1. Mirena

The levonorgesterl-releasing intrauterine system (LNG-IUS) is the preferred first choice treatment of menorrhagia – if the anticipated minimum use is 12months or less.

2. Tranexamic acid or NSAID or Combined Pill

When menorrhagia co-exists with dysmenorrhoea NSAIDs should be prescribed in preference to tranexamic acid.

Combine Oral Contraceptive (COC) is suitable for women who cannot or do not want NSAIDs

3. Norethisterone

15mg daily from day 5 to day 26 of the cycle

Alternatively long-acting progesterogen only injectables

4. If that doesn’t work…

  • one hormonal and one non-hormonal
  • Stop NSAIDs and/or tranexamic acid if no improvement within 3 cycles

…combine treatment

  • Combine NSAID with Tranexamic acid – particularly when pain a problem
  • Never combine Tranexamic Acid with Merena or COC
  • NSAIDs with COC
  • NSAIDs in combination with LNG-IUS (levonorgestrel intrauterine system = mirena)
  • IF pain and bleeding is this bad need to reconsider the cause and think about referral