• See NICE guideline NG88: Heavy menstrual bleeding for more information. The guidance also recommends the combined oral contraceptive pill as an option instead of tranexamic acid or a NSAID.
• NSAID may be preferred to tranexamic acid where dysmenorrhoea is also a factor.
• See the ‘Treatment of musculoskeletal pain’ pathway in the Musculoskeletal and joint diseases chapter of the formulary for more information on the prescribing of NSAIDs.
• Low dose norethisterone is not an effective choice for menorrhagia.
• Both combined hormonal contraception and tranexamic acid have effects on clotting, therefore prescribers should be aware that the effects of combining these medications on clotting are unknown.
• NSAIDs / tranexamic acid should be prescribed at an appropriate dose (see BNF) for at least 3 menstrual cycles. Treatment should be continued if patient benefit.
• Patients with menorrhagia and also with dysmenorrhoea should be prescribed NSAIDs in preference to tranexamic acid.
• Women prescribed a Levonorgestrel-releasing intrauterine device should be informed of potential changes to the bleeding pattern for the first 6 months and advised to persevere for at least 6 cycles to see the benefits of treatment.
• Levonorgestrel IUS should be prescribed by the brand name only.
• Lower dose Levonorgestrel-releasing intrauterine device (Kyleena) are less likely to improve heavy menstrual bleeding compared to a 52mg device (Levosert, Benilexa, Mirena) but could be considered in patients declining one of these methods.