A 34-year-old woman with regular cycles complains of heavy menstrual bleeding causing anaemia (haemoglobin 9.5 g/dL). Pelvic examination and ultrasound show a normal-sized uterus with no fibroids, polyps, or adenomyosis. Coagulation profile is normal. After counselling, which single medical treatment offers her the greatest reduction in menstrual blood loss?

• A Levonorgestrel intrauterine system ✓
• B Combined oral contraceptive pill
• C Tranexamic acid taken during menses
• D Cyclical oral medroxyprogesterone acetate

Explanation

For heavy menstrual bleeding without structural or hormonal pathology, the levonorgestrel intrauterine system reduces blood loss by about 70 to 95 percent and is the most effective medical therapy; NICE recommends offering it first line if long-term use is acceptable. Tranexamic acid achieves roughly 40 to 50 percent reduction, the combined pill about 35 to 45 percent, and cyclical progestogen less than either. Its local progestogenic effect producing glandular atrophy explains the superior efficacy over systemic agents.

Reference: Jeffcoate's Principles of Gynaecology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.