A 40-year-old woman with regular cycles complains of heavy menstrual bleeding causing anaemia (haemoglobin 9.8 g/dL). Pelvic ultrasound and endometrial biopsy are normal. Which single medical intervention provides the greatest reduction in menstrual blood loss?

• A Tranexamic acid during menses
• B Levonorgestrel-releasing intrauterine system ✓
• C Combined oral contraceptive pill
• D Mefenamic acid during menses

Explanation

The levonorgestrel-releasing intrauterine system reduces menstrual blood loss by roughly 70 to 90 percent and is the most effective medical therapy for heavy menstrual bleeding, often rendering periods scanty or absent. Tranexamic acid reduces loss by about 40 to 50 percent, NSAIDs such as mefenamic acid by about 20 to 30 percent, and combined oral contraceptives by around 40 percent. NICE guidance recommends offering the LNG-IUS first line when long-term treatment is acceptable to the woman.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.