Recommendations

  1. A history of heavy cyclical menstrual blood loss over several consecutive cycles without any intermenstrual or postcoital bleeding should be obtained (C).
  2. An abdominal and pelvic examination should be performed in all women complaining of menorrhagia (C).
  3. full blood count should be obtained in all women complaining of menorrhagia (B)
  4. Thyroid function tests do not need to be routinely performed in the initial evaluation of menorrhagia unless the woman has symptoms or signs of hypothyroidism (C).
  5. No other endocrine investigations are necessary in the investigation of menorrhagia (B).
  6. An endometrial biopsy is not required in the initial assessment of menorrhagia (C).
  7. Tranexamic acid and mefenamic acid are effective treatments for reducing heavy menstrual blood loss (A).
  8. Antifibrinolytic drugs and non-steroidal anti-inflammatory drugs are both effective in reducing heavy menstrual blood loss in women with intrauterine contraceptive devices (A).
  9. Combined oral contraceptives can be used to reduce menstrual blood loss (A).
  10. A progestogen-releasing intrauterine device is an effective treatment for menorrhagia (A).
  11. Continued use of long-acting progestogens renders most women amenorrhoeic and therefore could be considered for use in menorrhagia (C).
  12. Low dose, luteal phase administration of norethisterone is not an effective treatment for menorrhagia (A).
  13. Ethamsylate, at currently recommended doses, is not an effective treatment for menorrhagia (A).

Clinical evaluation

Medical management

NICE referral guidelines

 

NICE referral guidelines 2001

Treatment options 2007