Menorrhagia and dysmenorrhoea

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  • For the relief of pain in dysmenorrhoea NSAIDS are suitable; naproxen is a lower-cost alternative to mefenamic acid.
  • For the treatment of menorrhagia, Levosert IUS is first choice for women under 45 years and Mirena IUS is first choice for women 45 years and over.  A 52mg levonorgestrel IUS may be particularly useful in women with menorrhagia who also need contraception; for this indication both products are effective for 5 years. 
  • If a 52mg levonorgestrel IUS is unsuitable, tranexamic acid, NSAIDs or combined oral contraceptives (Contraceptives) should be considered as second choice treatment.
  • If a NSAID is to be used; naproxen off-label, mefenamic acid or ibuprofen off-label (Drugs used in rheumatic diseases and gout) should be prescribed.
  • Refer also to local guidelines on the management of menorrhagia and to NICE guideline CG44.
  • Gonadorelin analogues (Other endocrine drugs) may also be used in menorrhagia.

LEVONORGESTREL INTRAUTERINE SYSTEM (LGN-IUS)

Important: Therapy notes

  • Levosert® - First line for women under 45 years of age
  • Mirena® - First line for women 45 years of age and above

Important: Formulation and dosage details

Formulation:

Intrauterine system (Levosert®) 52mg 

Dosage:

First line for women under 45 years of age

Important: Formulation and dosage details

Formulation:

Intra-uterine system (Mirena®) (releasing levonorgestrel 20 micrograms/24 hours) 

Dosage:

First line for women 45 years of age and above

TRANEXAMIC ACID

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 500mg

Dosage:

By mouth, menorrhagia (initiated when menstruation has started): 1 gram 3 times daily for up to 4 days; maximum 4 grams daily.

Important: Formulation

Injection 500mg/5mL

NAPROXEN

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 250mg

Dosage:

For dysmenorrhoea: 250mg 3 times daily.
For menorrhagia: 250mg to 500mg 3 times daily for 5 days starting at the onset of bleeding off-label.

MEFENAMIC ACID

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 500mg

Dosage:

For dysmenorrhoea: 500mg 3 times daily.
For menorrhagia: 500mg 3 times daily for 5 days starting at the onset of bleeding.

NORETHISTERONE

Important: Therapy notes

  • For routine maintenance of menorrhagia, further guidance is available in the Menorrhagia referral guideline.

Important: Formulation and dosage details

Formulation:

Tablets 5mg

Dosage:

To arrest prolonged bleeding or delay menstruation: this may be given, 5mg 3 times daily, for up to 3 weeks.

MEDROXYPROGESTERONE

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 5mg

Dosage:

Mild to moderate endometriosis: 10mg 3 times daily for 90 consecutive days, beginning on day 1 of cycle.