Regarding heavy menstrual bleeding (HMB), the first-line pharmacological treatment recommended by NICE CG44 (updated 2018) for women who do not desire immediate fertility and have no structural pathology is:
- A Levonorgestrel-releasing intrauterine system (LNG-IUS 52 mg) ✓
- B Tranexamic acid 500 mg thrice daily during menstruation
- C Mefenamic acid 500 mg twice daily during menstruation
- D Combined oral contraceptive pill
Correct answer: A. Levonorgestrel-releasing intrauterine system (LNG-IUS 52 mg)
Explanation
NICE CG44 guidelines for HMB recommend the LNG-IUS 52 mg (Mirena) as the first-line treatment in the absence of structural pathology (and when fertility is not immediately desired) because it reduces menstrual loss by 80–97%, is highly cost-effective, and provides long-term (5-year) contraception. Tranexamic acid and NSAIDs are effective for non-hormonal management but are second-line per NICE. Combined OCP is an alternative but LNG-IUS has superior efficacy for HMB.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.