A 41-year-old woman has heavy regular menstrual bleeding for several months. Transvaginal ultrasound shows no fibroids, polyps, or adenomyosis, endometrial thickness is 9 mm, and coagulation screening is normal. She wants effective long-term treatment and is not seeking fertility. Which single intervention provides the greatest sustained reduction in menstrual blood loss?

• A Tranexamic acid during menstruation
• B Levonorgestrel-releasing intrauterine system ✓
• C Mefenamic acid started at onset of bleeding
• D Cyclical norethisterone days 5 to 26

Explanation

For confirmed heavy menstrual bleeding without structural pathology and no fertility desire, the 52 mg levonorgestrel intrauterine system is first line, reducing measured blood loss by around 70 to 95 percent and maintaining benefit for up to 5 years. Tranexamic acid and NSAIDs reduce loss by roughly 30 to 50 percent but act only while taken, and cyclical progestogens are less effective and more side-effect prone. Endometrial sampling was unnecessary here given age under 45 with no risk factors.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.